Compliance Statement Energy/Water Conservation Standards for Appliances

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Overview

Input
Product Description
Instructions

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Sheet 1: Input

	Product Type:		Water Closets			Version 3.0		Overall Status	No Data
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	Manufacturer:
			Type manufacturer name in the box above
�	If Applicable: Third Party Representative
					If applicable, enter the name of the third party representative in the box above
	Compliance Statement - (Appendix A to Subpart F of 10 CFR Part 430)
	This compliance statement and all certification reports submitted are in accordance with 10 CFR Part 430 (Energy or Water Conservation Program for Consumer Products) and the Energy Policy and Conservation Act, as amended. The compliance statement is signed by a responsible official of the above named company. The basic model(s) listed in certification reports comply with the applicable energy conservation standard or water (in the case of faucets, showerheads, water closets, and urinals) conservation standard. All testing on which the certification reports are based was conducted in conformance with applicable test requirements prescribed in 10 CFR Part 430 subpart B. All information reported in the certification report(s) is true, accurate, and complete. The company is aware of the penalties associated with violations of the Act, the regulations thereunder, and is also aware of the provisions contained in 18 U.S.C. 1001, which prohibits knowingly making false statements to the Federal Government.
							�Type your full name in the box to signify compliance
								Must enter name
	� Enter your email address							Must enter email address
		�Certification Report
	· Please enter your data in the columns shaded in gray below, using a separate line for each model. · Click on the column heading or any cell for instructions on how to complete that cell. · Cells highlighted in yellow indicate an "Error." "Error" means that information is missing or there is an issue with the entry. · If the "Status" for a row is "Error," you can see an explanation in the columns to the right of the Status column. · Reports submitted with errors cannot be processed and will be returned for resubmission.												The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".		The cells below provide an explanation for "Errors".
	· To review the effective dates of current standards for consumer products and certain commercial and industrial equipment										click here
	Line No.	Manufacturer	Brand	Model	Action	Product Class	Explanation of 'Other' Product Class	Maximum Flush Rate (gallons/flush)	Maximum Flush Rate (liters/flush) Optional	Status		Manu-facturer Status	Brand Status	Model Status	Action Status	Product Class Status	Explanation of 'Other' Product Class Status	Maximum Flush Rate (gpf) Status	Maximum Flush Rate (Lpf) Status
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Sheet 2: Product Description

The following is a description of each product class:
Product Class	Product Class Description
1	Gravity tank-type toilets
2	Flushometer tank toilets
3	Electromechanical hydraulic toilets
4	Blowout toilets
Other	Other toilets not listed above (if you enter "Other", you must provide a rationale in the 'Explanation of "Other" Product Class' column on the "Input" sheet).

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Sheet 3: Instructions

Instructions for CCMS Reporting Templates

Use your mouse, the "Tab" key and arrows on your keyboard to navigate through the fillable fields in the template. If all fields have been completed correctly the "Overall Status" indicator on the top right corner of the template will show "ok." If this indicator reads "Error," look for incomplete/incorrect field entry explanations by comparing the mirrored cells on the right of your template screen with your report entries. Call 505-663-1302 ext 101 for additional assistance.

Step 1

Enter the manufacturer's name

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Type manufacturer name in the box above

Step 2

Enter the full name of the third party representative if "applicable" in the cell above "If applicable, enter the name of the third party representative in the box above"

If Applicable: Third Party Representative

�

If applicable, enter the name of the third party representative in the box above

Step 3

Enter your full name in the cell above "Must enter name." Be certain that your are aware of the provisions contained in 18 U.S.C. 1001 before entering your name.

�

Type your full name in the box to signify compliance

Must enter name

Awareness Statement

Step 4

Enter your contact email address to the left of "Must enter email address."

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Enter your email address

Must enter email address

Step 5

Starting on line No. 1, begin entering applicable data in each field. When you have chosen a field, an instruction box will display. Each template has different product type standards. Although all product template instructions are similar, your product template may display different data entry fields from the examples below. If the status at the end of the line reads "Error," review your data to verify entries and check the explanation table to the right of the data entry table for an error description. Lines with an "ok" status have been completed correctly.

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Step 6

Save the template to a local drive for safekeeping. You will upload this template later to DOE via the CCMS application.

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