Form 6100-09 Annual Reporting Form Manufacturer

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

Manufacturer Annual Reporting
EPA WaterSense® Program Partners: Please complete and submit to EPA contractor Eastern Research Group, Inc. (ERG) by March 1, 2010.
Note on confidentiality of data: Sensitive business information may be claimed confidential under 40 CFR Part 2, Subpart B. ERG has an EPA-approved
security plan in place to protect confidential business information from unauthorized disclosure. All data submitted as confidential will be handled as such.
Please submit the form in hard copy by March 1, 2010 to the address provided below. Please do not submit it via e-mail to the Helpline.
Mail:

EPA WaterSense Annual Reporting, c/o ERG
14555 Avion Parkway, Suite 200
Chantilly, VA 20151

Call:

(866) 987-7367 if you have any questions about how to complete or submit this form.

Section I: General Information

Manufacturer Name on Partnership Agreement: ________________________________________________________________________________
If you do not yet have a Partnership Agreement, please contact the WaterSense program to complete one.

Contact Name (for questions regarding this form):___________________________________________________________________________
Please provide a U.S. contact if possible.

E-mail: _______________________________________________________________________ Phone: ______________________________________

Contact Name (optional additional contact): _____________________________________________________________________________
Please provide a U.S. contact if possible.

E-mail: _______________________________________________________________________Phone:_______________________________________
Section II: Form Instructions
Did you join the WaterSense program on or before 12/31/2009? Check one.  Yes  No
If you answered “No”, you will be eligible to report in 2011 and you do not need to complete this form at this time.
Which section(s) below should I complete?
 All manufacturer partners who joined the WaterSense program on or before 12/31/2009 should complete and submit Section III.
 Fill out Table 1 below to determine if you should complete additional parts in Section IV.

EPA Form Number 6100-09. The public reporting and record keeping burden for this collection of information is estimated to average 18 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 annual data form to this address.

Manufacturer Name on Partnership Agreement: _________________________________________________________________________________
What if I am a private labeler1?
 WaterSense is only collecting product shipment data from partners who are original equipment manufacturers (OEMs)2, not private labelers. Private
labelers should complete and submit Table 1 and Section III.
 If you have questions about whether you are considered an OEM or a private labeler, please contact the WaterSense Helpline at (866) 987-7367 or
[email protected].

Table 1. Eligibility Information and Instructions

Product Type
Tank-type toilets

A. Do you make or ship
for sale these products
to or within the U.S.?
 Yes  No

B. Please indicate whether
your company is the OEM or
a private labeler.3
 OEM
 Private label

Instructions




Lavatory faucets

 Yes  No

 OEM
 Private label





Lavatory faucet
accessories
(e.g., faucet flow
restrictors, flow
regulators, aerator
devices, and laminar
devices)

 Yes  No

 OEM
 Private label





If you marked Yes and OEM in columns A & B, please print and
complete Section III and Section IV Part A.
If you marked Yes and private label in columns A & B, please
print and complete Section III ONLY.
If you marked No in column A, complete Section III ONLY.
If you marked Yes and OEM in columns A & B, please print and
complete Section III and Section IV Part B.
If you marked Yes and private label in columns A & B, please
print and complete Section III ONLY.
If you marked No in column A, complete Section III ONLY.
If you marked Yes and OEM in columns A & B, please print and
complete Section III and Section IV Part C.
If you marked Yes and private label in columns A & B, please
print and complete Section III ONLY.
If you marked No in column A, complete Section III ONLY.

1

A private labeler is a party whose brand name appears on the end product, which is purchased from an original equipment manufacturer (OEM). Private labelers will be listed
as an additional company on an OEM’s WaterSense certification file.
2
For our purposes, the original equipment manufacturer is the party that holds the WaterSense certification file.
3
If you are the OEM and the private labeler for the same product type, check both boxes and only report data for those products for which you are the original manufacturer.

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Manufacturer Name on Partnership Agreement: _________________________________________________________________________________
Section III: WaterSense Labeled Product Availability and Program Feedback
Information on WaterSense's impact on the marketplace is vital to the continued success of the program. Please provide data on product availability and
promotion.
1. a. Are you promoting your WaterSense labeled products to consumers or other stakeholders?
 Yes  No
b. If yes, please estimate the number of consumers reached: ______________________________________________________________________
c. If yes, please indicate how you are promoting your WaterSense labeled products (please provide samples):
 On product packaging
 On product itself
 Brochures, other marketing materials
 Product guides
 Web site
 Other: ____________________________________________________________________________________________________________
d. If yes, are you working with retailers and/or distributors to promote your WaterSense labeled products?
_____________________________________________________________________________________________________________________
2.

Where can consumers find your WaterSense labeled products? Please list markets (e.g., Los Angeles, Denver) and retailer/distributor company names,
if possible. ________________________________________________________________________________________

3.

On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense label? Value: ________________________________________
How has the WaterSense label added value? ________________________________________________________________________________

4.

Please provide suggestions for improving the WaterSense program (e.g., general tools/materials, communications, Helpline, Web site, etc):

3

Manufacturer Name on Partnership Agreement: _________________________________________________________________________________
Section IV. Product Information
Part A: Tank-Type Toilets
Please complete this section only if instructed to do so under Section II. Please include data for all tank-type toilets shipped to or within the United States
only for the period between January 1, 2009 and December 31, 2009.
Please report the number of units (individual toilets) shipped rather than the number of individual models or model lines produced. If you sell toilets in packages
that include the seat and installation kit (i.e., all-in-one), please count each of these as one toilet unit and include in the U.S. total.
Table 2. Tank-Type Toilet Shipment Data

1.

2.

All Tank-Type Toilets
Total number of toilets shipped?
Note: Count ALL tank-type toilets shipped, including
both WaterSense labeled and non-WaterSense
labeled toilets.
Total number of high-efficiency toilets with an
effective flush volume of 1.28 gpf or less shipped?

U.S. Total

Claim as confidential?
 Yes  No

 Yes  No

Notes: Count both WaterSense labeled and nonWaterSense labeled toilets that meet this criterion.
The effective flush volume for dual flush toilets is
the average of one full and two reduced flushes.
3.

Total number of WaterSense labeled toilets
shipped?

 Yes  No

Please include any clarifications regarding your data here:

4

Manufacturer Name on Partnership Agreement: _________________________________________________________________________________
Section IV. Product Information
Part B: Lavatory Faucets
Please complete this section only if instructed to do so under Section II. Please include data for all lavatory faucets shipped to or within the United States
only for the period between January 1, 2009 and December 31, 2009.
Please report the number of units (individual faucets) shipped rather than the number of individual models or model lines produced. Please only include data on
lavatory faucets shipped for private use (e.g., for installation in homes, or hotel or hospital guest rooms). Do NOT include faucets sold for commercial (e.g.,
public restrooms) or kitchen sink use or data on lavatory faucet accessories (e.g., faucet flow restrictors, flow regulators, aerator devices, and laminar devices)
(see Section IV, Part C).
Table 3. Lavatory Faucet Shipment Data

1.

2.

All Lavatory Faucets
Total number of lavatory faucets shipped?
Note: Count ALL lavatory faucets shipped, including
both WaterSense labeled and non-WaterSense
labeled lavatory faucets.
Total number of lavatory faucets with a certified flow
rate that falls between a minimum of 0.8 gpm at 20
psi and a maximum of 1.5 gpm at 60 psi shipped?

U.S. Total

Claim as confidential?
 Yes  No

 Yes  No

Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucets that meet
these criteria.
3.

Total number of WaterSense labeled lavatory
faucets shipped?

 Yes  No

Please include any clarifications regarding your data here:

5

Manufacturer Name on Partnership Agreement: _________________________________________________________________________________
Section IV. Product Information
Part C: Lavatory Faucet Accessories
Please complete this section only if instructed to do so under Section II. Please include data for all lavatory faucets shipped to or within the United States
only for the period between January 1, 2009 and December 31, 2009. If possible, please separate out the number of lavatory faucet accessories shipped for
use as a component in lavatory faucets and those shipped directly for sale as an aftermarket lavatory faucet flow control device. Please do not include any data
on lavatory faucets here (see Section IV, Part B).
Please report the number of units (individual faucet accessories) shipped rather than the number of individual models or model lines produced. Please only
include data on lavatory faucets accessories shipped for private use (e.g., for installation in homes, or hotel or hospital guest rooms). Do NOT include
faucets accessories sold for commercial (e.g., public restrooms) or kitchen sink use.
Table 4. Lavatory Faucet Accessories Shipment Data
All Lavatory Faucet Accessories
1.

2.

Shipped as Components for
Lavatory Faucets

Total number of lavatory faucet accessories
shipped?
Note: Count ALL lavatory faucet accessories
shipped, including both WaterSense labeled
and non-WaterSense labeled lavatory faucet
accessories.
Total number of lavatory faucets with a certified
flow rate that falls between a minimum of 0.8
gpm at 20 psi and a maximum of 1.5 gpm at 60
psi shipped?

Shipped for Direct Sale as
Aftermarket Devices

Claim as confidential?
 Yes  No

 Yes  No

Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucet
accessories that meet these criteria.
3.

Total number of WaterSense labeled lavatory
faucet accessories shipped?

 Yes  No

Please include any clarifications regarding your data here:

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