Form 6100-09 Annual Update

OMB Control Number 2040-XXXX

Approval Expires XX/XX/XXXX

ANNUAL UPDATE

General Information (all partners)

Organization Name¹: ______________________________________________________________________

Contact Information (for questions from the EPA WaterSense Team regarding this plan)

Name: ________________________________Telephone:_______________________

Fax: ________________________________Email:___________________________

Number of residential customers in service area²: ________________________________

A. Retailers and Distributors

I. Promotional Activities

Have you implemented a WaterSense education campaign?  Yes  No

If yes, please estimate the number of households reached:___________________________

Campaign activities conducted, please indicate number of times for each campaign activity:

___ Print advertising

___ Exhibit(s) at public fair, meetings, etc.

___ Bill insert

___ Program/workshop for consumers

___ Presentation(s) to schools, groups, etc.

___ Web site promotion

___ Partnership with other organization (e.g., a retailer or utility (name of partner:___________)

____ Other, please describe: _______________________________________

Activities conducted:  Print advertising

• In-store promotions

• Television/radio advertising

• Billboard advertising

• Web site promotion

• Program/workshop for consumers

• Partnership with government or utility (name:___________)

• Newsletter or trade journal article placed (name of journal: ________, date)

 Other, please describe:

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II. Sales Data

For each WaterSense product sold:

Product Name (Make and Model): _________________________________________________

Estimated marketshare of WaterSense product compared with conventional product: _________

Units sold: ____________

Geographic area in which sales occurred (if available) :________________________________________

B. Product Manufacturers

I. Product Information

For each WaterSense certified product:

Product Name (Make and Model): __________________________________________

Date of market launch: _____________________________

Total WaterSense labeled units shipped: _______________________

Total units shipped for each model in product line: __________

Percent of total units in product line that are WaterSense labeled_________

C. Certifying Organizations

Name/Number of professionals certified in delivery of water-efficient services

D. Promotional Partners

I. Promotional Activities (All promotional partners)

Have you implemented a WaterSense education campaign?  Yes  No

If yes, please estimate the number of households reached:___________________________

Campaign activities conducted, please indicate number of times for each campaign activity:

___ Print advertising

___ Exhibit(s) at public fair, meetings, etc.

___ Bill insert

___ Program/workshop for consumers

___ Presentation(s) to schools, groups, etc.

___ Web site promotion

___ Partnership with other organization (e.g., a retailer or utility (name of partner:___________)

____ Other, please describe: _______________________________________

II. Rebates (Utility partners only)

Residential population served (e.g., number of residential hook-ups):______________________

Did you offer rebates on any WaterSense products? □ Yes □ No

For each product, please indicate the rebate amount and number of rebates issued:

Name of Product Amount of Rebate Number of Rebates Issued

III. Water Distribution Information (Utility partners only)

Gallons of water sold: ______________________(please specify time period; e.g., average annual residential use per hookup)

Price per gallon of water: __________________________

IV. Wastewater Treatment Information (Utility partners only)

Gallons of waste water treated: ______________________(please specify time period; e.g., annually, daily)

The public reporting and recordkeeping burden for this collection of information is estimated to average 18 hours per response. 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 (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed promotional annual update to this address.

1 Please use the same name used on your partnership agreement. If you do not yet have a partnership agreement, please contact us to complete one.

2 For utilities only

E PA Form Number 6100-09