# Instructions for Allowance Deduction Form

(Optional)

The Acid Rain Program and CAIR Trading Programs (CAIR NO X 

## Annual, CAIR SO 2 

## , and CAIR NO X 

## Ozone

Season) regulations allow for the identification of allowances to be deducted for annual compliance. The form

must be submitted by November 30 for the CAIR Ozone Season Program, or March 1 of the year after the

compliance year for the Acid Rain/CAIR SO2 Program and CAIR NO X 

## A nnual Program.

You are encouraged to use the CAMD Business System (CBS) to submit allowance deductions online. To

register for CBS, go to https://camd.epa.gov/loginrequest/index.cfm

.

If you need more space, photocopy page one . When you have completed the form, indicate the page order

and total number of pages ( e.g. , 1 of 4, 2 of 4, etc. ) in the spaces provided in the upper right hand corner of

each page.

E ither the designated representative ( D R) or the alternate DR may sign this form

.

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

- 343

- 9620.

Step 1 Make sure you select the correct a llowance program. Only check one box. If you want to deduct

allowances under more than one program, submit a separate form for each program.

Step 2 Enter the Compliance Year, the Allowance Tracking System (ATS) Account Number of the facility

(i.e., plant) from which allowances are to be deducted, and the Facility Name.

Step 3 List by serial number the allowances to be deducted. You may specify single allowances or a

series of allowances. In the total column, enter the total number of allowances to be deducted.

Verify the accuracy of your entries by computing one of the following simple equations:

Start Number = End Number

- Total + 1

or

End Number = Start Number + Total - 1

NOTE: If the serial number range does not correspond with the figure for the total number of

allowances, then EPA will rely on the serial number range and not the total number.

You may copy the form to list additional allowances to be deducted. When you have completed the form,

f or each ATS account number indicate the page order and total number of pages (e.g., 1 of 4, 2 of 4, etc.)

in the boxes in the upper right hand corner of each page.

T he allowance year of the allowances to be deducted must be the same as, or a year prior to, the

compliance year listed in Step 1.

If you do not identify enough allowances by serial number, EPA will deduct any additional allowances

necessary on a first

- in, first

- out (FIFO) basis starting with those allowances with the earliest date of

recordation into the compliance account (generally, allowances originally allocated by EPA to the unit will

have the earliest date of recordation).

If you identify more than enough allowances, EPA will deduct the allowances in the order listed on the

form. EPA will not deduct more allowances than necessary for compliance.

Step 4 Read the Certifications, sign, and date.

EPA Form 76 20-4 ( Revised 1 2- 2009 )

## Mailing Instructions Mail this form to EPA at one of the following addresses:

f or regular or certified mail: for overnight mail:

U.S. EPA U.S. EPA

Acid Rain Program (6204J) Acid Rain Program (6204J)

Attention: Annual Reconciliation Attention: Annual Reconciliation

1200 Pennsylvania Avenue, NW 1310 L Street, NW.,

Washington, DC 20460 Second Floor

Washington, DC 20005

Phone: 202

- 343

- 9150

For more information see the applicable rule:

Acid Rain: 40 CFR 73. 35

CAIR NO X 

## Annual: 40 CFR 96. 154 or 97.1 54 or the applicable State rule

CAIR SO 2 

## : 40 CFR 96.2 54 or 97.2 54 or the applicable State rule

CAIR NO X 

## Ozone Season: 40 CFR 96.3 54 or 97.3 54 or the applicable State rule

Paperwork Burden Estimate

The public reporting and recordkeeping burden for this collection of information is est imated to average 3

hours per response annually. Burden means the total time, effort, or financial resources expended by persons

to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the

time needed to review instructions; develop, acquire, install, and utilize technology and systems for the

purposes of collecting, validating, and verifying information, processing and maintaining information, and

disclosing and providing information; adjust the existin g 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 other wise disclose the information.

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

unless it displays a currently valid OMB control number.

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

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

collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency

(2822T), 1200 Pennsylvania Ave., NW., Washington, D.C. 20460. Include the OMB control number in any

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

EPA Form 76 20-4 ( Revised 1 2- 2009 )

### United States OMB Nos. 2060

- 0258 and 2060

- 0570

Environmental Protection Agency Approval expires 11/30/2012



# Allowance Deduction Form

(Page 1 of ___ in this submission)



## STEP 1

Select the type of

allowances to be

deduct ed. Choose one only:

Acid Rain/CAI R SO 2 

## Allowances

CAIR NO X 

## Ozone Season Allowances

CAIR NO X 

## Allowances

STEP 2

Enter

compliance year

and Facility

information Compliance Year Account Number Facility Name



## STEP 3

List the

allowances to

be deduct ed by

serial number in

order of

deduction

.

You may

specify single

allowances or a

series of

allowances. In

the total

column, enter

the total

number of

allowances to

be deduct ed.

Enter separate

series or series

with a different

use date on a

separate line. Start Number End Number

Year Start End Total

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## EPA Form 76 20-4 ( Revised 1 2- 2009 )

## EPA Form 76 20-4 ( Revised 1 2- 2009 ) Account # (from page 1) (Page 2 of in this submission)



## STEP 4

Complete Steps 5

and 6 . Read the

certification, print

name, and sign

and date. Certification

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

source or units for which the submission is made. I certify under penalty of law that I have

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

this document and all its attachments. Based on my inquiry of those individuals with

primary responsibility for obtaining the information, I certify that the statements and

informa tion 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.

Name

Signature Date



## Submission

Information Mail to the following address:

By regular/certified mail:

U.S. Environmental Protection Agency

Clean Air Markets Division (6204J)

Attn: Annual Reconciliation

1200 Pennsylvania Avenue, NW

Washington, D.C. 20460 Or overnight mail:

U.S. Environmental Protection Agency

Clean Air Markets Division (6204J)

Attn: Annual Reconciliation

1310 L Street, NW

Second Floor, Office 202B

Washington, DC 20005

(202) 343

- 9168