6100-09 Annual Reporting Form Promotional

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

Promotional Partner Annual Reporting
EPA WaterSense® Program Partners: Please complete and submit to WaterSense by March 1, 2010.
Section I: General Information
Organization Name: _____________________________________________________________________________
Contact Name: ____________________________

Email: ____________________________________________

Telephone: _______________________________

If water provider, population served: ______________________

Section II: Promotional Activities
1. Please indicate what types of WaterSense promotional activities you conducted last year and what you plan to
implement in 2010.
Activities

2009

2010

Web site promotion with link to WaterSense

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Print advertising

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Television/radio advertising

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Exhibit(s) at public fair, conferences, events

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Bill insert

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Workshops for consumers

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Workshops/training for contractors

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Presentation(s) to schools, community groups, etc.

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Promotion of WaterSense irrigation partners

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Recruitment of new WaterSense partners

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Incentive programs (e.g., tax-free holidays, rebates):

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Newsletter or trade journal article (Journal:

date:

Consumer handouts
Public signage (Type:

e.g., billboards, bus stops)

Other (Please describe:

)

)

2. If you participated in the 2009 Fix a Leak Week (Mar. 16-20), please describe your activities:

3. To help WaterSense plan for the future, please describe your efforts in other water conservation areas such as
commercial programs and plumber outreach:

Section III: Incentive Programs
Please provide the following information for each incentive amount and quantity issued between January 1, 2009, and
December 31, 2009. If you have a tracking sheet, feel free to attach it to this form.
Type of Incentive
Type of Product

(e.g., rebate, giveaway,
tax-free holiday)

Number of Incentives Issued
WaterSense

Non-WaterSense

Combination

Toilets*
Bathroom Sink Faucets
Bathroom Sink Aerators or other faucet
accessories
Other

* Only toilets that are ≤ 1.28 gpf can earn the WaterSense label, though not all ≤ 1.28 gpf (high-efficiency) toilets are
WaterSense labeled. Please refer to the WaterSense labeled product list at www.epa.gov/watersense.

Section IV: 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 promotional 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, 2010.
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 6100-09
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.