6100-17 WaterSense Awards Application

2008

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

WaterSense® Awards

Application

Organization Name:_______________________________________________________________________________
Number of Employees:_____________________________________________________________________________
Number of Customers/Members (if applicable):_________________________________________________________
Contact Name:_ __________________________________________________________________________________
Contact Title:_____________________________________________________________________________________
Contact Phone:______________________ Fax: _ __________________ E-mail:________________________________
1. Please select the award category you are applying for:
❏❏
❏❏
❏❏
❏❏

Promotional Partner of the Year
Manufacturer Partner of the Year
Retailer or Distributor Partner of the Year
Irrigation Partner of the Year

2. Please verify your eligibility:
❏❏ Joined WaterSense partnership prior to January 1, 2008?

Date joined:________________

❏❏ Submitted 2008 annual update?*

Date submitted: ____________

3. Please provide a brief description (no more than 300 words) of your organization. If you are selected to receive
an award, this text will be the basis for describing your organization in recognition materials. (For irrigation partners, please describe the irrigation services you offer).
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
4. To complete the application process, carefully review the
general instructions and category-specific evaluation criteria
in the 2008 WaterSense Awards Instruction Manual, prepare
your written statement, and submit the application package
by April 4, 2008.
* Irrigation partners are not required to submit annual data.

Important Dates
Annual update deadline*: March 1, 2008
Application deadline: April 4, 2008
Award winner notification: June 27, 2008
Recognition ceremony: October 8-10, 2008
Irrigation partner recognition: December, 2008

The public reporting and recordkeeping burden for information collection requirements associated with the Awards Application for each respondent is estimated to
be 21 hours. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. 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 form to this address.
EPA Form Number 6100-17.

(866) WTR-SENS (987-7367) · www.epa.gov/watersense · [email protected]