1 

# Instructions for General
Account Form

The Acid Rain Program CAIR Trading Programs (CAIR NO X Annual, CAIR SO 2 , and CAIR NO X Ozone

Season ) , and Transport Rule Programs (TRNO

x Annual, TRNO

x Ozone Season, TRSO 2 Group 1, and TRSO 2 Group 2) regulati ons require any person, company, or organization wishing to open a general account for the purpose of holding and transferring allowances to submit a completed G eneral Account form

. You also may use this form to change the information previously submitted for a general a ccount, such as the identity of the authorized account representative. In such cases, enter your allowance account identification number in the

space pro vided at the top of the form. Note: A compliance account can only be established, and information concerning a compliance account can only be changed, by submitting a Certificate of Representation form

.

If you need assistance, call the Clean Air Markets Hotline at 202

- 343

- 9620.

STEP 2 The owners may choose an alternate to act on behalf o f the Authorized Account Representative.

STEP 3 Identify all parties with an ownership interest in the allowances held in this account. All of these parties must be subject to a binding agreement authorizing the representation of the account by the

autho rized account representative, and, if applicable, the alternate authorized account representative, identified in Steps 1 and 2. If you (the authorized account representative) are the only person with an ownership interest in the allowances held in the acc ount, list your name here. If additional space is needed, please attach a separate sheet of paper.

STEP 4 If you are establishing a general account, b oth the authorized account representative and the alternate (if any) must sign and date the certificatio ns

. You are encouraged to use the CAMD Business System (CBS) to submit general account information online. To register for CBS, go to https://camd.epa.gov/loginrequest/index.cfm.

For more information see the applicable rule:

Acid Rain: 40 CFR 73.31

CAI R NO X Annual: 40 CFR 96.151 or 97.151 or the applicable State rule

CAIR SO 2 : 40 CFR 96.251 or 97.251 or the applicable State rule

CAIR NO X Ozone Season: 40 CFR 96.351 or 97.351 or the applicable State rule Transport Rule NO X Annual: 40 CFR 97.420

Trans port Rule NO X Ozone Season: 40 CFR 97.520 Transport Rule SO 2 Annual: 40 CFR 97.620 or 97.720

Paperwork Burden Estimate

The public reporting and recordkeeping burden for this collection of information is estimated to average 10 hours per response. Burd en 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

instru ctions 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 m ethods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Includ e the OMB control number in any correspondence. Do not send the completed form to this address.EPA Form 7610

- 5 ( Revised 8

- 2011 ) United States Environmental Protection Agency OMB Nos. 2060

- 0258

, 2060

- 0570 and 2060

- 0667 Approval expires 07/31 /201 4 

# General Account Form

For more information, see instructions.

This submission is: New (to open a new general account)
Revised (to revise information on an existing general account)

Thi s account is authorized to hold allowances in these programs:

Acid Rain/CAIR SO 2 Trading Transport Rule NO X Ozone Season Trading

CAIR NO X Ozone Season Trading Transport Rule SO 2 Gr oup I Trading

CAIR NO X Annual Trading Transport Rule SO 2 Gr oup II Trading Transport Rule NOx Annual Trading

If you are opening a new allowance account, co mplete all steps in this form. I f this is a revised
submission, ente r your account # and a ccount name and complete Step 4 to authorize the change of information. Only the authorized account representative or alternate authorized account repre sentative can authorize the change.

Account #

Account Name

STEP 1 Enter requested

information for the

authorized account representative. Name Title

Company Name

Mailing Address

Phone Number Fax Number

E

- mail Address

STEP 2

Enter re quested

information for the

alternate authorized account representative (r equired only if you want the general

account to have an

alternate au thorized account representative ). Name Title

Company Name

Mailing Address

Phone Number Fax Number

E

- mai l AddressEPA Form 7610

- 5 ( Revised 8

- 2011 ) STEP 3

Enter the names of all parties (persons or companies) subject to the binding agreement authorizing your representation of the

account. Name

Name

Name

Name

STEP 4

Read the certifications and sign and date. Acid Rain Prog ram

I certify that I was selected under the terms of an agreement that is binding on all persons who have an ownership interest with respect to allowances held in the Allowance Tracking System account. I certify that I have all necessary authority to

car ry out my duties and responsibilities on behalf of the persons with an ownership interest and that they shall be fully bound by my actions, inactions, or submissions

under 40 CFR Part 73. I am authorized to make this submission on behalf of the persons wi th an ownership interest for whom this 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 and all its attachments. Based on my inquiry of tho se 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 material information, including the possibility of fine or imprisonment for violations.

Clean Air Interstate Rule (CAIR) NO X Annual Trading Program

I certify that I was selected as the CAIR authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to CAIR NO X allowances held in the general account. I certify that I have al l the necessary authority to carry out my duties and responsibilities under the CAIR NO X Annual Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any or der or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the CAIR NO X allowances held in the general account. I certify under penalty of law that I have personally examined, and am familiar with, the

statements and information submitted in this document and 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 statem ents and information, including the possibility of fine or imprisonment.

Clean Air Interstate Rule (CAIR) SO 2 Trading Program

I certify that I was selected as the CAIR authorized account representative or the alternate CAIR authorized account representat ive, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to CAIR SO 2 allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and responsibilities under the CAIR SO 2 Trading Program on behalf of such persons and that each such person shall be fully bound by myEPA Form 7610

- 5 ( Revised 8

- 2011 ) representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the g eneral account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the CAIR SO 2 allowances held in the general account. I certify under penalty of law that I have personally examined, and am famil iar with, the

statements and information submitted in this document and 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 o f 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.

Cle an Air Interstate Rule (CAIR) NO X Ozone Season Trading Program

I certify that I was selected as the CAIR authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreement that is binding on all perso ns who have an ownership interest with respect to CAIR NO X Ozone Season allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and responsibilities under the CAIR NO X Ozone Season Trading Program o n behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to m ake this submission on behalf of the persons having an ownership interest with respect to the CAIR NO X Ozone Season allowances held in the general account. I certify under penalty of law that I have personally examined, and am familiar
with, the statements and information submitted in this document and 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 belie f 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.

Transport Rule ( TR ) NO X Ann ual Trading Program

I certify that I was selected as the Transport Rule authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to TR NO X allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and responsibilities under the TR NO X Annual Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an o wnership interest with respect to the TR NO X allowances held in the general account. I certify under penalty of law that I have personally examined, and am familiar with, the

statements and information submitted in this document and all its attachments. B ased 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.

Transport Rule (TR) NO X Ozone Season Trading Program

I certify that I was selected as the Transp ort Rule authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreementEPA Form 7610

- 5 ( Revised 8

- 2011 ) that is binding on all persons who have an ownership interest with respect to TR NO X Ozone Season allowances held in the gene ral account. I certify that I have all the necessary authority to carry out my duties and responsibilities under the TR NO X Ozone Season Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, action s, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the TR NO X Ozone Season allowances held in the general account. I certify under penalty of law that I have personally examined, and am familiar with, the statements and information submitted in this document and all its attachments. Based on my inquiry of those indiv iduals 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 st atements and information or omitting required statements and information, including the possibility of fine or imprisonment.

Transport Rule ( TR ) SO 2 Trading Program Group I

I certify that I was selected as the Transport Rule authorized account representa tive or

the alternate TR authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to TRSO 2 Group I SO 2 allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and responsibilities under the TRSO 2 Group

I SO 2 Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the TRSO 2 Group I SO 2 allowances held in the general acc ount. I certify under penalty of law that I have personally examined, and am familiar with, the

statements and information submitted in this document and all its attachments. Based on my inquiry of those individuals with primary responsibility for obtainin g 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 s tatements and information, including the possibility of fine or imprisonment

Transport Rule ( TR ) SO 2 Trading Program Group II

I certify that I was selected as the Transport Rule authorized account representative or

the alternate TRSO 2 authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect

to CAIR SO 2 allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and respo nsibilities under the TRSO 2 Group

II SO 2 Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the TRSO 2 Group II SO 2 allowances held in the general

account. I certify under penalty of law that I have pe rsonally examined, and am familiar with, the statements and information submitted in this document and all its attachments. Based on my inquiry of those individuals with primary responsibility for obtaining the information, I certify that the statements an d 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 possibilit y of fine or imprisonment

.EPA Form 7610

- 5 ( Revised 8

- 2011 ) Signature (Authorized Account Representative) Date

Signature (Alternate Authorized Account Representative, if any) Date

STEP 5 (Optional) Respond to the questions by marking all appropriate boxes

. (EPA

will use th is information for program evaluation purposes only

. ) Is the authorized account representative employed by an allowance brokerage firm?

No

Yes (if yes, please mark all boxes that apply)

This acco unt will be used to transfer allowances between clients

This account will be used to hold allowances for investment purposes

This account will be used for other purposes

What types of business are represent ed by the owner(s) of allowances in this account (mark all boxes

that apply)?

Utility

Non

- Utility Generators of Electricity

Industrial Boiler

Fuel Supplier

_______ Coal

_______ Oil

_______ Gas _______ Other

Pollution Control Equipment Manufacturer or distributor

Public Interest Group

_______ Consumer _______ Other

_______ Environmental

Other

────────────── ──────── ───────── ▸EPA Form 7610

- 5 ( Revised 8

- 2011 ) Submission

Information Mail to the following address:

By regular/certified mail: Or overnight mail:

U.S. Environmental Protection Agency U.S. Environmental Protection Agency Clean Air Markets Division (6204J) Clean Air Markets Division (6204J) Attn: Allowance Tracking System Attn: Allowance Tracking System 1200 Pennsylvania Avenue, NW 1310 L Street, NW Washington, DC 20460 Second Floor, Office 202B Washington, DC 20005 (202) 343

- 9168