HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
DATE
Addressee's Name
Addressee's Title
Addressee’s Email
Company Name
Street Address
City, State ZIP
Subject: Materials Compliance Declaration
Dear HP Supplier,
HP Contact Name Please follow the instructions in each section below, sign in the signature block, and return to the
HP inc. HP sender within ten business days.
Your HP Street Address
City, State, Zip Code
T +0 000 000 0000
HP collects information from its suppliers on substances restricted in the EU RoHS Directive
[email protected] (Directive 2011/65/EU on Restrictions of Hazardous Substances, as amended, and Directive
2015/863); similar regulations that apply in other countries (e.g. China, India), states, and regions;
and by HP’s materials specifications. For these requirements, existing exemptions are being
phased out or modified over a multi-year timeline, and new substances are being restricted.
This new verification of RoHS and materials compliance declaration letter, revision L.0, replaces
prior versions provided by HP and must now be used instead of earlier versions. This letter should
only be used if the Materials Declaration Form (MDF) does not work and your company does not
have access to the HP supplier portal.
By completing this template, including the sections on the use of exemptions and use of
substances that will be restricted in the future, you minimize the chance that HP will need to
request a new declaration for the covered parts when a new exemption phase-out milestone is
reached. The existing and new EU RoHS requirements, other countries requirements, and HP’s
material restrictions are in HP’s General Specification for the Environment (GSE) Doc No. HX-
00011-00.
HP’s GSE sets out the environmental specifications which HP brand and HP-owned brand
products must comply with in order to be legally compliant and therefore HP requires its suppliers
to ensure that products and parts supplied comply with the requirements of the GSE.
Sincerely,
Firstname Lastname
title
Page 1 of 12
Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
HP’s RoHS Requirements:
Except for the specific applications listed in this document, parts and products supplied to HP shall not contain
RoHS restricted substances in any homogeneous material:
a) Greater than quantity limit of 0.1% (1000 PPM) for: lead (Pb), mercury (Hg), hexavalent chromium
in non-metallic applications (paints, pigments, and plastics), polybrominated biphenyls (PBBs),
polybrominated diphenyl ethers (PBDEs) including DecaBDE.
b) Metallic applications of chromium (such as corrosion preventative coatings and conversion coatings)
must not be hexavalent chromium coatings as determined by IEC 62321 series of test standards.
c) Greater than quantity limit of 0.01% (100 PPM) for: Cadmium (Cd).
Note that expired RoHS exemptions are no longer allowed in parts and products, and they do not appear in this
letter.
PARTS/PRODUCTS COVERED BY THIS DECLARATION
Instructions: Please fill in the blank fields in the following table to identify the types of parts or products that
are covered by this declaration. All exemptions or material used for all parts or products of the type specified in
the table below must be identified in Section 1- 5 of this letter.
Note: If, in the future, the use of any listed exemptions and/or newly restricted substances are eliminated, a new
Materials Compliance Declaration may be required.
If you provide an assembly with lower level parts, you will need to:
1. Validate that all lower level parts, components, and materials are compliant.
2. List any exemptions used in Section 2.
3. List the use of restricted substances in Section 3, 4, and 5.
Your signature certifies that parts and products and all lower level parts comply with HP’s Materials
Compliance Requirements.
Page 2 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
Respondin
g
Company
HP MVendor ID
Company DUNS No
HP Part Descriptio Part Supplier Name Supplier part Supplier
Number/ HP n Weigh Number Part
Product Number (optional) t Obsolete
Date
Section 1: RoHS Compliance for Restricted Substances
Instructions: Check only one of the following three boxes:
☐ 1a. Item(s) complies with HP’s RoHS Requirements, defined above, and does NOT use any RoHS
exemptions.
Continue to Section 3, 4, and 5
.
☐ 1b. Item(s) complies with HP’s RoHS Requirements, defined above, and uses one or more of the RoHS
exemptions marked in Section 2
Continue to Section 2, 3, 4, and 5.
☐ 1c. Item(s) does NOT comply with HP’s RoHS Requirements defined above
If checked please contact your HP representative.
Page 3 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
Section 2: Declarations of RoHS exemptions used
Instructions: For use only if box 1b is checked above. Check the appropriate box(es) to indicate all RoHS
exemptions used in the item(s). If item(s) uses any exemptions not listed below, identify them and contact your
HP representative.
Exemptions that HP disallows as of July 21, 2016 and can no longer be used in HP products
1 Mercury in single capped fluorescent lamps
2(a) Mercury in double-capped fluorescent lamps for general lighting purposes
2(b) Mercury in other fluorescent lamps
3 Mercury (Hg) in cold cathode fluorescent lamps and external electrode Fluorescent lamps (CCFL and EEFL)
for special purposes
4(a) Mercury in other low pressure discharge lamps
4(b) Mercury in High Pressure Sodium (vapour) lamps for general lighting purposes in lamps in improved
colour rendering index Ra > 60
4(c) Mercury in other High Pressure Sodium (vapour) lamps for general lighting purposes
4(e) Mercury in metal halide lamps
Exemptions that expire June 30, 2019
☐ 6(a) Lead as an alloying element in steel for machining purposes and in galvanised steel containing up to
0.35 % lead by weight. Transitions to exemption 6(a)-1 below
☐ 6(b) Lead as an alloying element in aluminium containing up to 0.4 % lead by weight. Transitions to
exemptions 6(b)-1 and 6(b)-2 below
Exemptions that expire February 29, 2020
☐8(b) Cadmium and its compounds in electrical contacts. Transitions to exemption 8(b)-1 below
☐15 Lead in solders to complete a viable electrical connection between semiconductor die and carrier within
integrated circuit flip chip packages. Transitions to exemption 15(a) below
Page 4 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
Exemption that expires July 21, 2021
☐15(a) Lead in solders to complete a viable electrical connection between the semiconductor die and carrier
within integrated circuit flip chip packages where at least one of the following criteria applies:
a semiconductor technology node of 90 nm or larger;
a single die of 300 mm2 or larger in any semiconductor technology node;
stacked die packages with die of 300 mm2 or larger, or silicon interposers of 300 mm2 or larger
Exemptions expected to expire in 2021
☐4(f) Mercury in other discharge lamps for special purposes not specifically mentioned in this Declaration
☐5(b) Lead in glass of fluorescent tubes NOT exceeding 0.2% by weight
Exemptions expected to expire in 2026
☐ 6(a)-1 Lead as an alloying element in steel for machining purposes containing up to 0.35% lead by weight
and in batch hot dip galvanised steel components containing up to 0.2% lead by weight
☐ 6(b)-1 Lead as an alloying element in aluminum containing up to 0.4 % lead by weight, provided it stems
from lead-bearing aluminum scrap recycling
☐ 6(b)-2 Lead as an alloying element in aluminum for machining purposes with a lead content up to 0.4 % by
weight
☐ 6(c) Lead in copper alloys containing up to 4% lead by weight
☐ 7(a) Lead in high melting temperature type solders (i.e. lead-based alloys containing 85% by weight or more
lead)
☐ 7(c)-I Electrical and electronic components containing lead in a glass or ceramic other than dielectric
ceramic in discrete capacitors components (e.g. piezoelectronic devices or in a glass or ceramic matrix
compound)
☐ 7(c)-II Lead in dielectric ceramic in capacitors for a voltage 125 V AC or 250 V DC or higher
☐ 7(c)-IV Lead in PZT based dielectric ceramic materials of capacitors being part of integrated circuits or
discrete semiconductors
☐ 8(b)-I. Cadmium and its compounds in electrical contacts used in:
circuit breakers; thermal sensing controls; thermal motor protectors (excluding hermetic thermal motor
protectors); AC switches rated at:
o 6 A and more at 250 V AC and more; or
o 12 A and more at 125 V AC and more;
o DC switches rated at 20 A and more at 18 V DC and more; and
o switches for use at voltage supply frequency ≥ 200 Hz.
Page 5 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
☐ 13(a) Lead in white glasses used for optical applications
☐ 13(b)-I. Lead in ion coloured optical filter glass types
☐ 13(b)-II. Cadmium in striking optical filter glass types; excluding applications falling under point 39 of
Annex II of the RoHS Directive (Directive 2011/65/EU).
☐ 13 (b)-III. Cadmium and lead in glazes used for reflectance standards
Page 6 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
Section 3: Declarations of specific substances
Instructions: For each substance listed below, supplier MUST check one of the two boxes. This declaration
states whether any of the parts listed in this form contains specific substances listed in HP’s General
Specification for the Environment (GSE), in excess of the quantity limit identified in the GSE. Full details of
the GSE requirements can be found at https://h20168.www2.hp.com/supplierextranet/supplierhandbook.do .
HBCDD – Hexabromocyclododecane, CAS# 25637-99-4, 3194-55-6
☐ intentionally added or present in amounts greater than 0.005% (50 ppm) by weight
☐ NOT intentionally added or present in amounts greater than 0.005% (50 ppm)
4 phthalates restricted by EU Directive 2015/863 as of 21-July-2019
DEHP – Bis (2-ethylhexyl) phthalate, CAS# 117-81-7
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
BBP – Butyl benzyl phthalate, CAS# 85-68-7
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
DBP – Dibutyl phthalate, CAS# 84-74-2
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
DIBP – Diisobutyl phthalate CAS# 84-69-5
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
Page 7 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
Section 4: Declarations of specific substances subject to future restrictions
Instructions: For each substance listed below, supplier MUST check one of the two boxes.
HP expects the following to be restricted by 20231
Antimony Trioxide, CAS# 1309-64-4
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous materials OR information
on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous materials
TBBPA - Tetrabromobisphenol A, Brominated Flame Retardant in Printed Circuit Boards (PCB)
☐ Present in amounts greater than 0.09% (900 ppm) by weight in any printed circuit boards and substrate
laminates OR information on this substance is not available at this time
☐ NOT present in amounts greater than 0.09% (900 ppm) by weight in any printed circuit boards and substrate
laminates or PCBs and substrate laminates are not in this product
MCCP- Medium chain chlorinated paraffins, CAS# 85535-85-9
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
Beryllium and it’s compounds
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
Indium phosphide, CAS #: 22398-80-7
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight, in any homogenous materials
HP expects the following to be restricted by 2026
Brominated Flame Retardants
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials OR
information on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials or
part does not contain any homogeneous plastic materials
Chlorinated Flame Retardants
1
These substances are under consideration for restriction in EU RoHS regulations.
Page 8 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials OR
information on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials or
part does not contain any homogeneous plastic materials
Chlorinated Flame Retardants in Printed Circuit Boards
☐ Present in amounts greater than 0.09% (900 ppm) by weight in any printed circuit boards and substrate
laminates OR information on this substance is not available at this time
☐ NOT present in amounts greater than 0.09% (900 ppm) by weight in any printed circuit boards and substrate
laminates or PCBs and substrate laminates are not in this product
Combined Brominated and Chlorinated Flame Retardants in Printed Circuit Boards
☐ Combined chlorinated flame retardants and brominated flame retardants are present in amounts greater than
0.15% (1,500 ppm) by weight in any printed circuit boards and substrate laminates OR information on this
substance is not available at this time
☐ NOT present in amounts greater than 0.15% (1,500 ppm) by weight in any printed circuit boards and
substrate laminates or PCBs and substrate laminates are not in this product
PVC - Polyvinyl chloride
☐ Present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials OR
information on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials or
part does not contain any homogeneous plastic materials
HP is collecting declarations on the following substance requirements. Please mark the appropriate box.
Bromine and chlorine in plastic parts weighing more than 25 g
☐ Bromine or chlorine present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic
materials OR information on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic materials or
part is not a plastic part weighing more than 25 g
Bromine and chlorine in PCB substrate laminate
☐ Bromine or chlorine present in amounts greater than 0.1% (1,000 ppm) by weight in any PCB substrate
laminate OR information on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any PCB substrate laminate or part
does not contain PCB substrate laminate
Bromine and chlorine in fans
☐ Bromine or chlorine present in amounts greater than 0.1% (1,000 ppm) by weight in any fans OR
information on this substance is not available at this time
Page 9 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any fans or part is not or does not
contain a fan
Bromine and chlorine in plastic material
☐ Bromine or chlorine present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic
material OR information on this substance is not available at this time
☐ NOT present in amounts greater than 0.1% (1,000 ppm) by weight in any homogenous plastic material or
part does not contain plastic material
Page 10 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
Section 5: Declarations of polycyclic aromatic hydrocarbons (PAH) substances2
Instructions: Supplier MUST check one of the two boxes.
Rubber or plastic material on the external or user-accessed surfaces of a product must not contain the Polycyclic
Aromatic Hydrocarbons (PAHs) listed below in concentrations greater than 0.0001% (1ppm) by weight (per
PAH).
Benzo[a]pyrene (CAS No. 50-32-8)
Benzo[e]pyrene (CAS No. 192-97-2)
Benzo[a]anthracene (CAS No. 56-55-3)
Chrysene (CAS No. 218-01-9)
Benzo[b]fluoranthene (CAS No. 205-99-2)
Benzo[j]fluoranthene (CAS No. 205-82-3)
Benzo[k]fluoranthene (CAS No. 207-08-9)
Dibenzo[a,h]anthracene (CAS No. 53-70-3)
PAHs are known to be found in pigments used in plastic resin and elastomer formulations.
External or user-accessed surfaces include but are not limited to black or grey rubber or plastic materials such as
case parts, control panels, switches, cables, screens, paper trays, feeders, printer lid, printer cartridge body,
printer cartridge carriage, and optical drives.
This requirement does not apply to surfaces of internal parts that are not user-accessed such as: ceramics in
electronic components, connectors, resistors, integrated circuit packaging, lubricants, internal cables, internal
fans, and printed circuit assemblies.
☐Part or product contains PAH in amounts greater than 0.0001% (1 ppm) by weight
☐Part or product does NOT contain PAH in amounts greater than 0.0001% (1 ppm) by weight OR requirement
does not apply
2
These are restrictions in the amended Annex XVII of Regulation (EC) No. 1907/2006 of the European Parliament on the
Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH).
Page 11 of 12 Rev. L.0
HP Inc.
1501 Page Mill Road
Palo Alto, CA 94304-1112
hp.com
DECLARATION SIGNATURE
The Declaration set out above is designed for HP to gather information so that HP can ensure that its products
comply with legal and contractual obligations. HP relies on your Declaration to ensure that it complies with
legal and contractual obligations. Providing inaccurate information may result in HP incurring penalties, costs,
and expenses.
HP and, if different, the procuring company, must be informed in writing of any change to the information
provided in the Declaration that might affect the compliance status of the above-mentioned manufacturer part
number(s).
No changes, modifications, or additions to any part of this Declaration will be valid or binding on either party
unless in writing and signed by an authorized representative of each party.
By your signature3 below, you verify that you have completed the Declaration above accurately.
_____________________________________________ Date____________________
Supplier’s Signature3 (authorized representative of the company)
Printed Name:
Title:
Phone:
Email:
Company Name:
Address:
3
Must be physically signed by an authorized representative of the company. HP will not
accept any signatures applied by other means, such as typed signatures or digital signatures.
Page 12 of 12 Rev. L.0
