Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

(Insert Company Letterhead)

*** By signing this document, you are representing that you are authorized to make claims on behalf of
your company regarding TSCA and that such claims can be relied upon ***

DECLARATION: PFAS REPORTING UNDER TSCA

The United States Toxic Substances Control Act (TSCA) is a federal regulation that allows the Environmental
Protection Agency (EPA) to comprehensively manage chemicals in U.S. Commerce. This includes reporting
requirements under TSCA Section 8(a)(7), which apply to perfluoroalkyl and polyfluoroalkyl substances
(PFAS). TSCA mandates the reporting of certain information from U.S. manufacturers of all PFAS chemicals,
including PFAS created as manufacturing byproducts. Reporting is also required for PFAS imported into the
United States, whether on their own or as an incorporated article component.

PFAS are a large and complex group of chemicals; TSCA PFAS requirements apply to all types of PFAS used
in U.S. commerce, as defined by the EPA's Chemical Data Reporting (CDR) database. More information is
available from the EPA's TSCA PFAS webpage.

To whom it may concern,

We hereby send you information related to the U.S. Environmental Protection Agency (EPA) and the Toxic
Substances Control Act (TSCA) Section 8(a)(7); this communication applies to all products sold or otherwise
placed on the market by [Your Company Name] prior to the signature date of this declaration.

OR, We hereby send you information related to the U.S. Environmental Protection Agency (EPA) and the
Toxic Substances Control Act (TSCA) Section 8(a)(7); this communication applies to all products sold or
otherwise provided to [Requesting Client] prior to the signature date of this declaration.

If no products contain any of the reportable PFAS chemicals, this option must be selected:
Checking this box certifies that none of the products referenced above contain any of the reportable
substances.

OR, if any products contain any reportable PFAS chemicals, this table must be completed:

Where in the product is the


Product(s) Substance Name or CAS Number Concentration (%)
substance found?

Name: Signed:

Title: Date:

Email: Phone:

You might also like