Part I: INTRODUCTION AND CBI INFORMATION

CBI

Sector(s) If you chose "Other" as an enduse, please specify here.

End-Use(s) CBI

2. Indicate the sector and end-use for which you are submitting this SNAP Information Notice.

Select the appropriate box identifying the type of notice submitted (Select only one box):

New alternative (substance, formulation or technology) not previously listed as acceptable, acceptable subject to use conditions 

or unacceptable under SNAP

New end-use or application of substitute previously listed as acceptable, acceptable subject to use conditions or unacceptable 

under SNAP

Section B: Identification of Alternatives

1. Name of Alternative. Note: Additional information about the proposed substitute must be provided in Part III, Section A

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

SNAP INFORMATION NOTICE

When completed send CBI and public versions of this form and attachments electronically via CD or USB drive (preferred), or 

print to:

Via US Postal Service:

SNAP Document Control Officer

U.S. EPA

Mail Code: 6205T

1200 Pennsylvania Ave, NW

Washington DC 20460

Via Delivery Service:

SNAP Document Control Officer

U.S. EPA

Stratospheric Protection Division

4th Floor (MC 6205M)

1201 Constitution Ave., NW

Washington, DC 20004

Part I: INTRODUCTION AND CBI INFORMATION

Section A: Introduction

GENERAL INSTRUCTIONS

This form may be used to submit information under the Significant New Alternatives Policy (SNAP) program for the review of alternatives to Class I and 

Class II ozone-depleting substances (ODSs) under section 612 of the Clean Air Act. Submitters are required to provide this information on new 

substitutes or new end-uses of existing substitutes to assist the Agency in assessing the acceptability of chemicals or processes that are considered 

alternatives in sectors that previously used ODSs. A separate notice must be filed for each alternative you are submitting. You may submit a single 

notice for multiple uses of the same alternative. If the alternative is a new chemical substance, you must submit a Premanufacturing Notice (PMN) to 

EPA's New Chemicals Program and the TSCA/SNAP Addendum form to SNAP. 

Please visit the SNAP website for instructions and frequently asked questions. 

Case Number:

AGENCY USE ONLY

OMB Control No.: 2060-0226

Expires: X/XX/2017

Date of Receipt:

NOTE: Please [Bracket] the information you claim as confidential

1 of 2
Part I: INTRODUCTION AND CBI INFORMATION

Part II: Contact Information

Part III: General Information

Part VIII: Aerosols

Part IX: Sterilants

Part XI: Tobacco Expansion

Part XIII: Attachments

Part XIV: Certification

Part XII: Additional Information

Part X: Adhesives, Coatings & Inks

Part VII: Fire Suppression

Section C: Confidentiality Claims

Anyone submitting data which are to be treated as Clean Air Act Confidential Business Information (CBI), must assert and substantiate a claim of confidentiality at the 

time of the initial submission. All information claimed as CBI will be treated in a manner consistent with 40 CFR Part 2, Subpart B. Failure to assert and substantiate a 

claim of confidentiality at the time of submission may result in disclosure of information by the Agency without further notice.

To assert a claim on this form, [bracket] the information you claim as confidential and mark the confidential box in the column on the right-side of the corresponding 

row. If any information is claimed as confidential, you must substantiate those claims below and provide a “sanitized” version of this notice, including attachments, to 

EPA at the time of the initial submission. 

For any portion of a submission that you claim as confidential, the following information must be included in a Statement of Data Confidentiality Claims. 

• Identify specifically by page and line number(s) each portion of the document for which you claim confidentiality.

• Give the reasons why the cited passage qualifies for confidential treatment.

• If you assert that disclosure of this information would be likely to result in substantial harmful effects to you, describe those harmful effects and explain why they 

should be viewed as substantial.

• Indicate the length of time - until a specific date or event, or permanently - for which the information should be treated as confidential.

• Identify the measures you have taken to guard against undesired disclosure of this information.

• Describe the extent to which the information has been disclosed, and what precautions have been taken in connection with these disclosures.

• Enclose copies of any determinations of confidentiality previously made by EPA, other Federal agencies, or courts concerning this information. 

Information submitted as CBI may be accessed by companies designated as Authorized Representatives of the United States Environmental Protection Agency (EPA) 

under an EPA contract for the purpose of assisting EPA in the development and implementation of national regulations for the protection of stratospheric ozone, 

including the evaluation of SNAP Information Notices. These Authorized Representatives may have access to any information received by the Stratospheric Protection 

Division within the EPA’s Office of the Atmospheric Programs. Access to such information is necessary to ensure that these companies can complete the work 

required by the contract. Such Authorized Representatives of the Administrator are subject to the provisions of 42 U.S.C. 7414(c) respecting confidential business 

information as implemented by 40 CFR 2.301(h).

STATEMENT OF DATA CONFIDENTIALITY CLAIMS

Please complete the following tabs of this submission form (click to go to each section):

Sector Specific (please fill out the sector specific Part(s) for which you are applying):

Part IV: Refrigeration and Air Conditioning

Part V: Foam Blowing

Part VI: Cleaning Solvents

NOTE: Please [Bracket] the information you claim as confidential

2 of 2
Part II: CONTACT INFORMATION

Name of Authorized Official Title CBI

CBI

Mailing Address Telephone Number CBI

CBI

Name of Authorized Official Title CBI

CBI

Mailing Address Telephone Number CBI

CBI

Is this person granted full access to Confidential Business Information?

Name of Authorized Official Title CBI

CBI

Mailing Address Telephone Number CBI

CBI

Is this person granted full access to Confidential Business Information?

Name of Authorized Official Title CBI

CBI

Mailing Address Telephone Number CBI

CBI

Is this person granted full access to Confidential Business Information?

Email Address

CONFIDENTIALITY CLAIMS: All contacts listed on this page will be granted access to CBI, unless otherwise noted.

Email Address

4. Joint Submitter (if applicable): Identify the joint submitter, if any, who is authorized by the primary submitter to provide some of the information required 

in the notice.

Company/Organization

Email Address

2. Agent (if applicable): Complete only if you authorize an agent to assist you in preparing this notice. The agent must also sign the certification. 

Company/Organization

Email Address

3. Technical Contact (in U.S.): If applicable, identify a person who can provide EPA with additional technical information on the substitute during the review 

period. If the authorized agent is also the technical contact, include that person's information in both locations.

Company/Organization

Company/Organization

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part II: CONTACT INFORMATION

Section A: Submitter Contact Information

1. Person Submitting Notice (in U.S.): Enter information for the official who signs the certification in Part XIV Certification.

NOTE: Please [Bracket] the information you claim as confidential

1 of 1
Part III: GENERAL INFORMATION

(b) Percent Composition (by weight) (c) Chemical Abstracts Service 

(CAS) registry number (d) Molecular Formula CBI

CBI

Patent Name Patent Number (if available) CBI

CBI

(a) Impurity Chemical Name (b) Percent Composition (by weight) (c) CAS registry number CBI

(a) Byproduct/Degradation Product 

Chemical Name (b) Percent Composition (by weight) (c) CAS registry number (d) When is product Formed? (e) Amount (g) /Rate of Formation (g/s) CBI

CBI

CBI

g/mol

at 20°C

°C at 1 atm. pressure

°C at 1 atm. pressure

at 20 °C

ppm or %

ppm or %

°C

°C

CBI

(l) If you have performed chemical analysis and testing on the 

substitute to derive the properties, attach copies of all test 

reports and specify the protocol used. Supporting 

documentation attached?

(k) If you are extracting this information from a public reference source (e.g., CRC Handbook of Chemistry and Physics, Merck 

Index), attach copies of the reference. Supporting documentation attached?

(h) Bubble point (for blends)

2. Commercial/trade name(s) of alternative:

3. Generic name: If the name of the commercial/trade name of the proposed substitute is claimed Confidential Business Information, provide a generic name. The name should reveal the 

chemical identity or alternative process description to the maximum extent possible.

(e) For alternative processes and technologies (e.g., Absorption Chillers, Stirling Cycle), describe the technology and provide a technical drawing and a diagram of the system as an attachment. Also 

provide the location and identity of any chemical constituents. 

(g) Upper Flammability Limit (LFL) (Using ASTM E681 ) 

(d) Boiling point

(e) Specific gravity (Relative to water or air, specify )

(f) Lower Flammability Limit (LFL) (Using ASTM E681 ) 

5. Byproducts and Degradation Products: Describe any byproducts or degradation products resulting from the manufacturer, processing, use or disposal of the chemical alternative or chemicals 

used in the new alternative. If there are unidentified byproducts/degradation products enter “unidentified.” Indicate when the byproduct/degradation product is formed (e.g. during 

manufacturing, during use, in contact with fire, etc.) and the amount or rate at which it is formed.

4. Impurities: Identify any impurities that are reasonably anticipated to be present in the proposed substitute as manufactured for commercial purposes. If there are unidentified impurities, enter 

“unidentified” and estimate their total weight percentages. Do not include substances that are mixed with the proposed substitute after manufacture of the primary ingredients. 

(d) Molecular Formula

(f) If you have applied for or hold a patent on the proposed substitute, provide the following:

Part III: GENERAL INFORMATION

1. Identify Proposed Substitute: If a blend, provide the percent composition of each constituent by weight. 

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

(i) Flash point

(j) Other (specify)

Section A - Alternative-Specific Information

Topics Covered in Patent

(a) Molecular weight

(b) Physical state

(c) Melting point

7. Physical and Chemical Properties: Attach copies of all test reports and specify the protocol used. If submitting a blend substitute, physical and chemical properties are required for the blend.

6. Test Marketing: Has a test marketing notification been sent to EPA?

(a) Chemical Name (preferably IUPAC nomenclature)

NOTE: Please [Bracket] the information you claim as confidential

1 of 3
Part III: GENERAL INFORMATION

(a) ODP relative to CFC-11 CBI

Supporting documentation 

attached? CBI

Proposed Substitute 

(If blend, include GWP of each 

constituent)

(a) 100-year GWP 

(Relative to carbon dioxide) (c) Atmospheric Lifetime (ATL) CBI

Supporting Documentation 

Attached? CBI

10. VOC Status Information: CBI

CBI

CBI

MIR (g O3/g VOC) kOH value Other

CBI

CBI

Titles of the Clean Air Act (CAA) other than Title VI

Clean Water Act (CWA)

Safe Drinking Water Act (SDWA)

Resource Conservation and Recovery Act (RCRA)

Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA)

Statute Statute Citation & Explanation of Requirements

(b) Provide any additional data on the ODP of the proposed substitute (e.g. chlorine or 

bromine loading potentials). 

8. Ozone-depletion potential (ODP): Provide the 100-year ODP of the proposed substitute relative to CFC-11. If the substitute is a blend, provide the ODPs of the individual constituents. Reference the 

source for each ODP.

(b) For blends, which components, if any, are exempt from the definition of VOC at 40 CFR 51.100(s)?

(a) Is the substitute exempt from the definition of volatile organic compound (VOC) under CAA regulations (see 40 CFR 51.100(s)) addressing the development of 

State Implementation Plans (SIPs) to attain and maintain the national ambient air quality standards?

(d) For compounds that are not VOC exempt, provide information on the reactivity of the compound(s) in the atmosphere, such as the maximum incremental reactivity in grams of O3 per gram of 

VOC and/or the kOH value.

Proposed Substitute/Component

Toxic Substances Control Act (TSCA)

Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)

12. Environmental Regulations.

9. Global Warming Characteristics: Provide the alternative's global warming potential relative to carbon dioxide over a 100-year time horizon and atmospheric lifetime, if known. Reference the Fourth 

Assessment Report of the Intergovernmental Panel on Climate Change (IPCC AR4). Alternate sources may include the 2010 World Meteorological Organization (WMO) Scientific Assessment of Ozone 

Depletion or the peer-reviewed literature. If the substitute is a blend, provide the GWPs of the individual constituents and an estimate of the GWP of the blend at its nominal composition.

Information Sources

(d) If the proposed substitute or any components of a blend is captured as a byproduct of another manufacturing or industrial process, indicate the source of the 

alternative.

(c) Provide information on any environmental regulatory statute (such as those listed below) applicable to the manufacture, use, and disposal of the proposed substitute.

(a) Is the substitute, or a component of the substitute, a hazardous air pollutant?

(b) Is the substitute, or a component of the substitute, a hazardous waste under RCRA regulations?

11. Cost of Proposed Substitute (chemical or blend): Provide an estimated cost of the substitute in US$/kg, US$/lb, or other. 

(c) Has a request for VOC exemption been submitted? If so, provide details below (e.g., date of submission).

(c) Reference the source of this information and attach any 

supporting documentation.

Information Sources Proposed Substitute 

(If blend, include ODP of each constituent )

CBI

CBI

NOTE: Please [Bracket] the information you claim as confidential

2 of 3
Part III: GENERAL INFORMATION

CBI

Proposed Substitute (If blend, include all 

constituents), Impurity, and/or 

Byproduct

(a) Permissible Exposure Limits 

(PELs)

(b) Occupational Exposure Limits 

(OELs) 

(e.g., WEEL, TLV, STEL)

(c) Manufacturer’s Acceptable 

Exposure Limits (AELs) Sources CBI

CBI

15. Safety Documents. Please attach a copy of any documents that will be provided to any person who is reasonably likely to be exposed, such as:

CBI

(d) If available, summarize the acute and chronic toxicity of the proposed substitute and of its constituent chemicals on any 

organism (e.g. human and/or other mammals, fish, wildlife, and plants). Attach all complete test reports that are reasonably 

available to you.

Supporting Documentation Attached?

Occupational Safety and Health Administration (OSHA) (e.g., TLV-TWA, Personal Protective 

Equipment [29 CFR 1910.132])

13. Health and Safety Regulations: If applicable, describe how occupational, consumer, or general population exposure to the alternative is regulated under health and safety related statutory authorities. 

Statutory Authority (a) How does regulation apply? Provide CFR citation. 

Emergency Planning and Community Right to Know Act (EPCRA or SARA Title III)

State and local laws

Other applicable environmental federal, state, and local laws not mentioned above

Supporting Documentation Attached?

Department of Transportation (DOT) (e.g., Vapor UN1013, Class 2.2)

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the 

bracketed information redacted or removed.

Warning Labels

Other (provide name)

Safety Document

14. Toxicity Limits. For the proposed substitute, impurities and/or byproducts, provide permissible exposure limits (PELs), occupational exposure limits (OELs), or acceptable exposure limits (AELs) set for 

use in the workplace, if available. 

Material Safety Data Sheet (MSDS)

Hazard Warning Statement

Other (e.g., Food and Drug Administration Threshold of Regulation [TOR] Exemptions)

State and local laws

NOTE: Please [Bracket] the information you claim as confidential

3 of 3
Part IV: REFRIGERATION AND AIR CONDITIONING-SPECIFIC INFORMATION

End-Use Application (a) Mark all that apply (b) New (N) equipment, retrofit (R) 

equipment, or both (N,R)?

(c) ODS and other substances 

being replaced

(d) Replacement ratio 

(lb: lb) CBI

Centrifugal

Positive Displacement Chillers 

(includes Reciprocating, Screw, 

Scroll, Rotary Compressors) 

Industrial Process Refrigeration (IPR)

Industrial Process Air Conditioning

Ice Skating Rinks

Cold Storage Warehouses

Refrigerated Trailers (Reefers) 

Refrigerated Shipping Containers 

Refrigeration Equipment within 

Motorized Vehicle (e.g., food 

delivery, ice cream truck, ship 

hold)

Remote Rack System, Direct

Remote Rack System, Indirect

Stand-alone Units (self-contained 

equipment such as individual 

reach-in coolers, glass door 

merchandisers, fountain 

beverage dispenser, frozen 

beverage dispenser, etc.)

Remote Condensing Units for 

Walk-in Coolers or Multiple 

Reach-in Coolers

Vending Machines

Built-in Water Fountain

Stand-alone Water Coolers 

Self-contained Ice Machines

Remote Ice Machines

Household Refrigerator and 

Freezers

Small Refrigerated Household 

Appliances (e.g., chilled kitchen 

drawers, wine coolers, and minifridges) 

Room Air Conditioners (such as 

window units, packaged terminal 

air conditioners (PTAC) and heat 

pumps (PTHP), and portable selfcontained air conditioners)

Mini-Splits, Non-Ducted

Multi-Splits, Non-Ducted

Split-Systems, Ducted, Household 

(Central A/C)

Split-Systems, Ducted, Light 

Commercial (Central A/C)

Packaged Rooftop Units 

Water-Source Air Conditioning 

and Heat Pumps

Chillers (Commercial Comfort AC)

Refrigerated Transport

Retail Food Refrigeration

Drinking Water Coolers

Commercial Ice Machines

Household Refrigerators and Freezers

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part IV: REFRIGERATION AND AIR CONDITIONING-SPECIFIC INFORMATION

Section A: Refrigeration and Air-Conditioning Use Profile

1. Specific End-Use: Identify each end-use and specific applications (if applicable) for which you are seeking review in new and/or retrofit equipment. Identify the ODS and other alternatives used in the end-use 

and/or application and the quantity of proposed substitute needed to replace it for each end-use and/or application (i.e., the replacement ratio).

Note: If the proposed substitute can be used both as a retrofit and in new equipment, these uses should be treated as separate end-uses throughout this form. The applications listed below are not meant to be allinclusive and do not reflect regulatory requirements. The purpose of defining these applications is to inform the Agency's understanding of how the alternative being submitted to SNAP will be used.

Residential and Light Commercial Air 

Conditioning and Heat Pumps

NOTE: Please [Bracket] the information you claim as confidential

1 of 4
Part IV: REFRIGERATION AND AIR CONDITIONING-SPECIFIC INFORMATION

Ground-Source Air Conditioning 

and Heat Pumps

Residential Dehumidifiers

Light-duty Vehicles (e.g., 

passenger cars)

Light-duty Trucks (e.g., minivans, 

full size pick-up trucks, and fullsize SUVs)

Heavy-duty Vehicles (e.g., heavyduty pickup trucks and vans, and 

commercial medium and heavyduty on-highway vehicles)

Off-road Vehicles (e.g., farm and 

construction equipment)

Buses and Passenger Rail 

Thermosiphon 

Recirculating Coolers 

Mechanical Heat Transfer Organic Rankine Cycle (ORC)

Very Low Temperature Refrigeration

Uranium Isotope Separation 

Processing 

Ice Cream Makers

CBI

End-Use Application

(a) Technology changes, 

including material 

compatibility issues when 

retrofitting

(b) Capital costs associated with 

proposed substitute, alternative 

process, new equipment, and/or 

new materials

(c) Changes in labor and energy 

costs

(d) Ongoing operational 

costs of equipment CBI

End-Use Application CBI

End-Use Application (a) Years until maximum 

market penetration

(c) Anticipated market share 

at market penetration (%) CBI

End-Use Application CBI

4. Production: Provide estimated information on production of the proposed substitute or equipment using the proposed substitute by end-use and/or application. 

6. Energy Efficiency: Provide the alternative’s impact on energy efficiency relative to the substance it is replacing in similar equipment. Attach documentation, if available.

Energy Efficiency (+/- X%) relative to substance(s) being replaced Supporting Documentation Attached?

(b) Maximum annual production at market penetration

5. Market Share: Estimate the timing for market penetration and percentage of the market that is anticipated to be captured by this proposed substitute.

(a) Year proposed substitute or technology will be available (or 

note if currently available) (b) Anticipated first year annual production for end-use (kg)

Motor Vehicle Air Conditioning

Non-mechanical Heat Transfer 

Other (specify)

2. Additional End-Use Description: Please describe the specific uses for which you are applying. For example, what is the equipment layout and where is the refrigerant located? Is it a direct expansion unit and/or 

does it use a secondary loop? In what types of locations will the equipment be used (e.g., for refrigeration this could include supermarkets, convenience stores, and/or restaurants)? Is the equipment for low, 

medium, or high temperature refrigeration or air conditioning? Is air conditioning for the purpose of human comfort cooling or another application?

3. Technology Changes and Costs: Describe any new equipment technology changes and associated costs that will be necessary in order to use the proposed substitute. Provide information on materials compatibility 

(e.g., piping, refrigerant oil) and attach any available test results. Provide specific information on each different end-use and application and their associated costs, including design changes to equipment (e.g., component 

changes larger compressor, special safety features), changes in labor, and changes in energy costs, and ongoing operational costs.

NOTE: Please [Bracket] the information you claim as confidential

2 of 4
Part IV: REFRIGERATION AND AIR CONDITIONING-SPECIFIC INFORMATION

CBI

End-Use Application (a) Equipment Lifetime (years) (b) Typical charge size (kg) (c) Maximum charge size (kg) (d) Equipment capacity 

(kWh, tons) CBI

End-Use (e) Typical room size (m3

) (f) Minimum room size (m3)

(g) Anticipated room air 

exchange rate (ACH) CBI

CBI

CBI

atm

kJ/mol

°C

atm

CBI

CBI

CBI

atm

Joules

Supporting Documentation 

Attached? CBI

Supporting Documentation 

Attached?

3. Flammability Concerns and Mitigation: Provide any information on flammability concerns and mitigation measures. CBI

(a) Detail any abatement techniques that are used to minimize the risks 

associated with flammable substances or mixtures:

(b) Additional information on flammability concerns and mitigation 

measures: 

(b) Maximum rate of pressure increase during combustion (Required only for refrigerants designated as 

ASHRAE flammability class 3 )

(c) Minimum ignition energy (MIE)

2. Flammability Assessments and Test Data. 

(a) Fault Tree Analysis or Failure Mode and Effects Analysis (Required for each end-use)

(b) Risk assessment for all end-uses, consumer and occupational (technician) exposure

(c) Results of ASTM E681 Flammability Limits in Air (include temperature at which test was conducted in 

summary of results)

(d) Fractionation during Leakage (Required only for blends with flammable components)

Required if flammable Summary of Results

Section C: Flammability

1. Flammability-Related Physical and Chemical Properties. Provide information on the physical and chemical properties relevant to evaluating the flammability of the proposed substitute in refrigeration and airconditioning end-uses.

(a) Maximum pressure of combustion 

Published by ASHRAE SSPC 34. If so, provide the following information:

Substitute or Blend ASHRAE Designation ASHRAE Classification

(d) Critical Pressure 

2. ASHRAE Designation: If applicable, indicate the status of submission to or publication by the ASHRAE Standing Standard Project Committee 34 (SSPC 34).

Not submitted to ASHRAE SSPC 34.

Submitted to ASHRAE SSPC 34, not yet published. If proposed designation and classification are available, provide below.

Please also provide vapor pressure-temperature curve: Attached?

(b) Heat of combustion

(c) Critical temperature 

Other (i.e., International Electrochemical Commission (IEC), International 

Organization for Standardization (ISO))

Section B: Refrigeration and Air Conditioning Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in refrigeration and air conditioning end-uses.

(a) Vapor pressure @ 20 °C 

Underwriters Laboratories (UL) (e.g., UL 484, UL 250)

Society of Automotive Engineers (SAE) International

Standard-Setting Organization (a) Standard Number and Title (b) Status (e.g., under development, final)

American Society of Heating, Refrigerating, and Air Conditioning Engineers 

(ASHRAE) (e.g., ASHRAE 15)

Application

9. End-Use Specific Standards: List any standard-setting organizations (U.S. or ANSI/ISO) that have or will evaluate the proposed substitute and/or equipment in the proposed end-use(s) and identify the associated 

standard. 

7. Refrigerant Oil: Provide information on the chemical class of refrigerant oil you anticipate will be used (e.g., polyalkylene glycol, polyolester, mineral oil, etc.) and information on refrigerant/oil solubility. 

8. Application of Proposed Substitute. Please provide information on the equipment lifetime, charge size, associated room size, and associated equipment size anticipated for the proposed substitute in the enduse(s) and application(s) for the proposed substitute. Note if personal monitoring data is provided in Section D: Exposure, you are not required to respond to questions (e) through (g) below.

NOTE: Please [Bracket] the information you claim as confidential

3 of 4
Part IV: REFRIGERATION AND AIR CONDITIONING-SPECIFIC INFORMATION

CBI

CBI

CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

CBI

CBI

CBI

Supporting Documentation 

Attached?

CBI

Supporting Documentation 

Attached?

CBI

Supporting Documentation 

Attached?

CBI

6. Information on Recovery Practices: Section 608 of the Clean Air Act prohibits the intentional release (venting) of refrigerants, ozone-depleting and their substitutes, while maintaining, servicing, repairing, 

or disposing of air conditioning or refrigeration equipment. Please provide information below on how the substitute will be recovered.

(a) How will the refrigerant be recovered? Please provide standards, reports, or analyses from ETL, UL, AHRI, or equivalent on refrigerant-specific servicing equipment or the 

feasibility of using existing refrigerant recovery/recycling equipment.

(b) Please provide a description of recovery procedures (e.g., recover and recharge or recover and send to reclaimer).

(c) Indicate the anticipated recovery efficiency of the refrigerant (percent of charge).

Is supporting documentation (e.g., personal monitoring data) attached?

5. Exposure during Use of Equipment

(a) Identify and explain the activity during which end-user exposure to the proposed substitute is expected to be the highest (e.g., operational leaks).

4. Provide information on training materials related to manufacture, installation and servicing, and disposal. If the proposed substitute is 

flammable, describe how these guidelines differ from training for non-flammable refrigerants. Are any training materials attached?

(b) Installation and servicing

(c) Disposal

CBI

Typical Maximum

ppm ppm

% %

(b) Identify who is most likely to be exposed to the substitute at the enduse (e.g., consumers, workers)?

(c) Estimate the typical and maximum annual leak rates from the equipment, in terms of (1) ppm and/or (2) percent of charge.

Scenario Typical Number of Pieces Maximum Number of Pieces

(a) Manufacture and charging of equipment

(b) Installation and servicing (e.g., 

connecting and disconnecting refrigerant 

lines)

(c) Disposal (e.g., connecting and 

disconnecting refrigerant lines)

Is supporting documentation (e.g., personal monitoring data) attached?

3. Estimate typical and maximum number of pieces of equipment a worker would (a) manufacture and/or charge, (b) install and/or service, and (c) dispose per day.

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which worker exposure to the proposed substitute is expected to be the highest for each 

scenario in (a) through (c).

Scenario

Identify activities with typical 

and maximum potential for 

exposure

Duration of Activity Exposure Concentration

(a) Manufacture and charging of 

equipment (e.g., filling)

(d) Identify engineering controls used to reduce or prevent releases to the 

environment (e.g., safety valves, gas scrubbers). (e) Identify the contact pathway (e.g., ingestion, inhalation, dermal). (f) Describe any protective equipment and engineering controls used to protect workers (e.g., goggles, gloves, chemical hoods).

1. Exposure Media and Release Information

(a) Identify the media(s) to which the proposed substitute is released (e.g., 

indoor air, outdoor air, water, land).

(b) Indicate the physical form of chemicals at the time of 

handling/exposure (e.g., solid, liquid, gas).

(c) If releases occur outdoors (e.g., outdoor air, water, land), 

provide information or estimates of the magnitude of release 

(ppm or percent of charge).

Section D: Exposure

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the 

bracketed information redacted or removed.

NOTE: Please [Bracket] the information you claim as confidential

4 of 4
Part V: FOAM BLOWING-SPECIFIC INFORMATION

End-Use (a) Mark all that apply CBI

Rigid Polyurethane: Appliance

Rigid Polyurethane: Spray

Rigid Polyurethane: Commercial 

Refrigeration

Rigid Polyurethane: Sandwich Panels

Rigid Polyurethane: Slabstock and Other

Rigid Polyurethane & Polyisocyanurate 

Laminated Boardstock

Flexible Polyurethane

Integral Skin Polyurethane

Polystyrene: Extruded Sheet

Polystyrene: Extruded Boardstock & Billet

Polyolefin

Phenolic Insulation Board & Bunstock

Other (specify)

CBI

End-Use

(b) Capital costs associated with 

proposed substitute, alternative 

process, new equipment, and/or 

new materials

(c) Changes in labor and energy costs (d) Ongoing operational costs CBI

End-Use

(a) Year proposed substitute or 

technology will be available (or note 

if currently available)

(b) Anticipated first year annual 

production for end-use (kg)

(c) Years until maximum market 

penetration

(d) Maximum annual production at 

market penetration

(e) Anticipated market share 

at market penetration (%) CBI

End-Use CBI

6. Application of Proposed Substitute. Please provide information on the amount of blowing agent, associated room size, and anticipated room air exchange rate for the proposed substitute in the proposed end-use(s). Note: If 

personal monitoring data is provided in Section D: Exposure, you are not required to respond to questions (c) through (e) below.

5. Energy Efficiency: Provide the alternative’s impact on energy efficiency relative to the substance it is replacing in similar products. Attach documentation, if available.

(a) Energy efficiency (+/- X%) relative to substance(s) being replaced (b) Source of Information

3. Technology Changes and Costs: Describe any new equipment technology changes and associated costs that will be necessary in order to use the proposed substitute. 

2. Additional End-Use Description: Please describe the specific uses for which you are applying. For example, what type of material will be blown? What method or type of equipment is used for foam blowing? Who will be using the 

foam blowing agent/equipment? Will the foam blowing agent be used by consumers or restricted to commercial use? For spray foams, how many components are used? Will the alternative be used in high or low pressure spray 

foam? 

4. Production and Market Share: Provide estimated information on production of the proposed substitute by end-use. If possible, estimate the percentage of the market held by the ODS being replaced that will be captured by this proposed 

substitute.

(a) Technology changes to use alternative

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part V: FOAM BLOWING-SPECIFIC INFORMATION

Section A: Foam Blowing Use Profile

1. Specific End-Use: Identify each end-use that may be reasonably anticipated for the alternative. Identify the ODS and other alternatives used in the end-use and/or application and the quantity of proposed substitute needed to 

replace it for each end-use and/or application (i.e., the replacement ratio).

Note: If more than one end-use if listed, consider each end-use separately throughout application. 

(b) ODS and other substances being replaced (c) Replacement ratio (lb: lb)

NOTE: Please [Bracket] the information you claim as confidential

1 of 3
Part V: FOAM BLOWING-SPECIFIC INFORMATION

End-Use (a) Typical amount of blowing agent 

(kg)

(b) Maximum amount of blowing 

agent (kg)

(c) Typical room size 

(m3)

(d) Minimum room size 

(m3)

(e) Anticipated room air 

exchange rate (ACH) CBI

CBI

atm

W/m·K

Supporting Documentation 

Attached? CBI

CBI

kJ/mol

°C

ppm or %

CBI

CBI

Scenario Identify activities with typical and 

maximum potential for exposure CBI

(a) Manufacture

ppm

(b) End-Use (e.g., in products containing 

and processes using the proposed 

substitute) ppm

(c) Disposal

ppm

CBI

CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

(a) Is the proposed substitute is expected 

to be used in the spray foam end-use? CBI

(b) If your answer to (a) is yes, please identify and explain potential worker 

exposure to the proposed substitute during application of the blowing agent 

(e.g., onsite, field). 

(c) Is consumer use of the spray foam (e.g., do-it-yourself spray foam cans) expected? If yes, please answer 

questions (e) and (f).

(a) Manufacture and charging of 

equipment (e.g., preparation of foam 

formulations, injecting foam into 

appliances)

(c) Disposal of foam blowing agent

Is supporting documentation (e.g., personal monitoring data) attached?

3. Application of Spray Foam (If Applicable)

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which worker exposure to the proposed substitute is expected to be the highest for each scenario in (a), (b), and 

(c). If monitoring data is available, please provide it as an attachment.

Scenario Identify activities with typical and 

maximum potential for exposure

Duration of Activity Exposure Concentration

(b) Manufacture of foam product/foam 

blowing

CBI

(f) Indicate the physical form of chemicals at the time of handling/exposure (e.g., 

solid, liquid, gas). (g) Identify the contact pathway (e.g., ingestion, inhalation, dermal). (h) Describe any protective equipment and engineering controls used to protect workers (e.g., goggles, gloves, chemical hoods).

(d) Identify engineering controls used to reduce or prevent releases to the environment (e.g., safety valves, gas 

scrubbers). (e) If the proposed substitute is to be disposed of, indicate the method and location of disposal.

Section D: Exposure

1. Exposure Media and Release Information

Identify the media(s) to which the proposed substitute is released 

(e.g., indoor air, outdoor air, water, land) in each scenario below.

Provide the estimated amount of each component in foam blowing agent 

released to the environment (e.g., as a solid waste or wastewater effluent) 

at the point of, or subsequent to, each scenario below.

(b) Additional Analyses (optional)

3. Flammability Concerns and Mitigation: Provide any information on flammability concerns and mitigation measures.

(a) Detail any abatement techniques that are used to minimize the risks 

associated with flammable substances or mixtures:

(c) Additional information on flammability concerns and mitigation measures: 

(a) Results of ASTM E681 for Flammability Limits in Air (Required if substitute is flammable)

(b) For flammable foam blowing agents used in spray foam, provide a training 

program that addresses flammability concerns 

Attached?

(b) Auto ignition temperature

(c) For blowing agent blends containing flammable components, indicate the concentrations at which the blend is 

flammable

2. Flammability Assessments and Test Data. 

2. Manufacture and Degradation Products. Provide information on the catalyst used in the manufacture of foam blowing agent and the degradation products under different external conditions (e.g., 

temperature) during use to assess potential hazards of breakdown/degradation products of foam during use. Attach supporting documentation.

Section C: Flammability

1. Flammability-Related Physical and Chemical Properties. Provide information on the physical and chemical properties relevant to evaluating the flammability of the proposed substitute in foam blowing end-uses.

(a) Heat of combustion

Section B: Foam Blowing Agent Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in foam blowing end-uses.

(a) Vapor pressure @ 20 °C 

(b) Thermal conductivity 

NOTE: Please [Bracket] the information you claim as confidential

2 of 3
Part V: FOAM BLOWING-SPECIFIC INFORMATION

CBI

CBI

CBI

Typical Maximum

CBI

Section E: Additional Information for Submission of Blends of Foam Blowing Agents

Blends of different foam blowing agents may also require additional information, depending on the end-use. 

1. For the following end-uses, a submission is required for blends of blowing agents, including blends with blowing agents that are already listed as acceptable:

• Polyolefin

• Polystyrene: Extruded Boardstock and Billet

• Rigid Polyurethane and Polyisocyanurate Laminated Boardstock

• Rigid Polyurethane: Spray Foam*

• Phenolic Insulation Board and Bunstock

*For spray foam, if any components of the blend are flammable, then an additional submission is required for the blend.

2. For the following end-uses, it is permissible to blend blowing agents that are already listed as acceptable without an additional submission for the blend: 

• Rigid Polyurethane: Appliance 

• Rigid Polyurethane: Commercial Refrigeration

• Rigid Polyurethane: Sandwich Panels

• Rigid Polyurethane: Spray Foam*

• Rigid Polyurethane: Slabstock and Other

• Flexible Polyurethane

• Integral Skin Polyurethane

• Polystyrene: Extruded Sheet

*For spray foam, if all components of the blend are acceptable and non-flammable, then it is permissible to blend those blowing agents without an additional submission for the blend.

(d) Identify control measures used to reduce or prevent end-user exposures.

(e) For each end-use, provide maximum annual emission rates for blowing agent leaks from foam application during the foam's lifetime (i.e., after manufacturing and before disposal) as a percentage of the original total amount of 

blowing agent used to produce the foam. Please also specify the anticipated number of years for which the blowing agent would be leaking from the foam (i.e., the emissive lifetime). For reference, please refer to EPA's standard 

annual emission rates listed in the Instructions. CBI

(b) Identify who is anticipated to be exposed to the substitute at the end-use 

(e.g., consumers, workers)?

(c) Provide (1) typical and (2) maximum exposure concentration estimates (ppm). If monitoring data is available, please provide it as an attachment.

CBI

Supporting Documentation Attached?

ppm ppm

End-Use Annual Emission Rate Emissive Lifetime of Foam (years)

(b) Provide information on training materials related to spray foam applications. If the proposed substitute is flammable, describe how these guidelines differ 

from training for non-flammable foam blowing agents. Are any training materials attached?

5. Exposure during Use

(a) Identify and explain the activity during use of blowing agent in which end-user exposure to the proposed substitute is expected to be the highest (e.g., rigid cell foams used in residential construction or insulation). 

Is supporting documentation (e.g., personal monitoring data) attached?

4. Training Materials

(a) Provide information on training materials related to manufacture, installation and servicing, and disposal. If the proposed substitute is flammable, describe 

how these guidelines differ from training for non-flammable foam blowing agents. Are any training materials attached?

CBI

Typical Maximum

ppm ppm

(d) Please describe the application system for the consumer (e.g., size of 

system/container and amount of foam blowing agent in system/container).

(e) Estimate the typical and maximum concentrations of consumer exposure (ppm). If monitoring data is available, please provide it as an attachment.

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the bracketed information redacted or 

removed.

NOTE: Please [Bracket] the information you claim as confidential

3 of 3
Part VI: CLEANING SOLVENT-SPECIFIC INFORMATION

End-Use (a) Mark all that apply (c) Replacement Ratio 

(lb: lb) (d) Open or closed process? CBI

Metal cleaning

Electronics cleaning

Precision cleaning

CBI

End-Use

(b) Capital costs associated with 

proposed substitute, alternative 

process, new equipment, and/or 

new materials

(c) Changes in labor and 

energy costs

(d) Ongoing operational 

costs

CBI

End-Use

(a) Year proposed substitute or 

technology will be available (or note if 

currently available)

(b) Anticipated first year annual 

production for end-use (kg)

(c) Years until maximum market 

penetration

(d) Maximum annual 

production at market 

penetration

(e) Anticipated market 

share at market 

penetration (%)

CBI

CBI

CBI

g/L

atm

Pa·s

specify units

CBI

kJ/mol

CBI

(a) Heat of combustion

2. Flammability Concerns and Mitigation: Provide any information on flammability concerns and mitigation measures.

(a) Detail any abatement techniques that are used to minimize the risks associated with flammable substances or 

mixtures:

(b) Additional information on flammability concerns and mitigation measures: 

Section D: Exposure

1. Exposure Media and Release Information

(b) Odor Threshold

(c) Dissociation Constant

(d) Volatilization from soil 

1. Flammability-Related Physical and Chemical Properties. Provide information on the physical and chemical properties relevant to evaluating the flammability of the proposed substitute in solvent cleaning enduses.

(e) Volatilization from water 

(f) pH 

(g) Vapor pressure @ 20 °C 

(h) Viscosity

(i) Henry's Law constant

Section C: Flammability

4. Production and Market Share: Provide estimated information on production of the proposed substitute by end-use. If possible, estimate the percentage of the market held by the ODS being replaced that will be 

captured by this proposed substitute.

(a) Solubility 

Section B: Cleaning Solvent-Specific Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in solvent cleaning end-uses.

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part VI: CLEANING SOLVENT-SPECIFIC INFORMATION

Section A: Cleaning Solvent Use Profile

1. Specific End-Use: Identify each end-use for which you are seeking review. Identify the ODS and other alternatives used in the end-use or application and the quantity of proposed substitute needed to replace it for each 

end use (i.e., the replacement ratio).

(b) ODS and Other Substances Being Replaced

2. Additional End-Use Description: Please describe the specific uses for which you are applying. For example, what type of work pieces will be cleaned? What type of equipment will be used to perform cleaning 

(e.g., open top vapor degreaser, vacuum sealed equipment, conveyorized equipment)? Where will the cleaning occur (e.g., commercial or industrial setting)? Please note that this end-use does not include manual 

cleaning or textile cleaning.

5. Compatibility: Provide information on and address any issues with materials compatibility of the proposed substitute with metals and plastic with regards to its use as a cleaning solvent (e.g., is the solvent 

corrosive to some materials). 

3. Technology Changes and Costs: Describe any new equipment or technology changes and associated costs that will be necessary in order to use the proposed substitute. 

(a) Technology Changes to Use Alternative 

NOTE: Please [Bracket] the information you claim as confidential

1 of 2
Part VI: CLEANING SOLVENT-SPECIFIC INFORMATION

CBI

CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

CBI

CBI

(a) End-Use (e.g., during removal of 

cleaned work pieces from an open-top 

degreasing unit)

(b) Disposal (e.g., removing spent solvent 

from degreaser)

Is supporting documentation (e.g., personal monitoring data) attached?

3. Describe disposal practices of used solvent (e.g., solvent collected and sent to a wastewater treatment facility, solvent collected and incinerated, recycling).

4. Provide information on training materials related to use and disposal. Are any training materials attached?

(c) Provide the anticipated room air exchange rate (as air changes per hour [ACH]) during use and disposal of the substitute.

CBI

(d) Identify engineering controls used to reduce or prevent releases to the 

environment (e.g., safety valves, gas scrubbers). (e) Identify the contact pathway (e.g., ingestion, inhalation, dermal).

(f) Describe any protective equipment and engineering 

controls used to protect workers (e.g., goggles, gloves, 

chemical hoods).

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which worker exposure to the proposed substitute is expected to be the highest for each 

scenario in (a) through (b).

Scenario Identify activities with typical and 

maximum potential for exposure

Duration of activity Exposure Concentration

(a) Identify the media(s) to which the proposed substitute is released (e.g., indoor 

air, outdoor air, water, land).

(b) Indicate the physical form of chemicals at the time of 

handling/exposure (e.g., solid, liquid, gas).

(c) If releases occur outdoors (e.g., outdoor air, water, 

land), provide information or estimates of the magnitude 

of release (ppm).

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the bracketed information 

redacted or removed.

NOTE: Please [Bracket] the information you claim as confidential

2 of 2
Part VII: FIRE SUPPRESSION AND EXPLOSION PROTECTION-SPECIFIC INFORMATION

End-Use Application (a) Mark all that apply (b) ODS and other substances 

being replaced

(c) Weight and volume 

equivalence replacement ratio 

(lb: lb)

Note: Calculate using method 

described in Instruction Manual

CBI

Normally Occupied Areas

Normally Unoccupied Areas

Streaming Applications

CBI

End-Use Application

(b) Capital costs associated with 

proposed substitute or 

alternative process

(c) Changes in labor 

and energy costs

(d) Ongoing 

operational costs CBI

End-Use Application

(a) Year proposed substitute or 

technology will be available (or note 

if currently available)

(b) Anticipated first year 

annual production for end-use 

(kg)

(c) Years until maximum market 

penetration

(d) Maximum annual 

production at market 

penetration

(e) Anticipated 

market share at 

market penetration 

(%)

CBI

End-Use Application (a) Typical charge size (kg) (b) Maximum charge size (kg) (c) Typical room size (m3

)

(d) Minimum room size 

(m3)

(e) Anticipated room 

air exchange rate 

(ACH)

CBI

CBI

CBI

atm

kJ/mol

J/K

Pa·s

g/m3

g/m3

CBI

(f) Extinguishing Concentration 

(Total flooding agents; use either a cup burner in heptane or full scale testing ) 

(g) Design Concentration 

(Total flooding and gaseous agents; provide design concentration as defined by NFPA and actual (if it is likely to be higher) based on 

manufacturer recommendations)

2. Degradation Products. Provide information on the degradation products of the alternative following discharge in a fire situation. Explain the conditions used in determining these products (e.g., flame temperature, time 

required to extinguish the fire, amount of O2 present, combustible material).

(c) Vapor Heat Capacity 

(d) Viscosity 

(e) Particle Size Distribution 

(only applies to non-gaseous agents)

Section B: Fire Suppression Agent Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in fire suppression end-uses.

(a) Vapor pressure @ 20 °C 

(b) Heat of vaporization

Other (e.g., International Maritime Organization (IMO), Federal Aviation Administration/International Civil 

Aviation Organization (FAA/ICAO))

2. Additional End-Use Description: Please describe the specific uses for which you are applying. For example, what is the method of distribution (e.g., localized, sprinkler system, handheld, gaseous)? Is it a clean agent? Is the 

agent aerosolized? Where will the fire suppression system be installed (e.g., marine, aviation, data center)? Where will handheld extinguishers be intended for use (e.g., residential, commercial, aviation)?

4. Production and Market Share: Provide estimated information on production of the proposed substitute by end-use. If possible, estimate the percentage of the market held by the ODS being replaced that will be captured 

by this proposed substitute.

5. Application of Proposed Substitute. Please provide information on the charge size, associated room size, and anticipated room air exchange rate for the proposed substitute in the end-use(s) specified. Note: If personal 

monitoring data is provided in Section D: Exposure, you are not required to respond to questions (c) through (e) below.

6. End-Use Specific Standards: Identify any standards set by standard-setting organizations (U.S. or ANSI/ISO) or requirements set by other organizations (e.g., IMO, FAA/ICAO) that will evaluate the proposed substitute 

and/or equipment in the proposed end-use(s).

(a) Standard Number and Title (b) Status (e.g., under development, final)

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part VII: FIRE SUPPRESSION AND EXPLOSION PROTECTION-SPECIFIC INFORMATION

Section A: Fire Suppression Use Profile

1. Specific End-Use: Identify each end-use and application (if applicable) for which you are seeking review and provide the requested information.

Note: If more than one end-use if listed, consider each end-use separately throughout application. 

Underwriters Laboratories (UL) (e.g., UL 711)

National Fire Protection Association (NFPA) (e.g., NFPA 2010)

Other (e.g., International Organization for Standardization (ISO))

Organization

3. Technology Changes and Costs: Describe any new equipment and associated technology changes and costs that will be necessary in order to use the proposed substitute. 

(a) Technology changes to use alternative and address material 

compatibility issues when retrofitting

(d) Purpose of space in which the extinguisher 

will be used 

(e.g., engine room, machinery space, cargo 

room)

Total Flooding Agents

NOTE: Please [Bracket] the information you claim as confidential

1 of 3
Part VII: FIRE SUPPRESSION AND EXPLOSION PROTECTION-SPECIFIC INFORMATION

CBI

CBI

CBI

CBI

(c) Identify the discharge rate 

(g/s) of the fire extinguishing 

device.

CBI

CBI

CBI

(e) Identify the contact pathway (e.g., 

ingestion, inhalation, dermal). CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

CBI

CBI

3. Provide information on training materials related to manufacture of the proposed substitute and/or fire suppression equipment and installation and servicing of fire 

suppression equipment. Are any training materials attached?

4. Exposure during Use of Equipment

(a) Identify and explain the activity in which end-user exposure to the proposed substitute is expected to be the highest (e.g., discharge of fire suppression agent).

CBI

(a) Manufacture and charging of equipment (e.g., assembly of 

generators)

(b) Installation and servicing (e.g., accidental discharge during 

servicing of fire suppression equipment)

Is supporting documentation (e.g., personal monitoring data) attached?

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which worker exposure to the proposed substitute and/or associated equipment is expected to be the 

highest for each scenario in (a) and (b).

Scenario Identify activities with typical and 

maximum potential for exposure

Duration of Activity Exposure Concentration

(d) Identify engineering controls used to reduce or prevent releases 

to the environment (e.g., safety valves, gas scrubbers).

(g) Describe any protective measures taken to 

limit worker exposure (e.g., ventilation, 

detection system).

Section D: Exposure

(a) Identify the media(s) to which the proposed substitute is released 

(e.g., indoor air, outdoor air, water, land).

(b) Indicate the physical form of pre- and post-activation products at 

the time of handling/exposure (e.g., solid, liquid, gas).

(c) If releases occur outdoors (e.g., outdoor air, water, land), provide information 

or estimates of the magnitude of release (ppm or percent of charge).

(f) Describe any protective equipment and engineering controls 

used to protect workers (e.g., goggles, gloves, chemical hoods).

1. Exposure Media and Release Information

(e) Identify the settling rate of the particles, the mass median 

aerodynamic diameter (MMAD) (μm) and concentration (mg/m3) of 

the effluent released from the nozzle.

(f) Provide the composition of flooding agent before and after discharge, including the amounts and 

weight percentages of all effluent gases and particulates that may not be filtered.

(g) Identify the maximum egress time for 

personnel from the space and several 

approaches to facilitate safe egress (e.g., 

training, installation guidelines). 

Ocular irritation studies (Draize test)

Dermal irritation study (powdered aerosols)

5. Powdered Aerosol Flooding Agents Used in Occupied Spaces. Provide the following additional information regarding the use of powdered aerosol flooding agents in occupied spaces which requires special considerations 

of the physical properties and toxicity of the agent and visibility in the protected space.

(a) Identify the likelihood that the fire extinguisher will accidentally 

discharge (reported as the number of accidental discharges in 1 

million).

(b) Identify the number of extinguishing devices (i.e., generators) 

installed in a room and the location of these devices within the space.

(d) Identify the length of time it takes for the 

particles to become distributed throughout the 

space and the particle size distribution over 

time.

4. Not-in-kind Halon Alternatives (Powdered Aerosols or Foam). Provide the following additional information for foam streaming agents or powdered aerosol flooding agent used in occupied spaces.

Additional Information Attached?

Acute toxicity inhalation study with rats (foam streaming agent )

Static Acute toxicity inhalation study with rats at design application density (powdered aerosol flooding agent )

3. In-kind Halon Alternatives (Halocarbons). Provide the following additional information for halocarbon steaming agents or flooding agents used in occupied spaces.

Additional Information Attached?

Cardiac Sensitization Study

Acute, sub-acute, and subchronic toxicity inhalation studies with rats in addition to those already listed in Section C, Number 1.

2. Genotoxicity Studies: Provide genotoxicity studies (e.g., Ames assays, forward mutation assays, cytogenetic assays) to determine the potential for the agent to induce DNA damage.

Genotoxicity Study Name Attached?

Section C: Fire Suppression Agent Toxicity and Hazard Information

1. Inhalation Toxicity Studies: Provide an inhalation toxicity study at least 28 days long if a) workers are exposed to the chemicals during manufacture or b) 8-hr TWA exposure levels have not been determined by OSHA, 

NIOSH, ACGIH, or AIHA. For reference, please refer to the list of recommended toxicity tests for this sector in the Instructions.

Inhalation Toxicity Study Name Attached?

NOTE: Please [Bracket] the information you claim as confidential

2 of 3
Part VII: FIRE SUPPRESSION AND EXPLOSION PROTECTION-SPECIFIC INFORMATION

ppm or %

(b) Identify who is anticipated to be exposed to the substitute at the 

end-use (e.g., consumers, workers)?

(c) Provide (1) typical and (2) maximum exposure concentration estimates (ppm). If monitoring data is available, please provide it as an attachment.

CBI

Typical

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the bracketed information redacted or 

removed.

Is supporting documentation (e.g., personal monitoring data) attached?

Maximum

ppm or %

NOTE: Please [Bracket] the information you claim as confidential

3 of 3
Part VIII: AEROSOLS-SPECIFIC INFORMATION

End-Use Application (b) Mark all that apply (d) Replacement Ratio

 (lb: lb) CBI

Consumer

Technical

Medical

Consumer

Technical

Medical

CBI

End-Use Application (a) Technology changes, including 

material compatibility issues

(b) Capital costs associated with 

proposed substitute, alternative 

process, new equipment, and/or 

new materials

(c) Changes in labor and 

energy costs.

(d) Ongoing operational costs CBI

End-Use Application CBI

End-Use Application (a) Years until maximum market 

penetration

(c) Anticipated market share 

at market penetration (%) CBI

End-Use Application (a) Typical amount of substitute per 

can (g)

(b) Maximum amount of substitute 

per can (g)

(c) Typical total weight of 

aerosol can (g)

(d) Maximum total weight of 

aerosol can (g) CBI

CBI

CBI

CBI

g/L

Pa s

atm

4. Production: Provide estimated information on production of the proposed substitute or equipment using the proposed substitute by end-use. 

(a) Year proposed substitute or technology will be available (or note if 

currently available) (b) Anticipated first year annual production for end-use (kg)

(c) ODS and other substances being replaced

Propellants

(c) Vapor pressure @ 20 °C 

(a) Solubility 

(b) Viscosity

5. Market Share: If possible, estimate the percentage of the market that is anticipated to be captured by this proposed substitute.

(b) Maximum annual production at market penetration

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part VIII: AEROSOLS-SPECIFIC INFORMATION

Section A: Aerosol Use Profile

1. Specific End-Use: Identify each end-use and application that may be reasonably anticipated for the alternative. Identify the ODS and other alternatives used in the end-use or application and the quantity of proposed substitute 

needed to replace it for each end use (i.e., the replacement ratio).

2. Additional End-Use Description: Please describe the specific uses for which you are applying. For example, in what type of products will the substitute be used (e.g., personal care, automotive, electrical contact cleaner, 

degreaser, medical adhesive spray, MDI)? 

3. Technology Changes and Costs: Describe any new equipment technology changes and associated costs that will be necessary in order to use the proposed substitute. 

Solvents

6. Application of Proposed Substitute. Please provide information on the amount of the substitute to be used per can and associated aerosols can size anticipated for the proposed substitute in each proposed end-use. 

Section B: Aerosol-Specific Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in aerosol end-uses.

7. Consumer Use: Please indicate whether the proposed substitute will be used for consumer use. If yes, describe the anticipated consumer applications.

8. End-Use Specific Standards: List any standard-setting organizations (U.S. or ANSI/ISO) that have or will evaluate the proposed substitute and/or equipment in the proposed end-use(s) and identify the associated standard. 

Standard-Setting Organization (a) Standard Number and Title (b) Status (e.g., under development, final)

Please also provide vapor pressure-temperature curve (for aerosol propellants ): Attached?

NOTE: Please [Bracket] the information you claim as confidential

1 of 2
Part VIII: AEROSOLS-SPECIFIC INFORMATION

specify units

CBI

kJ/mol

°C

atm

ppm or %

CBI

CBI

CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

CBI

(b) Use of aerosol product

CBI

grams/sec grams/sec

ppm ppm

% %

CBI

CBI

5. For aerosol solvents (e.g., degreasers, flux removers), describe disposal practices of used solvent (e.g., solvent collected and sent to incinerator, recycling).

6. Provide information on training materials related to manufacture and filling and disposal of aerosol cans. If the proposed substitute is flammable, 

describe how these guidelines differ from training for non-flammable aerosols. Are any training materials attached?

(a) Manufacture and filling of aerosol cans

(c) Disposal

(a) Estimate the typical and maximum delivery rate for the aerosol product, in 

terms of grams/second

(b) Estimate the typical and maximum release rates in terms of (1) ppm and/or 

(2) percent of aerosol can.

4. Estimate typical and maximum (a) delivery rate and (b) release rate for the aerosol can.

Scenario Typical Maximum number of cans per day

(c) Disposal (e.g., collection of spent 

aerosol solvent)

Is supporting documentation (e.g., personal monitoring data) attached?

3. Estimate typical and maximum number of aerosol cans a worker would (a) manufacture and/or fill, (b) use, and (c) dispose per day.

Scenario Typical number of cans per day Maximum number of cans per day

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which worker exposure to the proposed substitute is expected to be the highest for each scenario in (a) 

through (c).

Scenario Identify activities with typical and 

maximum potential for exposure

Duration of Activity Exposure Concentration

(a) Manufacture and filling of aerosol 

cans (e.g., filling cans)

(b) Use of aerosol product

(c) Critical Pressure 

(d) Identify engineering controls used to reduce or prevent releases to the 

environment (e.g., safety valves, gas scrubbers). (e) Identify the contact pathway (e.g., ingestion, inhalation, dermal). (f) Describe any protective equipment and engineering controls used to protect workers (e.g., goggles, gloves, chemical hoods).

Section D: Exposure

1. Exposure Media and Release Information

(a) Identify the media(s) to which the proposed substitute is released (e.g., indoor 

air, outdoor air, water, land).

(b) Indicate the physical form of chemicals at the time of 

handling/exposure (e.g., solid, liquid, gas).

(c) If releases occur outdoors (e.g., outdoor air, water, land), 

provide information or estimates of the magnitude of release 

(ppm).

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the bracketed information redacted 

or removed.

CBI

(d) Odor Threshold

(h) pH 

(f) Volatilization from soil 

(g) Volatilization from water 

(e) Dissociation Constant

(d) Explosive Range (LEL/UEL) 

2. Flammability Concerns and Mitigation: Provide any information on flammability concerns and mitigation measures.

(a) Detail any abatement techniques that are used to minimize the risks associated with flammable substances or 

mixtures:

(i) Henry's Law constant

Section C: Flammability

1. Flammability-Related Physical and Chemical Properties. Provide information on the physical and chemical properties relevant to evaluating the flammability of the proposed substitute in aerosol end-uses.

(b) Additional information on flammability concerns and mitigation measures: 

(a) Heat of combustion

(b) Critical temperature 

NOTE: Please [Bracket] the information you claim as confidential

2 of 2
Part IX: STERILANTS-SPECIFIC INFORMATION

End-Use CBI

Sterilant

CBI

End-Use

(b) Capital costs associated with 

proposed substitute, alternative 

process, new equipment, and/or 

new materials

(c) Changes in labor and 

energy costs

(d) Ongoing operational costs CBI

End-Use

(a) Year proposed substitute or 

technology will be available (or note 

if currently available)

(b) Anticipated first year annual 

production for end-use (kg)

(c) Years until maximum market 

penetration

(d) Maximum annual 

production at market 

penetration

(e) Anticipated market share 

at market penetration (%) CBI

End-Use CBI

CBI

g/L

CBI

atm

kJ/mol

ppm or %

CBI

CBI

CBI

(d) Identify engineering controls used to reduce or prevent releases to the 

environment (e.g., safety valves, gas scrubbers). (e) Identify the contact pathway (e.g., ingestion, inhalation, dermal). (f) Describe any protective equipment and engineering controls used to protect workers (e.g., goggles, gloves, chemical hoods).

(b) Additional information on flammability concerns and mitigation measures: 

Section D: Exposure

1. Exposure Media and Release Information

(a) Identify the media(s) to which the proposed substitute is released (e.g., indoor 

air, outdoor air, water, land).

(b) Indicate the physical form of chemicals at the time of 

handling/exposure (e.g., solid, liquid, gas).

(c) If releases occur outdoors (e.g., outdoor air, water, land), 

provide information or estimates of the magnitude of release 

(ppm or percent of charge).

(c) Explosive range (LEL/UEL) 

2. Flammability Concerns and Mitigation: Provide any information on flammability concerns and mitigation measures.

(a) Detail any abatement techniques that are used to minimize the risks associated with flammable substances or 

mixtures:

(a) Solubility 

5. Application of Proposed Substitute. Please provide information on the application of the substitute in the proposed end-use(s). 

3. Technology Changes and Costs: Describe any new equipment and use profiles and associated costs that will be necessary in order to use the proposed substitute. 

(a) Technology changes to use alternative

4. Production and Market Share: Provide estimated information on production of the proposed substitute by end-use. If possible, estimate the percentage of the market held by the ODS being replaced that will be captured by 

this proposed substitute.

(a) Provide information on the leak-tightness of the equipment (e.g., maximum and typical leak rate of 

equipment)

1. Specific End-Use: Identify the ODS and other alternatives used in the end-use or application and the quantity of proposed substitute needed to replace it for each end use (i.e., the replacement ratio).

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part IX: STERILANTS-SPECIFIC INFORMATION

Section A: Sterilants Use Profile

(a) ODS and other substances being replaced (b) Replacement Ratio (lb: lb)

2. Additional End-Use Description: Please describe the specific uses for which you are applying. For example, provide information on how the sterilant is applied (e.g., sterilization chambers)?

Section B: Sterilant-Specific Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in sterilization.

(b) Anticipated room air exchange rate (ACH)

Section C: Flammability

1. Flammability-Related Physical and Chemical Properties. Provide information on the physical and chemical properties relevant to evaluating the flammability of the proposed substitute when used in sterilization.

(a) Vapor pressure @ 20 °C 

(b) Heat of combustion

NOTE: Please [Bracket] the information you claim as confidential

1 of 2
Part IX: STERILANTS-SPECIFIC INFORMATION

CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

CBI

(a) Provide information on training materials related to manufacture and disposal. If the proposed substitute is flammable, describe how these guidelines 

differ from training for non-flammable sterliants. Are any training materials attached?

3. Training Materials

(g) Describe disposal practices of used sterilant (e.g., sterilant collected and sent to a wastewater treatment facility, recycling).

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which worker exposure to the proposed substitute is expected to be the highest for each scenario in 

(a) through (c).

Scenario Identify activities with typical and 

maximum potential for exposure

Duration of Activity Exposure Concentration

(a) Manufacture and charging of 

equipment (e.g., filling)

(c) Disposal (e.g., of sterilant or 

associated equipment containing the 

sterilant)

Is supporting documentation (e.g., personal monitoring data) attached?

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the bracketed information 

redacted or removed.

CBI

(b) Use of sterilant or associated 

equipment containing steriliant

NOTE: Please [Bracket] the information you claim as confidential

2 of 2
Part X: ADHESIVES, COATINGS, AND INKS-SPECIFIC INFORMATION

End-Use CBI

Adhesives

Coatings

Inks

CBI

End-Use

(b) Capital costs associated with 

proposed substitute, alternative 

process, new equipment, and/or 

new materials

(c) Changes in labor and 

energy costs.

(d) Ongoing Operational costs CBI

End-Use

(a) Year proposed substitute or 

technology will be available (or note 

if currently available)

(b) Anticipated first year annual 

production for end-use (kg)

(c) Years until maximum market 

penetration

(d) Maximum annual 

production at market 

penetration

(e) Anticipated market share 

at market penetration (%) CBI

(a) Typical amount per 

dispenser (g or %)

(b) Maximum amount per 

dispenser (g or %)

(c) Typical total weight of 

dispenser (g)

(d) Maximum total weight of 

dispenser (g) CBI

CBI

CBI

g/L

atm

Pa·s

specify units

CBI

atm

kJ/mol

(a) Vapor pressure @ 20°C 

(b) Heat of combustion

(h) Viscosity

(i) Henry's Law constant

Section C: Flammability

1. Flammability-Related Physical and Chemical Properties. Provide information on the physical and chemical properties relevant to evaluating the flammability of the proposed substitute in adhesives, coatings, and 

inks end-uses.

(f) pH 

(g) Vapor pressure @ 20 °C 

(b) Odor Threshold

(c) Dissociation Constant

(d) Volatilization from soil 

(e) Volatilization from water 

(a) ODS and Other Substances Being Replaced (b) Replacement Ratio (lb: lb)

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part X: ADHESIVES, COATINGS, AND INKS-SPECIFIC INFORMATION

Section A: Adhesives, Coatings, and Inks Use Profile

1. Specific End-Use: Identify each end-use that may be reasonably anticipated for the alternative. Identify the ODS and other alternatives used in the end-use or application and the quantity of proposed substitute needed to 

replace it for each end use (i.e., the replacement ratio).

2. Additional End-Use Description: Please describe the specific use for which you are applying. For example, in what type of products will the substitute be used for adhesives (e.g., laminate, hardwood flooring, flexible 

foam, tire patch, metal to rubber, marine); coatings (e.g., metal coatings, wood stains, aerospace coating), or inks (e.g., flexographic printing, ratogravure printing)? What is the application method (e.g., spray gun, 

aerosol can, dip tank)?

4. Production and Market Share: Provide estimated information on production of the proposed substitute by end-use. If possible, estimate the percentage of the market held by the ODS being replaced that will be captured 

by this proposed substitute.

5. Application of Proposed Substitute. Please provide information on the charge size and associated dispenser size (i.e., total weight of contents) anticipated for the proposed substitute in the proposed end-use(s).

End-Use

3. Technology Changes and Costs: Describe any new equipment technology changes and associated costs that will be necessary in order to use the proposed substitute. 

(a) Technology Changes to Use Alternative and Address Material 

Compatibility Issues

Section B: Adhesives, Coatings, and Inks-Specific Physical and Chemical Properties

1. Physical and Chemical Properties: Provide information on the physical and chemical properties relevant to evaluating the proposed substitute in adhesives, coatings, and inks end-uses.

(a) Solubility 

6. Consumer Use: Please indicate whether the proposed substitute will be used for consumer use. If yes, describe the anticipated consumer applications.

NOTE: Please [Bracket] the information you claim as confidential

1 of 2
Part X: ADHESIVES, COATINGS, AND INKS-SPECIFIC INFORMATION

% or ppm

CBI

CBI

CBI

CBI

Typical Maximum Typical Maximum

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

hours/day hours/day ppm ppm

day/year day/year % %

CBI

CBI

grams/sec grams/sec

ppm ppm

% %

5. Provide information on training materials related to manufacture/filling and disposal of adhesives, coatings, and inks. Are any training materials attached? CBI

(a) Manufacture and filling

(c) Disposal

(a) Estimate the typical and maximum delivery rate for the dispenser product, in 

terms of grams/second

4. Estimate typical and maximum (a) delivery rate and (b) release rate for the adhesives, coatings, and inks dispenser.

Scenario Typical Maximum number of cans per day

(b) Estimate the typical and maximum release rates in terms of (1) ppm and/or 

(2) percent of dispenser.

(c) Disposal (e.g., disposing of spent 

dispensers)

Is supporting documentation (e.g., personal monitoring data) attached?

3. Estimate typical and maximum number of adhesives, coatings, and inks dispensers a worker would (a) manufacture and/or fill, (b) use, and (c) dispose per day.

Scenario Typical number of products per day Maximum number of products per day

(b) Use of adhesives, coatings, and inks product

2. Identify and explain the activities, duration of activities, and typical and maximum exposure concentrations in which exposure to the proposed substitute is expected to be the highest for each scenario in (a) 

through (c).

Scenario Identify activities with typical and 

maximum potential for exposure

Duration of Activity Exposure Concentration

(a) Manufacture and filling of dispensers 

(e.g., filling dispensers)

(d) Identify engineering controls used to reduce or prevent releases to the 

environment (e.g., safety valves, gas scrubbers). (e) Identify the contact pathway (e.g., ingestion, inhalation, dermal). (f) Describe any protective equipment and engineering controls used to protect workers (e.g., goggles, gloves, chemical hoods).

1. Exposure Media and Release Information

(a) Identify the media(s) to which the proposed substitute is released (e.g., indoor 

air, outdoor air, water, land).

(b) Indicate the physical form of chemicals at the time of 

handling/exposure (e.g., solid, liquid, gas).

(c) If releases occur outdoors (e.g., outdoor air, water, land), 

provide information or estimates of the magnitude of release 

(ppm or percent of dispenser).

2. Flammability Concerns and Mitigation: Provide any information on flammability concerns and mitigation measures.

(a) Detail any abatement techniques that are used to minimize the risks associated with flammable substances or 

mixtures:

(b) Additional information on flammability concerns and mitigation measures: 

Section D: Exposure

(c) Explosive Range (LEL/UEL) 

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public version of the submission must be submitted with the bracketed information 

redacted or removed.

(b) Use of adhesives, coatings, and inks 

product

NOTE: Please [Bracket] the information you claim as confidential

2 of 2
Part XI: TOBACCO EXPANSION-SPECIFIC INFORMATION

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part XI: TOBACCO EXPANSION-SPECIFIC INFORMATION

No additional information is needed for this sector.

NOTE: Please [Bracket] the information you claim as confidential

1 of 1
Part XII: ADDITIONAL INFORMATION

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public 

version of the submission must be submitted with the bracketed information redacted or removed.

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part XII: ADDITIONAL INFORMATION

Please provide any additional information in this section.

NOTE: Please [Bracket] the information you claim as confidential

1 of 1
Part XIII: ATTACHMENTS

# Attachment Name/Citation Associated Section of Information Notice 

(Part/Section/Question) Number of Pages CBI

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Part XIII: ATTACHMENTS

Identify attachments below. 

Select (X) in the CBI box next to any attachment that contains information you claim as confidential. The public version of the submission form 

must include the attachment name/citation at a minimum. All claims of confidentiality must be substantiated in Part I. 

Note: Information claimed as confidential should be placed in [brackets] and marked as CBI. If information is claimed as CBI, then a public 

version of the submission must be submitted with the bracketed information redacted or removed.

NOTE: Please [Bracket] the information you claim as confidential

1 of 1
Part XIV: CERTIFICATION

Part XIV: CERTIFICATION

Signature of Authorized Official (Original Signature Required): Date 

Print Name and Title of Authorized Official: Date 

Signature of Agent (Where Applicable): Date

Print Name and Title of Authorized Official: Date 

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

I certify to the best of my knowledge and belief that:

1. All information provided in this notice is complete and truthful as of the date of the submission.

2. I am submitting with this notice all test data in my possession or control and a description of all other data known to or reasonably ascertainable by me.

3. If this is a submission of a new alternative, the company named in Part I, Question 1a of this notice:

 (a) intends to manufacture, formulate, import, market, or use a new alternative to a Class I or Class II ozone-depleting substance which is identified in Part I, 

Section B, Question 2.

 (b) seeks an acceptability determination on a new alternative(s) to a Class I or Class II ozone-depleting substance, which is identified in Part I, Section B, Question 

2.

4. The accuracy of the statements made in this notice reflects my best prediction of the anticipated facts regarding the alternative described herein. Any knowing 

and willful misinterpretation is subject to criminal penalty pursuant to section 113(c) of the Clean Air Act and 18 U.S.C.§1001.

A printed copy of this signature page, with original signature, must be submitted with CD or paper submission.

Note: Please [Bracket] the information you wish to claim as confidential

1 of 1