Account Certificate of Representation

This form is required to establish an Authorized Account Representative for compliance accounts under

the NOx Budget Trading Program. For more information, see instructions on the reverse side of the form.

This submission is: New

Revised

Check this box if you are also the Designated Representative for this plant under the Acid Rain Program:

STEP 1

Plant Name	State	ORIS Code

STEP 2

Enter requested

information for the

Authorized Account

Representative (AAR).

Name	AAR ID Number (if known)
Address
Phone Number	Fax Number

E-mail Address (if available)
STEP 3

Enter requested

information for the

Alternate Authorized Account Representative,

if applicable.

Name	AAR ID Number (if known)

Phone Number

Fax Number

E-mail Address (if available)

STEP 4

Provide the name of

every owner and

operator of the

budget sources at

the plant. Identify

the budget sources

they own and/or

operate by boiler ID#.

Name	Owner	Operator

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

Name	Owner	Operator

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

Name	Owner	Operator

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

ID#

Plant Name (from Step 1)	Account Certificate of

Representation - Page 2

STEP 5

Read the certification,

sign and date.

I certify that I was selected as the NOx authorized account representative or alternate NOx authorized account representative, as applicable, by an agreement binding on the owners and operators of the NOx Budget source and each NOx Budget unit at the source. I certify that I have all the necessary authority to carry out my duties and responsibilities under the NOx Budget Trading Program on behalf of the owners and operators of the NOx Budget source and of each NOx Budget unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions and by any decision or order issued to me by the permitting authority, the Administrator, or a court regarding the source or unit.

I am authorized to make this submission on behalf of the owners and operators of the NOx Budget sources or NOx Budget 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 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 statements and information, including the possibility of fine or imprisonment.

Signature (Authorized Account Representative)

Date

Signature (Alternate Authorized Account Representative)

Date

INSTRUCTIONS

Under the state regulations to implement the NOx Budget Trading Program, the owners and operators for each budget source must designate a representative, and may designate an alternate, to act on their behalf. The owners and operators should choose the representative through a process that ensures that all owners and operators have notice regarding the selection. All budget sources at a plant must have the same Authorized Account Representative. The Authorized Account Representative is responsible for all submissions and allowance transactions relating to the budget sources at that plant. The Authorized Account Representative and the Alternate Authorized Account Representative are liable for acts or omissions within the scope of their responsibilities under the NOx Budget Trading Program. EPA will not record an allowance transaction until it has received a complete Account Certificate of Representation.

Please type or print. If more space is needed, photocopy the first page. Indicate the page order and total number of pages (e.g., 1 of 4, 2 of 4, etc.). Note: An Account Certificate of Representation amending an earlier submission supersedes the earlier submission in its entirety. A revised Account Certificate of Representation must therefore be complete, including signature and dating by the Authorized Account Representative (and the Alternate, if applicable).

Submit one Account Certificate of Representation form with original signatures. Remember that the Authorized Account Representative should notify each owner and operator of all NOx Budget Program submissions.

For assistance, call the EPA's Clean Air Markets Division Hotline at (202) 343-9620.

STEP 1: If any budget source at the plant is affected by the Acid Rain Program, the ORISPL code is embedded in the first six digits of the unit account number for that source under the Acid Rain Program. If there are not any budget sources at the plant affected by the Acid Rain Program, a budget source should use the plant or facility code registered with the Department of Energy (DOE) to obtain an ORISPL code. (For utilities reporting on the EIA-767, -860, and -861, the plant code would be used as the ORISPL code. For nonutilities reporting on the EIA-867, the facility code would be used as the (ORISPL code). If the budget source does not report to DOE, and therefore does not have an ORISPL code, the budget source should call the Acid Rain Program Hotline for assistance.

STEP 2: The Authorized Account Representative must

be a natural person and cannot be a company. Please enter the firm name and address as it should appear on all correspondence.

EPA Form 7620-16

Representative must rely on the Authorized Account Representative to forward information

mailed by EPA.

STEP 4 The owners and operators may be companies or natural persons. Identify each budget source at the plant that is owned or operated by the named party by providing the unit identification number for the budget source. If a budget source is affected by the Acid Rain Program, the source should

determine an appropriate ID# that it will use for all NOx Budget Trading Program purposes. This ID# must be six digits or less.

STEP 5 Note the certification statement.

SUBMISSION INSTRUCTIONS:

Submit this form prior to submission of the monitoring plan for the NOx Budget Trading Program. This form must be submitted before participating in transfers of allowances.

Submit a revised Account Certificate of Representation when any information in the existing Account Certificate of Representation changes.

Mailing Instructions

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

U.S. EPA

NOx Budget Trading Program (6204J)

for regular or certified mail: for overnight mail:

1200 Pennsylvania Ave, NW 1310 L Street, NW

Washington, DC 20460	Washington, DC 20005
Phone: 202-343-9620

Paperwork Burden Estimate

The public reporting and record keeping burden for this collection of information is estimated to average30 hours per response . 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 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 Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 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.