5900-179 Home Improvement Profile Form

OMB Control No. xxxx-xxxx

Change the World, Start with ENERGY STAR

Home Improvement Profile

Step 1

W hat’s Your Score? Use our Home Energy Yardstick to compare your home’s energy use to others across the country. Is higher or lower than average? If your score is low, set a goal to increase efficiency. Even if your home scores well, there are always opportunities to increase performance!

Step 2

G et Recommendations. Our online Home Advisor will quickly give you recommendations to improve your home’s energy efficiency. You can also contact a professional energy consultant to give you more customized recommendations and guide you through the improvement process. They can use specialized software to estimate what improvements will help you reach your goal.

Step 3

T ake the Pledge. “Change the World, Start with ENERGY STAR” is a national campaign that encourages all Americans to take steps to help fight global warming by using less energy at home, at work, and in their communities. Through the ENERGY STAR Pledge, you can commit to taking specific actions to improve energy efficiency.

S tep 4

Track Your Progress. Twelve months after you make the improvements, come back to the Home Energy Yardstick and see how much your score gone up. Complete the ‘Home Improvement Profile’ to show the changes you’ve made and the results you’ve achieved. If you wish, send us the completed Profile – and your project might be featured on the ENERGY STAR Web site!

Homeowner Name
[City, State]
[Annual Energy Saved]
Project Cost				Project Professionals
[$500]				[Consultant X] [Contractor Y]
ENERGY USE	Electric (kWh)		Natural Gas (therms)	Oil (gallons)		Other	Yardstick Score
Pre Project
[Dates]
Post Project
[Dates]
How We Changed the World with ENERGY STAR (check all the apply)
ENERGY STAR Products Installed		ENERGY STAR Home Improvements Made			Recommended Behavior Changes Made
Appliances:  Refrigerator/Freezer # ______  Dishwasher  Clothes Washer  Water Heater  Room Air Conditioner  Central Conditioner  Ceiling Fans # ______  Heat Pump  Furnace  Boiler Lighting:  Light Fixtures # ______  CFLs #_______ Home Office Equipment:  Computers/Laptops #_______  Printer/Scanner/Copier #_______ Electronics:  Televisions #_______  DVD/VCR Players #_______  Cable Box #_______  Home Audio Equipment #______  Portable Phone #_______  Battery Charger #_______		 Installed weather stripping around doors and windows  Sealed air leaks in attic and basement  Reduced whole-house air leakage (________ACH @ 50 Pa)  Added attic insulation (R-value_________)  Added wall insulation (R-value_________)  Added floor insulation (R-value ________)  Added crawlspace insulation  Sealed and insulated ductwork  Installed ENERGY STAR windows, doors, and/or skylights (#_______)  Installed a programmable thermostat  Other _________________________ __________________________________________________________________			 Cleared registers and vents covered by furniture or rugs  Changed furnace air filter regularly  Removed leaves, dirt, and debris from outdoor parts of HVAC system  Used ceiling fans to reduce need for air conditioning  Lowered water heater thermostat to 120o  Wrapped water heater with an insulating jacket  Installed low-flow shower heads and faucets  Turned off lights when you leave a room (or install a motion sensor)  Unplugged chargers and power adaptors when not in use  Used power strips to shut off electronics when not in use  Tightly closed fireplace damper when not in use  Other _______________________

EPA Form 5900-179

The government estimates the average time needed to fill out this form is 0.10 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.