United States

 Environmental Protection Agency OMB No. 2060-0445

Account Certificate of Representation

 This form is required to establish an Authorized Account Representative for compliance accounts under 

 the NOx Budget Trading Program. For more information, see instructions on the reverse side of the form. 

 This submission is: ~ New

 

 ~ Revised

 Check this box if you are also the Designated Representative for this plant under the Acid Rain Program: ~ STEP 1

Identify the budget source(s)

by plant name, State, and, if

applicable, ORISPL code. Plant Name State ORIS Code

STEP 2

Enter requested

information for the 

Authorized Account

Representative (AAR).

 Name AAR ID Number (if known)

 Address

Phone Number Fax Number 

 E-mail Address (if available)

 

STEP 3

Enter requested

information for the

Alternate Authorized Account

Representative,

if applicable.

 Name AAR ID Number (if known)

 Phone Number Fax Number 

E-mail Address (if available)

STEP 4

Provide the name of 

every owner and 

operator of the 

budget sources at

the plant. Identify

the budget sources

they own and/or

operate by boiler ID#.

Name ~Owner ~Operator

ID# ID# ID# ID# ID# ID#

ID# ID# ID# ID# ID# ID#

Name ~Owner ~Operator

ID# ID# ID# ID# ID# ID#

ID# ID# ID# ID# ID# ID#

Name ~Owner ~Operator

ID# ID# ID# ID# ID# ID#

ID# ID# ID# ID# ID# ID#
Plant Name (from Step 1)

 Account Certificate of

 Representation - Page 2

STEP 5

Read the certification,

sign and date.

I certify that I was selected as the NOx authorized account representative or alternate NOx authorized

account representative, as applicable, by an agreement binding on the owners and operators of the NOx

Budget source and each NOx Budget unit at the source. I certify that I have all the necessary authority to

carry out my duties and responsibilities under the NOx Budget Trading Program on behalf of the owners

and operators of the NOx Budget source and of each NOx Budget unit at the source and that each such

owner and operator shall be fully bound by my representations, actions, inactions, or submissions and by

any decision or order issued to me by the permitting authority, the Administrator, or a court regarding the

source or unit.

I am authorized to make this submission on behalf of the owners and operators of the NOx Budget

sources or NOx Budget units for which the submission is made I certify under penalty of law that I have

personally examined, and am familiar with, the statements and information submitted in this document all

its attachments. Based on my inquiry of those individuals with primary responsibility for obtaining the

information, I certify that the statements and information are to the best of my knowledge and belief true,

accurate, and complete. I am aware that there are significant penalties for submitting false statements and

information or omitting required statements and information, including the possibility of fine or

imprisonment.

Signature (Authorized Account Representative) Date

 Signature (Alternate Authorized Account Representative) Date

INSTRUCTIONS

Under the state regulations to implement the NOx Budget Trading Program, the owners and operators for each budget source must designate a representative,

and may designate an alternate, to act on their behalf. The owners and operators should choose the representative through a process that ensures that all owners

and operators have notice regarding the selection. All budget sources at a plant must have the same Authorized Account Representative. The Authorized Account

Representative is responsible for all submissions and allowance transactions relating to the budget sources at that plant. The Authorized Account Representative

and the Alternate Authorized Account Representative are liable for acts or omissions within the scope of their responsibilities under the NOx Budget Trading

Program. EPA will not record an allowance transaction until it has received a complete Account Certificate of Representation.

Please type or print. If more space is needed, photocopy the

first page. Indicate the page order and total number of pages

(e.g., 1 of 4, 2 of 4, etc.). Note: An Account Certificate of

Representation amending an earlier submission supersedes

the earlier submission in its entirety. A revised Account

Certificate of Representation must therefore be complete, including signature and dating by the Authorized Account

Representative (and the Alternate, if applicable).

Submit one Account Certificate of Representation form with

original signatures. Remember that the Authorized Account Representative should notify each owner and operator of all NOx Budget Program submissions.

For assistance, call the EPA’s Clean Air Markets Division

Hotline at (202) 343-9620.

STEP 1: If any budget source at the plant is affected by the Acid Rain Program, the ORISPL code is embedded in the

first six digits of the unit account number for that source

under the Acid Rain Program. If there are not any budget

sources at the plant affected by the Acid Rain Program, a 

budget source should use the plant or facility code

registered with the Department of Energy (DOE) to obtain an 

ORISPL code. (For utilities reporting on the EIA-767, -860,

and -861, the plant code would be used as the ORISPL code.

For nonutilities reporting on the EIA-867, the facility code

would be used as the (ORISPL code). If the budget source

does not report to DOE, and therefore does not have an

ORISPL code, the budget source should call the Acid Rain

Program Hotline for assistance.

STEP 2: The Authorized Account Representative must be a natural person and cannot be a company. Please enter the

firm name and address as it should appear on all

correspondence.

EPA Form 7620-16

Representative must rely on the Authorized Account

Representative to forward information

mailed by EPA.

STEP 4 The owners and operators may be companies or natural persons. Identify each budget source at the plant that is owned or

operated by the named party by providing the unit identification

number for the budget source. If a budget source is affected by the

Acid Rain Program, the source should

determine an appropriate ID# that it will use for all NOx Budget

Trading Program purposes. This ID# must be six digits or less.

STEP 5 Note the certification statement.

SUBMISSION INSTRUCTIONS:

Submit this form prior to submission of the monitoring plan for the

NOx Budget Trading Program. This form must be submitted before

participating in transfers of allowances.

Submit a revised Account Certificate of Representation when any

information in the existing Account Certificate of Representation

changes. 

Mailing Instructions

Mail this form to EPA at one of the following addresses: U.S. EPA

 NOx Budget Trading Program (6204J)

for regular or certified mail: for overnight mail:

1200 Pennsylvania Ave, NW 1310 L Street, NW

Washington, DC 20460 Washington, DC 20005 Phone: 202-343-9620
Paperwork Burden Estimate

The public reporting and record keeping burden for this collection of information is estimated to average30 hours per response . Burden means

the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a

Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the

purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to

respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise

disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless

it displays a currently valid OMB control number. 

Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for

minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW., Washington, D.C. 20460. Include the OMB control number

in any correspondence. Do not send the completed form to this address.