Form HC-500 "Hazardous Chemical Inventory Fee Return" - Indiana

What Is Form HC-500?

This is a legal form that was released by the Indiana Department of Revenue - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2004;
  • The latest edition provided by the Indiana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form HC-500 by clicking the link below or browse more documents and templates provided by the Indiana Department of Revenue.

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Download Form HC-500 "Hazardous Chemical Inventory Fee Return" - Indiana

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Indiana Department of Revenue
For Office Use Only
Hazardous Chemical Inventory Fee Return
Pymt Date
The Department of Revenue will not process any application which
does not contain a Federal Identification Number or Social Security
Pymt Amt
Number, and a signature of an owner or officer of the company.
HC-500
Year Ending
State Form 46332
1/04
For:
Due:
Mailing Address
Name
Federal ID Number or Social Security Number
(Enter individual, partnership or corporation name)
Address
City
State
Zip Code
Telephone Number
(including area code)
Owner Information
Name
Federal ID Number or Social Security Number
Address
City
State
Zip Code
Telephone Number
(including area code)
HC-500 Payment Summary
Fee Amount
Category
# of Facilities
Per Facility
Balance
A
X
$200.00
=
$
B
X
$100.00
=
$
C
X
$ 50.00
=
$
E
X
$
0.00
=
$
Exempt
1. Total No. of Facilities
Base Tax Due ........... $
2. If paid after the due date, enter 10% penalty of Line 1 .......................................................... $
3. If paid after the due date, enter interest ................................................................................ $
4. Total Amount Due (add lines 1, 2, and 3) ............................................................................ $
Under penalties of perjury, I have examined this return (including any accompanying schedules and statements) and to the best of my
knowledge and belief, it is true, correct, and complete.
Signature _______________________________________ Title ____________________________________ Date _________________
An Original Signature Must Appear on each Form Filed with the Department of Revenue. Do Not Send Copies.
Mail the Completed Form and Fee To:
Indiana Department of Revenue
Environmental Tax Section
100 N. Senate Avenue
Indianapolis, IN 46204-2253
Indiana Department of Revenue
For Office Use Only
Hazardous Chemical Inventory Fee Return
Pymt Date
The Department of Revenue will not process any application which
does not contain a Federal Identification Number or Social Security
Pymt Amt
Number, and a signature of an owner or officer of the company.
HC-500
Year Ending
State Form 46332
1/04
For:
Due:
Mailing Address
Name
Federal ID Number or Social Security Number
(Enter individual, partnership or corporation name)
Address
City
State
Zip Code
Telephone Number
(including area code)
Owner Information
Name
Federal ID Number or Social Security Number
Address
City
State
Zip Code
Telephone Number
(including area code)
HC-500 Payment Summary
Fee Amount
Category
# of Facilities
Per Facility
Balance
A
X
$200.00
=
$
B
X
$100.00
=
$
C
X
$ 50.00
=
$
E
X
$
0.00
=
$
Exempt
1. Total No. of Facilities
Base Tax Due ........... $
2. If paid after the due date, enter 10% penalty of Line 1 .......................................................... $
3. If paid after the due date, enter interest ................................................................................ $
4. Total Amount Due (add lines 1, 2, and 3) ............................................................................ $
Under penalties of perjury, I have examined this return (including any accompanying schedules and statements) and to the best of my
knowledge and belief, it is true, correct, and complete.
Signature _______________________________________ Title ____________________________________ Date _________________
An Original Signature Must Appear on each Form Filed with the Department of Revenue. Do Not Send Copies.
Mail the Completed Form and Fee To:
Indiana Department of Revenue
Environmental Tax Section
100 N. Senate Avenue
Indianapolis, IN 46204-2253
Instructions for Completing Form HC-500
Who should use this form?
Category E: Exempt - All federal, state and local units of
Those who are required to file an emergency and hazardous
government are exempt from filing Tier One/
chemical inventory form (Tier Two), must also file this form
Tier Two forms. Any facility that is exempt
and pay the fees. The Indiana Department of Environmental
from filing Tier One/Tier Two forms is also
Management (IDEM) regulates Tier Two filings.
exempt from paying inventory fees.
Are there any exemptions from this fee?
What if the information on the form is incorrect?
Yes. Refer to your inventory filing packet and instructions from
You should confirm that all information on the form is correct.
IDEM, or refer to Section 311(e) of Title III of SARA for
If the information is not correct, make the corrections.
exemptions. If you are required to file an inventory report, you
are then required to file the HC-500 and pay this fee.
If you have purchased or sold facilities during the calendar year,
you still owe the fee for any time you maintained ownership.
Why do I pay these fees?
Fees cannot be prorated. Proper notification of any ownership
These fees are required by law. Every year, the fees you pay
changes must be made to both the Indiana Department of
are distributed back to the counties to be used to develop and
Revenue and the Indiana Department of Environmental
implement emergency response plans to deal with chemical
Management. Send a detailed letter of explanation with this form
accidents.
when filing. You must also contact IDEM to obtain and complete
a report showing changes to facility information.
How much are the fees?
The fee you owe depends upon the maximum amount of
If any of these corrections affects the amount of your fees,
hazardous chemicals stored in your facility, at any one time,
make the necessary changes to the HC-500 Payment Summary
during the calendar year. This means that if you store hazardous
section on the front of this return.
chemicals for even one day, you still owe the full fee. This fee
cannot be prorated. The fee is also dependent on whether you
How do I calculate the fees?
store above ground or in an underground storage tank. Only
Line 1 - The payment summary reflects the fee amount
one fee rate applies to each facility location. If you have both
shown by the Department of Revenue as being due.
above and underground storage, you will pay the greater of the
Line 2 - Any time your payment is mailed after the due date,
fee rates.
you must include a ten percent (10%) penalty.
Multiply Line 1 (the Base Tax Due) by 10% (.10)
Category Column:
and enter the amount on Line 2.
Each facility is identified under the “Category” column. There
Line 3 - If the return and/or payment are submitted after the
are four categories. Only one category applies to each facility.
due date, interest must be calculated. For the current
The fees are as follows:
interest rate contact the Department at (317) 615-2589
or see Departmental Notice #3 on the Internet at:
Category A: $200.00 for each facility that stores one million
www.in.gov/dor/reference/notices/pdfs/dn03.pdf
(1,000,000) pounds or more of any single chemical
at any one time during the previous calendar year.
Who must sign this form?
Category B: $100.00 for each facility that stores fewer than
This form must be signed by the facility owner or a responsible
one million (1,000,000) pounds of any single
officer. Unsigned returns are not acceptable under Indiana Law.
chemical at any one time during the previous
calendar year.
Questions?
Category C: $50.00 for each facility that stores, in
If you have any questions regarding the information in this packet
underground storage tanks only, any single
or the completion of Form HC-500, please contact the Indiana
chemical at any one time during the previous
Department of Revenue by calling (317) 615-2589.
calendar year.
Correspondence should be directed to the Indiana Department
of Revenue, Attn: HC-500, 100 N. Senate Avenue, Indianapolis,
Note: All underground storage tank facilities
IN 46204.
must be in compliance with the Department
of Revenue and IDEM regulations.
If you have any questions regarding Tier One/Tier Two forms
or SARA Title III, please contact the Indiana Emergency
Exemption (HC-500 Only): Retail gasoline
Response Commission by calling (317) 233-0066.
stations with a minimum storage threshold of
75,000 gallons of gasoline or 100,000 gallons of
Tier One/Tier Two forms must be submitted to: Indiana
diesel fuel in storage tanks entirely underground,
Department of Environmental Management, Attn: Tier II, 100
not having any other regulated materials above
N. Senate Ave., P.O. Box 6015, Indianapolis, IN 46206-6015.
threshold.
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