OMB Control Number: 2060-0170 

Expiration Date: 4/30/12 

EPA Form # 5900-156, Revised 04/09

 U.S. Environmental Protection Agency 

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

NOTIFICATION OF TRANSFERS OF ARTICLE 5

ALLOWANCES, ESSENTIAL-USE ALLOWANCES, OR 

ESSENTIAL-USE CFCS

(Sec 82.12)

SECTION 1 TRANSFEROR/TRANSFEREE IDENTIFICATION

1.1 Date of Submission 1.2 Original Submittal Re-submittal

1.3 Number of Transactions 

Reported 1.4 Number of Pages 

Submitted 

1.5 Company Information

Company Type (Select only one) Transferor (for Transfers of Article 5 or Essential-Use Allowances) 

 Transferee (for Transfers of Essential-Use CFCs) 

Company Name 

Street Address 

City 

 

State 

 

Zip Code 

 

1.6 Company Contact Identification

Reporting Company Contact Person 

 

Phone Number 

 

Fax Number 

 

E-mail Address 

1.7 Signature of Reporting Company Representative

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached 

documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the 

submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, 

including the possibility of fine and imprisonment.

Name _____________________________________________________________________________________ 

Title ______________________________________________________________________________________ 

Signature _________________________________________________________________________________

Date _____________________ 

SEND COMPLETED FORMS TO: For U.S. Postal Service: 

Tracking System Program Manager 

Stratospheric Protection Division 

U.S. EPA (6205J) 

1200 Pennsylvania Avenue, NW 

Washington, DC 20460 

For Private Courier: 

Tracking System Program Manager 

Stratospheric Protection Division 

U.S. EPA (6205J) 

1310 L Street, NW; 10th Floor 

Washington, DC 20005

Information in reports submitted in compliance with the final rule may be claimed as confidential. A company may assert a claim of confidentiality for information 

submitted by clearly marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for information claimed as 

confidential at 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart. If no claim of confidentiality accompanies the report when 

it is received by EPA, it may be made public without further notice to the company (40 CFR 2.203). 

The public reporting and recordkeeping burden for this collection of information is estimated to average 2.4 hours per response. 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.
OMB Control Number: 2060-0170 

Expiration Date: 4/30/12 

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

NOTIFICATION OF TRANSFERS OF ARTICLE 5

ALLOWANCES, ESSENTIAL-USE ALLOWANCES, OR 

ESSENTIAL-USE CFCS

(Sec 82.12)

SECTION 2.A 

TRANSACTION RECORD FOR TRANSFERS OF ARTICLE 5 (A5) ALLOWANCES

OR ESSENTIAL-USE ALLOWANCES

 (Reproduce additional sheets as needed)

TRANSACTION # 

2.1 Transferee Identification

Transferee Company Name 

 

Transferee Contact Person 

 

Street Address 

City 

 

State 

 

Zip Code 

 

Phone Number 

 

Fax Number 

 

E-mail Address 

 

Are Article 5 allowances or essential-use allowances being transferred? Article 5 Essential Use 

2.2 Control Period for which Allowances Are Being 

Transferred (select only one) Current Year Allowances Baseline Year Allowances 

 2.3 Chemical Transferring From 2.4 ODP 

2.5 Amount of Allowances of Chemical in Section 2.3 

Being Transferred (kg) 

2.6 Calculated Level of Chemical in Section 2.3 Being 

 Transferred (Section 2.4 x Section 2.5) 

2.7 Chemical Transferring To 2.8 ODP 

2.9 Amount of Offset (0.01 x Section 2.5) (kg) 

 2.10 Amount of Allowances Subtracted from 

Transferor’s Balance of Chemical Being 

Transferred (Section 2.5 + Section 2.9) (kg)

 

 2.11 Amount of Allowances of Chemical in Section 2.7 

Being Received (Section 2.6 ÷ Section 2.8) (kg) 

2.12 For Essential-Use Allowance transfers, have you included signed documentation from the 

transferee identifying the CFC MDI products that will be produced using the Essential-Use 

Allowances (per Sec 82.12)? 

 Yes No 

EPA Form # 5900-156, Revised 04/09
OMB Control Number: 2060-0170 

Expiration Date: 4/30/12 

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

NOTIFICATION OF TRANSFERS OF ARTICLE 5

ALLOWANCES, ESSENTIAL-USE ALLOWANCES, OR 

ESSENTIAL-USE CFCS

(Sec 82.12)

SECTION 2.B TRANSACTION RECORD FOR TRANSFERS OF ESSENTIAL-USE CFCS 

 (Reproduce additional sheets as needed)

TRANSACTION # 

2.1 Transferor Identification

Transferor Company Name 

 

Transferor Contact Person 

 

Street Address 

City 

 

State 

 

Zip Code 

 

Phone Number 

 

Fax Number 

 

E-mail Address 

 

2.2 Essential-Use CFC being transferred (select only one) CFC-11 CFC-12 CFC-114

2.3 Amount of Essential-Use CFC in Section 2.2 being 

transferred (kg) 

2.4 The specific Metered Dose Inhaler (MDI) products (i.e. 

the MDI drug product or active moiety) that the 

Transferee plans to produce with the transferred CFCs

 

2.5 The country(ies) where the CFC MDIs produced with 

the transferred Essential-Use CFCs will be sold if other 

than in the United States

 

2.6 Have you provided certification that the Essential-Use CFCs will be 

used in the production of essential MDIs (per Sec 82.12)? Yes No

2.7 Have you submitted a letter by the transferor stating that it concurs 

with the terms of the transfer stated in your request (per Sec 82.12)? Yes No

EPA Form # 5900-156, Revised 04/09
OMB Control Number: 2060-0170 

Expiration Date: 4/30/12 

 U.S. Environmental Protection Agency 

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

NOTIFICATION OF TRANSFERS OF ARTICLE 5

ALLOWANCES, ESSENTIAL-USE ALLOWANCES, OR 

ESSENTIAL-USE CFCS

(Sec 82.12)

SECTION 3 UNEXPENDED BALANCE SUMMARY

3.1 Balance of Unexpended Allowances Prior to Transfers Reported

A B C 

Chemical Name Balance of Unexpended Article 5 

Allowances 

Balance of Unexpended Essential-Use 

Allowances for CFC use in Essential MDIs

CFC-11 

CFC-12 

CFC-13 

CFC-111 

CFC-112 

CFC-113 

CFC-114 

CFC-115 

Other CFCs (please specify) 

 

 

 

 

 

 

 

EPA Form # 5900-156, Revised 04/09