### EPA Form 5900-03 OMB No. 2060-0336, Approval Expires 04/30/2012 

### Federal Operating Permit Program (40 CFR Part 71)

FEE CALCULATION WORKSHEET (FEE)

Use this form initially, or thereafter on an annual basis, to calculate part 71 fees.

A. General Information

Type of fee (Check one): ___Initial ___Annual

Deadline for submitting fee calcul ation worksheet ____/____/_______

For initial fees, emissions are based on (Check one):

___ Actual emissions for the pr eceding calendar year. (Requir ed in most circumstances.)

___ Estimates of actual emissions for t he current calendar year. (Required when operations commenced during t he preceding calendar year.)

Date commenced operations ____/____/______

___ Estimates of actual emissi ons for the preceding calendar ye ar. (Optional after a part 71 permit was issued to replace a part 70 pe rmit, but only if initial fee payment is due between January 1 and March 31; otherwise use actual emissions for the preceding calendar year.)

For annual fee payment, you are required to use act ual emissions for the pr eceding calendar year.

B. Source Information: Complete this section only if you are paying fees but not applying for a permit.

Source or facility name _______________________________________________________________

Mailing address : Street or P.O. Box ____________________________________________________

City_______________________________________ State______ ZIP__________ - ______

Contact person__________________________________ Title_____________________________

Telephone (_____) _____ - _________ Ext________ Part 71 permit no. _____________________

C. Certification of Truth, Accuracy and Completeness : Only needed if not submitting a separate form CTAC.

I certify under penalty of law, based on informat ion and belief formed after reasonable inquiry, the

statements and information contained in this submi ttal (form and attachments) are true, accurate and complete.

Name (signed) ________________________________________

Name (typed) ________________________________________ Date:____ /____ /_______

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D. Annual Emissions Report for Fee Calculation Purposes -- Non-HAP

You may use this to report actual emissions (tons per year) of regulated pollutants (for fee calculation) on a calendar-year basis for both initial and annual fee calcul ation purposes. Section E is designed to report HAP emissions. Quantify all actual emissions, including fugiti ves, but do not include insignificant emissions and certain regulated air pollutants that are not counted fo r fee purposes, such as CO (see instructions). You may round to the nearest tenth of a ton on this form. Sum the emissions in each column and enter a subtotal at the bottom of the page. If any subtotal exceeds 4,000 tons, enter 4,000 for that column.

This data is for ____________ (year)

Emission Unit ID NOx VOC SO2 PM10 Lead Other

SUBTOTALS

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E. Annual Emissions Report for Fee Calculation Purposes -- HAP

HAP Identification . Identify individual HAP emitted at the fa cility, identify the CAS number, and assign a unique identifier for use in the second table in this section. Whenever assi gning identifier codes, use "HAP1” for the first, "HAP2" for the second, and so on.

Name of HAP CAS No Identifier

HAP Emissions . Report the actual emissions of individual HAP identified above. Use the identifiers assigned in the table above. Include all emissions, includi ng fugitives, and do not include insignificant emissions. You may round to the nearest tenth of a ton. Sum the emissions in each column and enter a subtotal at the bottom of the page. If any subtotal exceeds 4,000 tons, enter 4,000.

This data is for __________ (year)

Emissions Unit ID Act ual Emissions (Tons/Year)

HAP___ HAP___ HAP___ HAP___ HAP___ HAP___ HAP___ HAP___

SUBTOTALS

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F. Fee Calculation Worksheet

This section is used to calculate the total fee ow ed for both initial and annual fee payment purposes. Reconciliation is only for cases where you are paying the annual fee and you used any type of estimate of actual emissions when you calculated the initial fee. If you do not need to reconcile fees, only complete line 1-5 and then skip down to lines 21 – 26. See instructions for more detailed explanation.

1. Sum the emissions from section D of this form (non-HAP) and enter the total (tons).

2. Sum the emissions from section E of th is form (HAP) and enter the total (tons).

3. Sum lines 1 and 2.

4. Enter the emissions that were c ounted twice. If none, enter "0."

5. Subtract line 4 from line 3, round to t he nearest ton, and enter the result here.

RECONCILIATION (WHEN INITIAL FEES WERE BASED ON ESTIMATES FOR THE “CURRENT” CALENDAR YEAR)

Only complete lines 6-10 if you are paying the first annual fee and initial fees were based on estimated actual emissions for the calendar year in which you paid init ial fees; otherwise skip to line 11 or to line 21.

6. Enter the total estimated actual emissions for the year the initial fee was paid (previously reported on line 5 of the initial fee form).

7. If line 5 is greater than line 6, subtract line 6 from line 5, and enter the result.

Otherwise enter "0."

8. If line 6 is greater than line 5, subtract line 5 from line 6, and enter the result.

Otherwise enter "0."

9. If line 7 is greater than 0, multiply line 7 by last year’s fee rate ($/ton) and enter the result here. This is the underpayment. Go to line 21. 10. If line 8 is greater than 0, multiply line 8 by last year's fee rate ($/ton) and enter the result here. This is the overpayment. Go to line 21.

RECONCILIATION (WHEN INITIAL FEES WERE BASED ON ESTIMATES FOR THE “PRECEDING” CALENDAR YEAR)

Only complete lines 11-20 if you are paying the first annual fee and initial fees were based on estimated actual emissions for the calendar year preceding initial fee paym ent; otherwise skip to line 21. If completing this section, you will also need to complete sections D and E to report actual emissions for the calendar year preceding initial fee payment.

11. Sum the actual emissions from section D (non-HAP) for the cal endar year preceding initial fee payment and enter the result here.

12. Sum the actual emissions from secti on E (HAP) for the calendar year preceding initial fee payment and enter the result here.

13. Add lines 11 and 12 and enter the total here. These are total actual emissions for the calendar year preceding initial fee payment.

14. Enter double counted emission from line 13 here. If none, enter "0."

15. Subtract line 14 from line 13, round to th e nearest ton, and enter the result here.

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16. Enter the total estimated actual emission s previously reported on line 5 of the initial

fee form. These are estimated actual em issions for the calendar year preceding initial fee payment.

17. If line 15 is greater than line 16, subtract line 16 from line 15, and enter the result

here. Otherwise enter "0."

18. If line 16 is greater than line 15, subtract line 15 from line 16, and enter the result

here. Otherwise enter "0."

19. If line 17 is greater than 0, multiply line 17 by last year’s fee rate ($/ton) and enter the
result here. This is the underpayment.

20. If line 18 is greater than 0, multiply line 18 by last year’s fee rate ($/ton) and enter the
result on this line. This is the overpayment.

FEE CALCULATION

21. Multiply line 5 (tons) by the current fee rate ($/ton) and enter the result here.

22. Enter any underpayment from line 9 or 19 here. Otherwise enter "0."

23. Enter any overpayment from line 10 or 20 here. Otherwise enter "0."

24. If line 22 is greater than "0 ," add it to line 21 and enter the result here. If line 23 is greater than "0," subtract th is from line 21 and enter the result here. Otherwise enter

the amount on line 21 here. This is the fee adjusted for reconciliation.

25. If your account was credited for fee asse ssment error since the last time you paid
fees, enter the amount of the credit here. Otherwise enter "0."

26. Subtract line 25 from line 24 and enter the result here. St op here. This is the total fee amount that you must remit to EPA.

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EPA Form 5900-03 6

INSTRUCTIONS FOR FEE

FEE CALCULATION WORKSHEET

Use this form to initially or annually calculate fees. This form is for paying fees to EPA or a delegate agency (such as a State or tribe) under a part 71 operating permit program. The requirements for paying fees under part 71 programs, as well as the forms an d instructions contained herein, are based on the requirements of 40 CFR section 71.9

There may be cases, under a part 71 program, when you are not required to complete this form or pay the EPA fee rate (where the part 71 program has be en delegated and EPA’s fee has been suspended because EPA incurs no administrative costs). In such cases, the delegate agency will instruct you on how to calculate fees and how to pay them. If in doubt, contact your permitting authority.

General Rules for Fee Calculation under Part 71 :

 Use the fee rate in effect at the time you pay t he fee regardless of the time period that the emissions data represents. For example, if the annual fee for the current year is due July 1, you would use the fee rate in effect for the current year and the ac tual emissions for the pr evious calendar year.

 Do not prorate initial or annual fees. Pay full fees for the entire calendar year regardless of how many days you operated or were subject to t he program during the previous or current year.

 Do not hesitate to contact the permitting authority if you have any doubt about how to calculate fees, especially if you have an unusual set of circumstances not addressed specifically by these forms or whenever the permit requirements a ppear to conflict with these forms (however, always assume the permit requirements take precedence in such cases).

Section A. General Information

The deadline for submitting the fee form and paying the fee for initial fee payment purposes for most sources is the same deadline as for submitting all ot her forms required for the in itial permit application. Other deadlines apply for initial fee payment in certain limited circumstances:

 When a source is subject to part 71 because of an unresolved EPA objecti on to a part 70 permit, fees are not due with the part 71 application, but are due 3 months following the date of the issuance of the part 71 permit.

 When EPA withdraws approval of a part 70 progra m and implements a part 71 programs, fees are submitted according to a schedule based on the sour ce’s SIC code (within 6 to 9 months of the effective date of the part 71 program).

The deadline for submitting the fee form and paying the fee for annual fee paymen t purposes is the anniversary date of initial fee payment. This is r equired whether or not a permit has been issued. If you were required to pay initial fees between January 1 and March 31, the regulations allow for submittal of annual fees no later than April 1.

Whether you are paying initial or an nual fees see the instructions for se ctions D and E for more information on which calendar-year emission data to use (preceding or current year) and how to quantify such emissions (actual emi ssions or estimates of actual emissions).

Section B. Source Information

Complete this section only if you are preparing this form for submittal at a different time than for the other portions of an initial applicat ion or for annual fee purposes.

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Section C. Certification of Truth, Accuracy and Completeness This form and any other document required by a permi t must be signed by a responsible official certifying truth, accuracy and completeness of the information. If you are submitting a separate CTAC form, there is no need to complete this section of the form. If you complete this section, there is no need to submit form

CTAC separately.

Section D. Annual Emissions Report for Fee Calculation Purposes – Non-HAP

Calculate actual emissions of regul ated pollutants (for fee calculation) , except for HAP, on a calendar-year basis for the facility in this section. Section E is provided to report actual emi ssions of HAP. Note the phrase ”regulated pollutant (for fe e calculation)” is any “regulated ai r pollutant” except carbon monoxide (CO), and pollutants regulated solely because they are: 1) subject to regulation under section 112(r) of the Act, or 2) a class I or II substance under title VI of the Act.

If more than one year of data is being submitted wi th the fee calculation worksheet, copy this page and complete a separate table for each year. If you are subm itting an initial application, you may use emissions data already reported on form EMISS , provided this is the same data you would otherwise report in sections D and E of this form. If using EMISS in this manner, please note this on the fee calculation form. Also, sources must submit attachments to this form to show (at a minimum) exam ples of the calculations

used to determine these values.

Show actual emissions for each listed air pollutant for each emission unit. You may round to the nearest

tenth of a ton.

The column for "other" is for other regulated pollutants (for fee calculation) not already listed on the form. Write in the name of the pollutant in the proximity of the "other" column. If more than one such pollutant, show the pollutants, and the totals on an attachment.

Actual emissions must be calculated using actual operating hours, production rates, in-place control equipment, and types of materials processed, stored, or combusted over the preceding calendar year. Sources that have been issued title V permits are requi red to compute actual emissions using compliance methods required by the permits, such as monitoring or source testing data. If this is not possible, actual

emissions should be determined using other federally recognized procedures.

For initial fee calculation purposes , most sources are required to use actual emissions for the preceding calendar year. However, there are certain exceptions where estimates of act ual emissions are either required or allowed in place of actual em issions for the preced ing calendar year:

Exception Emission Data When the source commenced operation during the preceding calendar year. Estimates of actual emissions for the “current” calendar year are required

When EPA withdraws approval of a part 70 program and implements a part 71 program, and the source pays initial part 71 fees between January 1 and March Either estimates of actual emissions for the “preceding” calendar year or actual emissions for the pr eceding calendar year may be used.

When a part 71 permit was issued following an unresolved objection to a part 70 permit, and the source is required to pay initial part 71 fees between January 1 and March 31. Either estimates of actual emissions for the “preceding” calendar year or actual emissions for the pr eceding calendar year may be used.

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For annual fee purposes , fee calculation should be based on actual emissions for the preceding calendar year in all cases.

In most cases you will only need to report one set of emission data using sections D and E of this form (the

data that is the basis of the initial or annual fee bei ng paid as explained above). This data is subsequently

carried over to lines 1 and 2 of section F (Fee Calculation Worksheet) of the form.

However, there is one exception where you would be requi red to report two different sets of emissions data using sections D and E – when paying the first annual fee and reconciliati on is required because the initial

fee was based on estimated actual em issions for the “precedi ng” calendar year (the year preceding initial fee payment). In this case, the two data sets would be:

 actual emissions for the year initial fees paid (for annual fee purposes in lines 1-5 of section F of the form), and

 actual emissions for the year preceding initial fee payment (for reconciliation in lines 11-20 of the form)

Whenever reconciliation is required as part of annual fee payment, you will also need a copy of the fee forms you previously submitted with initial fee payment in order to obtain the value of estimated actual

emissions.

Include all fugitive emissions in the calculation of actual emissions, in cluding those that do not count for applicability. Do not include any insi gnificant emissions identified on form IE

.

The subtotal line in section D of the form is provided at the bottom of each column to enter total emissions for each pollutant reported above. If any subtotal exceeds 4,000 tons, enter 4,000 tons for that column. You may round to the nearest tenth of a ton.

Any necessary adjustments for double counting of em issions will be performed later in section F.

Section E

. Annual Emissions Report for Fee Calculation Purposes -- HAP

List the actual emissions of individual HAP from each emission unit. If you are initially applying for a permit, you may use the emissions of HAP reported on form EMISS, instead of completing this section of this form, provided these emissions are the same as you would other wise report using this section of the form. If you are doing this, please note it on the form.

This section is composed of two tables. The first t able is to identify individual HAP emitted at each emission unit. Assign a unique identifier for use in the second table. Please use "HAP1" fo r the first one, "HAP2" for
the second one, and so on. The second table is to calc ulate the actual emission of individual HAP at each

emission unit. Use the identifiers assigned in the first t able to label the column headers for the second

table. You may round these emissions to the nearest tenth of a ton. Sum the values in each column and

enter the subtotals at the bottom of the table. If any subtotal exceeds 4,000 tons, enter 4,000 for that

column.

See instructions for section D for more information on reporting emissions data.

Section F. Fee Calculation Worksheet

Total actual emissions from se ctions D (non-HAP) and E (HAP) of this form, or from form EMISS are reported, credit is given for double counting of emi ssions, reconciliation occurs if necessary, adjustments are made for fee assessment errors, and the total fee amount is determined.

A detailed explanation of Section F follows (separated into four parts):

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Emissions Calculation

The subtotals for each pollutant listed in Sections D and E (or from form EMISS ) are added together to calculate the total emissions (in tons per year) for the facility.

The emissions that are reported here will vary for initial fee payment purposes, depending on the specific circumstances, but will always be ac tual emissions for the preceding ca lendar year for annual fee purposes.

See the instructions for section D for more on the em issions data you should use in the part of the form.

The total emissions are adjusted for double counting and are rounded (if not already rounded) to the nearest ton. For example, double counting may occur where a pollutant is defined as HAP and VOC. If you adjust for double counting, attach an explanation for this.

Reconciliation (When Initial Fees Were Based on Estimates for the Current Calendar Year)

This section is only used by sources paying their first annual fee when their initial fee was based on estimates of calendar-year emi ssions for the “current” year (the same year that initial fees were paid). This reconciliation is done by comparing the actual emissions for the “current” year provided in sections D and E

of this submittal with the estimate of those emissions previously provided with initial fee payment. There may have been overpayment or underpayment of the initial fee. The fee you are paying now will be adjusted for this difference later.

Reconciliation (When Initial Fees Were Based on Estimates for the Preceding Calendar Year)

This section is only used by sources paying their first annual fee when their initial fee was based on estimates of calendar-year emissions for the year preceding initial fee payment, provided the source was required to pay its initial fee between January 1 and March 31, and EPA issued the Part 71permit to replace a Part 70 permit. This reconciliation is done by comparing the actual emi ssions for the “preceding” year provided in sections D and E of th is submittal with the estimate of those emissions provided with initial fee payment. There may have been overpayment or underpayment of the initial fee. The fee you are paying now will be adjusted for this difference later.



### Fee Calculation

Calculate the total fee amount to be paid by the required deadline.

The fee rate ($/ton) used to calculate fees should be the fee rate in effect at the time the fee is paid, rather than the fee rate in effect during the time period repres ented by the emissions data. For example, if you are paying fees during 2008 and your emission data is from ca lendar year 2007, you would use the fee rate in effect for 2008, rather that the fee rate in effect for 2007.

Fee assessment errors occur when the permitting authorit y determines that the source has calculated the fee incorrectly. If this occurs, you will be notified of the error. Any overpayment will be credited against the next fee owed. In the case of underpayment, you will be billed for the corrected fee and you will have 30 days to remit the amount. If you think the assessed fee is in error, you may submit a written explanation of the alleged error, but you must pay the fee. The permitti ng authority will provide a determination in 90 days. If the assessment of underpayment is in error, your account will be credited.

Fee payments must be in United States currency and s hall be paid by money order, bank draft, certified check, corporate check, or electronic funds transfer payable to the order of the U.S. Environmental Protection Agency.

Send fee payment (e.g., the check), along with form FF , the fee filing form, to the appropriate lockbox bank

account address listed in the instructions for form FF . Note that the lockbox bank account addresses are

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subject to change from time to time , so please confirm you have the correct lockbox address whenever you pay fees.

Form FEE (this form) should be sent to t he EPA regional office. We also ask that you submit a photocopy of the check to the EPA regional office.



### Penalties and Interest

The permitting authority will bill sources for appropriate penalties and interest. Interest will be assessed on payments received later than the due date. Penalties shall be assessed if payment is not paid within 30 days of the due date. For sources issued part 70 or 71 permits, penalties and interest shall be assessed for excessive underpayment of the annual fee amount.



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