6100-15 New Certified Product Notification Form: High-Efficiency

OMB Control Number 2040-0272
Approval Expires 01/31/2010

New Certified Product Notification Form

High-Efficiency Lavatory Faucet
EPA WaterSenseSM Program Partners: Please complete and submit within two weeks of notification from a licensed certifying body that your product or
product model has received the WaterSense label. By submitting this form, the manufacturer partner agrees to continue to uphold the requirements of its
manufacturer partnership agreement.
Section I: General Information
Manufacturer Name1: __________________________________________________________________
Contact Name (for questions from the EPA WaterSense Team regarding this form)
Name: ________________________________

Telephone: ______________________________

Fax:

E-mail:

________________________________

______________________________

Section II: Product Information
Product — Faucet or Faucet Accessory2
Brand Name

Type

Flow type/Spray Pattern

(faucet or faucet accessory)

(aerated, laminar, needle, bubble, other)

Model Name

Certified Flow Rate
Maximum @ 60 psi

Minimum @ 20 psi

For EPA Records Only (This information will not be posted on Web site)
Name of Licensed Certifying Body

Certification File Number

Certification Date
(mm/dd/yy)

Submit this form (rewriteable PDF) to WaterSense via:

Fax: (703) 841-1440
Mail: WaterSense, c/o ERG, 2300 Wilson Blvd, Suite 350, Arlington, VA 22201

Electronically: If you have Adobe Acrobat Standard or Professional, you can complete the form electronically and e-mail it to: [email protected].
Acrobat Reader users must print forms after completing them and fax or mail them. Contact the WaterSense Helpline at 866 WTR-SENS (987-7367)
if you have any questions.

1

Please use the same name used on your partnership agreement. If you do not yet have a partnership agreement, please contact the WaterSense Helpline at (866) WTR-SENS (987-7367) to
complete one.
2

Product certification can apply to either a faucet or a faucet accessory. A faucet accessory is sold independently of the faucet and is defined in the specification as “a component that can, at the
discretion of the user, be readily added, removed, or replaced, and that, when removed, will not prevent the fitting from fulfilling its primary function. An accessory can include, but is not limited to:
lavatory faucet flow restrictors, flow regulators, aerator devices, or laminar devices.” Please list the certified product and indicate the type.

EPA Form Number 6100-xx

Product 2 — Faucet or Faucet Accessory
Brand Name

Model Name

Type

Flow type/Spray Pattern

(faucet or faucet accessory)

(aerated, laminar, needle, bubble, other)

Certified Flow Rate
Maximum @ 60 psi

Minimum @ 20 psi

For EPA Records Only (This information will not be posted on Web site)
Name of Licensed Certifying Body

Certification File Number

Certification Date
(mm/dd/yy)

Product 3 — Faucet or Faucet Accessory
Brand Name

Type

Flow type/Spray Pattern

(faucet or faucet accessory)

(aerated, laminar, needle, bubble, other)

Model Name

Certified Flow Rate
Maximum @ 60 psi

Minimum @ 20 psi

For EPA Records Only (This information will not be posted on Web site)
Name of Licensed Certifying Body

Certification File Number

Certification Date
(mm/dd/yy)

Product 4 — Faucet or Faucet Accessory
Brand Name

Model Name

Type

Flow type/Spray Pattern

(faucet or faucet accessory)

(aerated, laminar, needle, bubble, other)

Certified Flow Rate
Maximum @ 60 psi

Minimum @ 20 psi

For EPA Records Only (This information will not be posted on Web site)
Name of Licensed Certifying Body

Certification File Number

Certification Date
(mm/dd/yy)

The public reporting and record keeping burden for this collection of information is estimated to average 8 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 New Certified Product Notification form to this address.

Please copy this side and submit additional sheets as needed.