Electronic Product Management

Documents/Resources Supporting Participation in the Electronic Waste Recovery and Recycling Payment System

The California Department of Resources Recycling and Recovery (CalRecycle) has developed a variety of tools to assist participants in the covered electronic waste recovery and recycling payment system. These resources are intended to ease compliance with regulations that were adopted to implement portions of landmark legislation that established a funding system for the collection and recycling of certain electronic wastes. Prospective collectors and recyclers must be approved prior to participation.

Important: Approved participants in the covered electronic waste (CEW) recovery and recycling payment system must keep all organizational information associated with applications updated with the CIWMB. This includes facility and operational status, locations, and personnel matters. Failure to do so may result in revocation of approval.

The tools listed below do not substitute for a thorough understanding of all system requirements. Prospective participants are urged to familiarize themselves with applicable statutes and regulations.

• Application to Participate in the CEW Payment System
• CEW Payment System Forms and Documents
• Other Related Resources and Forms
• Approved Collectors and Recyclers List
• Manufacturer Take-Back Payment System Information

Application to Participate in the Covered Electronic Waste (CEW) Payment System

Form/Date	Download Format	Description
Application for Approval: Covered Electronic Waste Recovery and Recycling Payment System (CIWMB Form 186) Last revised: April 2009	Form 186, MS Word, 203 KB Form 186, Adobe PDF, 677 KB	This application can be completed electronically using the text fields prior to printing; however it may not be submitted electronically and must be mailed or delivered to the CIWMB. Interested parties should review all payment system regulatory requirements and comply with any and all DTSC requirements regarding notification and inspections prior to applying. This application is to be used by entities intending to participate in the CEW Recovery and Recycling Payment System (CCR Title 14, Division 7, Chapter 8.2) established pursuant to the Electronic Waste Recycling Act of 2003 (Chapter 526, Statutes of 2003).
Payee Data Record (Std. 204) Last revised: June 2003	Form 204, Adobe PDF, 175 KB	This form is used by State agencies to prepare information returns (Form 1099) and is required as part of a recycler's application for approval to participate in the payment system.

Covered Electronic Waste (CEW) Payment System Forms and Documents

The following are forms and documents to support Approved Recyclers' and Approved Collectors' participation in the payment system. Note that these materials are provided as guidance and do not relieve participants of any other data, information or record maintenance requirements contained in regulation or statute.

Form/Date	Download Format	For Use By	Description
Proof of Designation (CIWMB Form 184) Last revised: July 2008	Form 184, MS Word, 68 KB Form 184, Adobe PDF, 550 KB	Designated approved collectors	May be used as a Proof of Designation by a Designated Approved Collector, pursuant to 14 CCR 18660.5(a)(34), when duly executed by, and secured from, a designating local government. This form demonstrates that the collector is providing covered electronic waste (CEW) recovery services on behalf of the local government. A designated approved collector may not be subject to certain "name and address" CEW source documentation required by 14 CCR 18660.20(j)(1)(B) when operating within the scope of their designation. A copy of this form must accompany the covered electronic waste (CEW) collection logs associated with CEWs transferred from a designated approved collector to an approved recycler. A copy of this form and associated collection logs must also accompany any recycling payment claim that includes CEWs received from a designated approved collector. (Note: Regardless of designation or source documentation requirements, all CEW collection activities require a log.)
Covered Electronic Waste Recycling Payment Claim (CIWMB Form 196) Last revised: July 2008	Form 196, MS Word, 86 KB Form 196, Adobe PDF, 565 KB	Approved recyclers	This form may be completed by Approved Recyclers for each reporting period within which payment is claimed. Information on this form includes calculation of payment claim, indication of supporting documents and declarations and signatures of authorized agents. additional documentation must accompany CIWMB Form 196 to make a complete payment claim package. Approved Recyclers may attach CIWMB Form 196A (Worksheet A) and/or CIWMB Form 196B (Worksheet B) depending on the type of covered electronic devices that are cancelled. If CRT and/or CRT-Containing and Non-CRT Covered Electronic Wastes are both cancelled, the approved recycler should submit both forms.
Worksheet A: Covered Electronic Waste Recycling Payment Claim (Cancellation of CRTs and/or CRT-Containing Wastes) (CIWMB Form 196A) Last revised: July 2008	Form 196A, MS Word, 128 KB Form 196A, Adobe PDF, 630 KB	Approved recyclers	This form may accompany CIWMB Form 196 if the Approved Recycler cancels CRTs and/or CRT-Containing Covered Electronic Wastes. Information documented will include the type of cancellation method used, calculation of payment, postcancellation disposition of glass cullet or bare CRTs, and estimated weights of treatment residuals for each reporting period.
Worksheet B: Covered Electronic Waste Recycling Payment Claim (Cancellation of Non-CRT Covered Electronic Wastes) (CIWMB Form 196B) Last revised: July 2008	Form 196B, MS Word, 139 KB Form 196B, Adobe PDF, 615 KB	Approved recyclers	This form may accompany CIWMB Form 196 if the Approved Recycler cancels Non-CRT Covered Electronic Wastes. Information documented will include calculation of payment, post-cancellation disposition of circuit boards and estimated weights of treatment residuals for each reporting period.
Covered Electronic Waste Transfer Receipt (CIWMB Form 197) Last revised: October 2006	Form 197, MS Word, 70 KB	Approved collectors and/or approved recyclers	This form may be used when materials are transferred between an Approved Collector and an Approved Recycler. The form allows for required declarations and weight verifications as required by regulation. While use of this form is not mandatory, if an approved recycler chooses not to use this form, they must provide equivalent information in supporting documentation and submit it as part of a complete payment claim package.
Covered Electronic Waste Transfer Summary (CIWMB Form 197S) Last revised: October 2006	Form 197S, MS Word, 70 KB)	Approved recyclers	This form may be used to summarize transactions between Approved Collectors and an Approved Recycler. The form captures quantity and payment information as required by regulation. While use of this form is not mandatory, if an approved recycler chooses not to use this form, they must provide equivalent information in supporting documentation and submit it as part of a complete payment claim package.
Covered Electronic Waste Collection Log (CIWMB Form 198) Last revised: November 2006	Form 198, MS Excel, 49 KB	Approved collectors	Use this form to record required information on all Covered Electronic Waste (CEW) accepted by the Collector. Information on this sheet must accompany the CEWs transferred from an approved collector to an approved recycler. It must also be submitted to the California Integrated Waste Management Board with the CEW Recycling Payment Claim (CIWMB 196).
Source-Anonymous CEW Collection Log (CIWMB Form 198 SA) Last revised: November 2006	Form 198 SA, MS Word, 69 KB	Eligible approved collectors	Eligible approved collectors may use this form to log and track the handling of source-anonymous covered electronic waste (SA CEW). SA CEWs must be logged separately from other CEWs. Depending on the circumstances, limitations may apply regarding who may collect SA CEWs. Refer to the regulation citations on the form.

Other Related Resources and Forms

• Covered Electronic Waste Recycling Payment Claim Checklist (MS Word, 77 KB)
  This checklist is intended to provide guidance to approved recyclers who are preparing Covered Electronic Waste (CEW) Recycling Payment Claims to ensure that all requirements for the payment claim have been met prior to claim submittal. This checklist does not replace or supersede relevant statutes and regulations. Interested parties are advised to keep apprised of subsequent changes to relevant statutes and regulations.
• DTSC Notification of Intent to Handle CRTs and/or UWEDs
  Any entity handling a minimum threshold of discarded cathode ray tubes (CRT) or universal waste electronic devices (UWED) is required to notify the Department of Toxic Substances Control (DTSC), regardless of whether they are participating in the SB 20 payment system. Information on the process is available on the DTSC website, including an informative fact sheet. Please note that, depending on a handler's activities, other DTSC requirements may apply.
• Net Cost Reporting Guidance
  Covers the reporting and documentation requirements and provides detailed, line-by-line instructions for completing the Annual CEW Net Cost Report (CIWMB Form 220) and Net Cost Estimation Worksheets for Collectors (CIWMB Form 220a) and Recyclers (CIWMB Form 220b).
• Sample Authorizing Resolution (MS Word, 23 KB)
  Provided as a sample template of the authorizing resolution required for local government applicants who are seeking approval as recyclers or dual entities (Section A-2). This document is a sample only; applicants should consult with their jurisdiction's legal counsel.

As the CIWMB, in consultation with the Department of Toxic Substances Control (DTSC), works to implement this important legislation, more information will be available through this website. Note that any guidance provided by the CIWMB should not substitute for careful reading of the original statute or subsequent regulations. Interested parties are encouraged to check back often, or subscribe to an email newsletter to be kept apprised of developments and events.

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