EPA Form 1265-07 (Revised 04/2011) 

Previous editions are obsolete

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United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

AGENCY USE ONLY

OMB Control No.: 2060-0226 

Expires: 06/30/2014 

TSCA/SNAP ADDENDUM 

for Significant New Alternatives

Date of Receipt:

When completed send this form via U.S. mail to: Or via overnight delivery to: 

SNAP Document Control Officer SNAP Document Control Officer 

Office of Air and Radiation, 6205 J U.S. EPA 

U.S. EPA 1310 L St, NW 

1200 Pennsylvania Ave, NW 10th Floor (MC 6205J) 

Washington, DC 20460 Washington, DC 20005

Date 90 Day Review Begins: 

Date Review Completed: 

PMN Document Control Number 

Enter the total number of pages in your SNAP information Notice: SNAP Document Control No. 

INTRODUCTION

GENERAL INSTRUCTIONS 

This form may be used in conjunction with the Premanufacture Notice (PMN) for new chemical substances (EPA Form 7710-25 

(Rev. 1-19)) to submit chemicals for review under the Significant New Alternatives Policy program as alternatives to Class I and II 

ozone-depleting substances. In addition to the information provided in the Premanufacture Notice, the Agency is requesting 

submitters provide information on the following topics. This information will assist EPA in assessing the acceptability of the

chemical as an alternative to ozone-depleting substances as required by Section 612 of the Clean Air Act. Please see the 

Instructions for the SNAP Information Notice and TSCA/SNAP Addendum (“Instructions”) for additional information on the 

relationship between the SNAP and TSCA PMN programs and for guidance on completing this form. 

To facilitate Agency review of alternatives, both this form and the complete PMN form (including the physical and chemical 

properties worksheet) must be filled out as completely as possible. Please provide all information requested to the extent that it 

is known or reasonably ascertainable. Make reasonable estimates if actual data are unavailable. 

PAPER SUBMISSIONS: All paper submissions must be provided in three complete copies. If information is to be claimed as 

confidential, all confidential information must be excised from one of the copies which will be placed in the public file; the other 

two copies must include the confidential material. If no claims of confidentiality are made for the submission, all copies must be 

identical. 

CD-ROM SUBMISSIONS: The SNAP program also accepts submissions via CD-ROM. If information is to be claimed as 

confidential, all confidential information must be excised from one of the files on the CD-ROM, which will be placed in the public 

docket; the other file must include the confidential material. The file with the confidential material must include “contains CBI” in 

the file name. Please provide a CD-ROM copy of your PMN submission along with your SNAP submission. 

CONFIDENTIALITY CLAIMS: Anyone submitting information must assert a claim of confidentiality at the time of submission for 

any data which is to be treated as Confidential Business Information (CBI). Substantiation of this claim must also be provided at 

this time. All information claimed as CBI will be treated in a manner consistent with 40 CFR Part 2, Subpart B. Failure to assert a 

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

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 development of the SNAP program. 

These Authorized Representatives may have access to any information received by the Stratospheric Protection Division within 

the EPA Office of Atmospheric Programs for use in reviewing the need for possible control of any substance, practice, process or 

activity that may reasonably be anticipated to affect stratospheric ozone. In general, this information will pertain to the feasibility, 

costs, and environmental and health impacts of using substitutes for Class I and Class II substances. Access to such information 

is necessary to ensure that these companies can complete the work required by the contract. 

Authorized Representatives of the Administrator are subject to the provision of 42 U.S.C. 7414(c) regarding confidential business 

information as implemented by 40 CFR 2.301(h)
EPA Form 1265-07 (Revised 04/2011) 

Previous editions are obsolete

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Part I - GENERAL INFORMATION

Section A - SUBMITTER IDENTIFICATION

1. (a) Person Submitting Notice (in U.S.)

_____________________________________________________________________________________________________ 

Name of Authorized Official Title 

______________________________________________________________________________________________________ 

Company/Organization 

______________________________________________________________________________________________________ 

Mailing Address Telephone & Fax Numbers 

______________________________________________________________________________________________________ 

Email Address 

(b) Agent (if applicable) 

______________________________________________________________________________________________________ 

Name of Authorized Official Title 

______________________________________________________________________________________________________ 

Company/Organization 

______________________________________________________________________________________________________ 

Mailing Address Telephone & Fax Numbers 

______________________________________________________________________________________________________ 

Email Address 

(c) Joint Submitter (if applicable)

______________________________________________________________________________________________________ 

Name of Authorized Official Title 

______________________________________________________________________________________________________ 

Company/Organization 

______________________________________________________________________________________________________ 

Mailing Address Telephone & Fax Numbers 

______________________________________________________________________________________________________ 

Email Address 

2. Technical Contact (in U.S.) 

______________________________________________________________________________________________________ 

Name of Authorized Official Title 

______________________________________________________________________________________________________ 

Company/Organization 

______________________________________________________________________________________________________ 

Mailing Address Telephone & Fax Numbers 

______________________________________________________________________________________________________ 

Email Address 

3. If you have had a prior communication with EPA concerning this notice, note the date and type of communication 

(letter, phone, etc.) and the EPA staff person’s name: 

Mark (X) if None ________________ 

 

Mark (X) this box if this page contains CBI __________ 
EPA Form 1265-07 (Revised 04/2011) 

Previous editions are obsolete

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Part II - ALTERNATIVE-SPECIFIC INFORMATION

1. Name of chemical (preferably IUPAC nomenclature) and molecular formula. 

2. Generic name (if chemical name of substitute is declared Confidential Business Information) 

 

3. End-uses and ozone-depleting substances (ODSs) being replaced: 

 (a) Describe each industrial sector and end-use that may be reasonably anticipated for the alternative. For a list of end uses, 

see Appendix A to the Instructions, beginning on p. 23. If the alternative is a refrigerant, indicate whether it is a candidate for use 

in retrofits of existing equipment, for use in new equipment only, or both. 

 (b) Identify the ODS and the quantity of substitute needed to replace it for each end-use (i.e., the replacement ratio). 

4. Ozone-depletion Potential (ODP): 

 (a) Provide the alternative’s 100-year ODP of the alternative relative to CFC-11, if known. Reference the source of the ODP. 

 (b) Provide any additional data on the ODP of the alternative (e.g., atmospheric lifetime, chlorine or bromine loading 

potentials). Reference the source of this information and attach any supporting documentation. 

 

 Mark (X) this box if this page contains CBI __________
EPA Form 1265-07 (Revised 04/2011) 

Previous editions are obsolete

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Part II - ALTERNATIVE-SPECIFIC INFORMATION (Continued)

5. Global-warming Characteristics 

 (a) Provide the alternative’s atmospheric lifetime and global warming potential (GWP) relative to carbon dioxide over 100-year 

time horizon, and 20-year or 500-year time horizon, if known. Reference the most recent 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 blend at its nominal composition. 

 (b) If known, provide the alternative’s expected impact on energy efficiency relative to the substance it is replacing (e.g. +/- 

X%) and results of any testing or modeling done (both theoretical and actual testing). Energy efficiency information is 

particularly useful for refrigerants and foams. 

 (c) For GWP values that do not come from AR4 or WMO 2010, provide any available additional data on the atmospheric 

lifetime and GWP of the alternative, including infrared absorption spectrum and infrared absorption capacity. Reference the 

source of this information. 

6. Flammability Concerns: 

 (a) Provide the alternative’s flash point, the upper and lower flammability limits (UFL & LFL) in percent by volume, the heat of 

combustion (kJ/kg), maximum pressure (PSI), and maximum rate of pressure rise. 

 (b) Provide any additional information on flammability concerns. For example, if any abatement techniques are being used to 

minimize the risks associated with flammable substances or mixtures, detail those techniques below. 

 (c) For flammable refrigerants, provide a fault tree analysis for each end use. For flammable foam blowing agents used in

spray foam, provide a training program that addresses flammability concerns specific to this substitute. 

7. Cost and Availability of Alternative: 

 (a) Estimate the cost per pound for the alternative chemical. Please describe the information used as the basis for this cost 

estimate. 

 (b) Describe any new equipment and use profiles that will be necessary in order to use the substitute. If retrofitting of existing 

equipment is required, detail changes in technologies needed to use the alternative and address any materials compatibility 

issues. Provide information on any new materials, equipment lifetime, changes in labor, and energy costs. 

 (c) Provide information on when the substitute is expected to be available, including: 

- Year substitute is expected to be available 

- Years to maximum market penetration - Maximum total production per year at maximum market penetration, providing units of 

measure and estimated percentage of market. 

 Mark (X) this box if this page contains CBI __________
EPA Form 1265-07 (Revised 04/2011) 

Previous editions are obsolete

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Part IV - LIST OF ATTACHMENTS

List below any attachments that complete the responses to the questions on this form or that provide additional information that 

may assist EPA’s review of the alternative under Section 612 of the Clean Air Act. Also, provide citations for information already 

submitted to EPA as part of past regulatory and information activities, as well as for other information that could not be included 

with this submission. If you have attached continuation pages, describe the Part, Section and question number being continued. 

Attach additional pages if necessary. Mark (X) in the CBI box next to any attachment that contains information you claim as 

confidential.

Attachment Name Question # Number of 

Pages

CBI

 

Mark (X) this box if this page contains CBI __________

 
EPA Form 1265-07 (Revised 04/2011) 

Previous editions are obsolete

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Part V - CERTIFICATION

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 ozonedepleting 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. 

Signature and Title of Authorized Official (Original Signature Required): Date 

 

Signature of Agent (Where Applicable): Date 

 

For persons filing a SNAP Information Notice, the reporting burden is estimated to average 171 hours 

per year. For persons filing a TSCA/SNAP Addendum, the reporting burden is estimated to average 36 

hours her year. Burden means that total time, 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 instruction; develop, acquire, install, and utilize technology and systems for the 

purposes of collecting, validating, and verifying information; adjust the existing ways to comply with any 

previously applicable instructions and requirements; train personnel to be able to respond to a 

collection of information; search data sources; complete and review the collection of information; and 

transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is 

not required to respond to, a collection of information unless it displays a currently valid OMB control 

number. 

Send comments on the Agency’s need for this information, the accuracy of the provided burden 

estimates, and any suggested methods for minimizing respondent burden, including through the use of 

automated collection techniques to the U.S. Environmental Protection Agency, Attn: Director, Collection 

Strategies Division, Office of Information Collection, 1200 Pennsylvania Avenue, NW, Mail Code 

2822T, Washington DC, 20460. Please include the EPA Docket ID Number OAR-2004-0077 and OMB 

Control Number 2060-0226 in any correspondence. Do not send the completed form to this address.