5900-191 Modular Home Rater Applicaton

OMB Control No. xxxx-xxxx

Modular Rater Application

I, (Name of Rater) , hereby assert that I meet or exceed all required capabilities and qualifications to provide inspection and testing services as a Rater under the ENERGY STAR Modular Home Program as indicated by completing the information on this form. Also, I hereby state that I do not have financial interests in or maintain any affiliation with the construction, sale or completion of a home, nor do I provide services that might affect my capacity to evaluate compliance with the ENERGY STAR program and render reports of findings objectively and without bias. Other persons performing ENERGY STAR services under my authority also meet these requirements.

Authorized company
representative: Company:

Signature: Date:

Address:

City/State/Zip:

Telephone:______________________ Fax:_____________________ E-Mail:

Rater must complete the following:

Modular housing design, construction and installation methods

(Must check all boxes below)

 Working knowledge of the residential building codes

 Knowledge of modular home design, construction, installation, material use, and fabrication

Building science and energy efficiency experience

(Must check at least one box below)

 Certified Home Energy Rating System (HERS) rater

Submit this form to SBRA:

 Fax number: 212-496-5389, or

 Mailing address: 2109 Broadway, Suite 200, New York, NY 10023, or

• E-Mail: [email protected]

If approved, SBRA will return a countersigned copy of this application to the rater. The rater shall provide a copy of the approved application to the builder.

Do not write in this space.

SBRA Approval: Date:

Energy Star Modular Homes Rev. 2/3/2021

EPA Form 5900-191

The government estimates the average time needed to fill out this form is 0.17 hours and welcomes suggestions for reducing this effort. Send comments (referencing OMB Control Number) to the Director, Collection Strategies Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.