5900-163 ENERGY STAR Imaging Equipment Unit Shipment Data

OMB Control No. 2060-0528

Approval expires 03/31/2011

United States

ENVIRONMENTAL PROTECTION AGENCY
Washington, D.C. 20460
ENERGY STAR Imaging Equipment
Office of Atmospheric Programs
NAME OF MANUFACTURER:
DATE OF SUBMISSION:
SUBMITTED BY (NAME):
PLEASE LIST ANY UNAFFILIATED
PRIVATE LABELERS THAT
REBRAND YOUR PRODUCTS:
Below, only report shipments to consumers or retailers. Do not include business to
business shipments (shipments to unaffiliated private labelers). If you ONLY ship to
private labelers, indicate zero shipments and list private labelers selling in the U.S.
marketplace on the line above.

Reporting Period: CALENDAR YEAR 2008 (JAN. TO DEC.)

Imaging Equipment Product Type

ENERGY STAR®
U.S. Unit
Shipments to
Consumers or
Retailers
(REQUIRED)

Total U.S. Unit

Shipments to

Consumers or

Retailers

(ENERGY STAR +

Non-ENERGY STAR)

(REQUESTED)

Copiers
Digital duplicators
Fax machines
Mailing machines
Multifunction Devices (MFDs)
Printers
Scanners
Total

0

0

Submission Deadline: February 27, 2009
Deadline to Avoid Partnership Termination: March 31, 2009
*Do not provide duplicate data to both ITI and ICF
ITI has agreed to aggregate data for all Imaging

Equipment Partners.

Please submit by email or fax to:

Ken Salaets
[email protected]
Fax: (202) 638-4922

EPA Form No. 5900-163

Please submit by mail, email, or fax to:
Elliott Rector
ICF International
1725 Eye Street, NW
Suite 1000
Washington, DC 20006
[email protected]
Fax: (202) 862-1144

OMB Control No. 2060-0528

Approval expires 03/31/2011

EPA plans to use the data only for program evaluations. EPA will release this information only as aggregated data and only to the
extent required by law.
The public reporting and recordkeeping burden for this collection of information is estimated to average 6.69 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 form to this address.

EPA Form No. 5900-163