6100-XX2 Annual Reporting Form Builder

OMB Control Number 2040-0272
Approval Expires xx/xx/xxxx

Builder Partner Annual Reporting
EPA WaterSense® Program Partners: Please complete and submit to WaterSense by March 1, 2011.
Section I: General Information
Organization Name: ___________________________________________________________________________
Contact Name: ___________________________

Email: ___________________________________________

Telephone: ______________________________
Section II: New Homes Information
1. Number of homes built to a WaterSense specification and labeled in 2010: ___________________________________
2. Markets (county, state) where you build homes: ____________________________________________
Section III: Promotional Activities
1. Please indicate what types of WaterSense promotional activities you conducted last year and what you plan to
implement in 2011.
Activities

2010

2011

Include WaterSense promotional label on company Web site

Include WaterSense promotional label in company literature (e.g., brochures)

Print advertising including WaterSense promotional label

Television/radio advertising including mention of WaterSense

Public signage including WaterSense (e.g., in front of new/model homes or in
developments)
Other (Please describe:
)

2. At what point in the sales process do you promote WaterSense? ____________________________________________
_______________________________________________________________________________________________________

Section IV: WaterSense Program Feedback
In the interest of serving you better, EPA would like to learn more about your opinions regarding the WaterSense
program and information needs. Please complete the following section to provide feedback to EPA.
1. On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? Value: ___________
How has WaterSense added value? _____________________________________________________________
2. On a scale of 1 to 5 (5 = most valuable), how valuable did you find the materials from the builder tool kit?
Value: ______
3. What WaterSense tools did you find most useful? ___________________________________________________

4. Please provide suggestions for improving the WaterSense program (e.g., tools/materials, communications, Helpline,
Web site, etc): ______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please submit to the WaterSense Helpline by March 1, 2011.
Fax: (703) 841-1440
Mail: 2300 Wilson Blvd., Ste. 350, Arlington, VA 22201
Electronically: If you have Adobe Acrobat Standard or Professional, you can complete the form electronically and
e-mail it to [email protected]. Acrobat Reader users must print forms after completing and fax or mail them.
Contact the WaterSense Helpline at (866) 987-7367 if you have any questions about how to complete this form or
submission instructions.
EPA Form Number 6100-XX
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.