6100-XX3 Annual Reporting Form Professional Certifying Organizati

OMB Control Number 2040-0272
Approval Expires XXXX

Professional Certifying Organization 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: _______________________________

Fax: ______________________________________________

Name of program(s) with the WaterSense label: _______________________________________________________
Approximate number of professionals currently certified under WaterSense labeled program(s): __________________
Section II: Promotional and Recruitment 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

Let the public know that they can save water—and money on their utility bills—by
hiring WaterSense irrigation partners who have completed your labeled program.
Publicize your program in newsletters, local newspapers, Web sites, public
service announcements, and at conferences.
Use the WaterSense label in conjunction with information about your certification
program.
Include a link to the WaterSense Web site on your Web site, along with a
description of the WaterSense program and information on the role of certified
professionals.
Educate irrigation professionals on the WaterSense program during instruction
provided to prepare for the certification exam.
Include information about WaterSense in a brochure or fact sheet about your
certification program.
At the location of the certification exam, provide exam takers with a copy of the
WaterSense Smart Way to Water Efficient Landscapes brochure.
Other:





























Section III: WaterSense Program Feedback (Optional)
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 tool kit?
Value: ______
3. 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.