Information Collection

Compliance Statement Energy/Water Conservation Standards for Appliances

IC 23396 under ICR 201101-1910-004 · OMB 1910-1400.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-1400 can be found here:

Documents and Forms

Document Name Document Type
Form DOE New Compliance Statement Energy/Water Conservation Standards for Appliances Form and Instruction
DOE New Commercial Packaged Boilers Copy of TEMPLATE_Commercial_Packaged_Boilers_v4 1.xls Form and Instruction
DOE New Intermed Base Incandes Lamps Copy of TEMPLATE_Candelabra__Intermed_Base_Incandes_Lamps_v4 1.xls Form and Instruction
DOE New Commercial Prerince Spray Valves Copy of TEMPLATE_Commercial_Prerinse_Spray_Valves_v4 1.xls Form and Instruction
DOE New Commercial Unit Heaters Copy of TEMPLATE_Commercial_Unit_Heaters_v4 1.xls Form and Instruction
DOE New Commercial Warm Air Furnaces Copy of TEMPLATE_Commercial_Warm_Air_Furnaces_v4 1.xls Form and Instruction
DOE New Dehumidifiers Copy of TEMPLATE_Dehumidifiers_v4 1.xls Form and Instruction
DOE New Flourescent Lamp Ballasts Copy of TEMPLATE_Flourescent_Lamp_Ballasts_v4 1.xls Form and Instruction
DOE New Illuminated Exit Signs Copy of TEMPLATE_Illuminated_Exit_Signs_v4 1.xls Form and Instruction
DOE New Refrig Beverage Vending Machine Copy of TEMPLATE_Refrig_Beverage_Vending_Machines_v4 1.xls Form and Instruction
DOE New Refrigerator Freezers Copy of TEMPLATE_Refrigerators_Refrigerator-Freezers_Freezers_v4 1.xls Form and Instruction
DOE New Residential Ceiling Fans Copy of TEMPLATE_Residential_Ceiling_Fans_v4 1.xls Form and Instruction
DOE New Residential Clothes Dryers Copy of TEMPLATE_Residential_Clothes_Dryers_v4 1.xls Form and Instruction
DOE New Direct Heating Equipment Copy of TEMPLATE_Residential_Direct_Heating_Equipment_v4 1.xls Form and Instruction
DOE New Residential Dishwashers Copy of TEMPLATE_Residential_Dishwashers_v4 1.xls Form and Instruction
DOE New Residential Faucets Copy of TEMPLATE_Residential_Faucets_v4 1.xls Form and Instruction
DOE New Residential Furnaces Boilers Copy of TEMPLATE_Residential_Furnaces_Boilers_v4 1.xls Form and Instruction
DOE New Gas Cooking Products Copy of TEMPLATE_Residential_Gas_Cooking_Products_v4 1.xls Form and Instruction
DOE New Residential Pool Heaters Copy of TEMPLATE_Residential_Pool_Heaters_v4 1.xls Form and Instruction
DOE New Room Air Conditioners Copy of TEMPLATE_Residential_Room_Air_Conditioners_v4 1.xls Form and Instruction
DOE New Residential Showerheads Copy of TEMPLATE_Residential_Showerheads_v4 1.xls Form and Instruction
DOE New Small Duct High Velocity AC Copy of TEMPLATE_Residential_Small_Duct_High_Velocity_AC_HP_v4 1.xls Form and Instruction
DOE New Residential Space Constrained AC Copy of TEMPLATE_Residential_Space-Constrained_AC_HP_v4 1.xls Form and Instruction
DOE New Residential Torchieres Copy of TEMPLATE_Residential_Torchieres_v4 1.xls Form and Instruction
DOE New Residential Urinals Copy of TEMPLATE_Residential_Urinals_v4 1.xls Form and Instruction
DOE New Residential Water Closets Copy of TEMPLATE_Residential_Water_Closets_v4 1.xls Form and Instruction
DOE New Residential Water Heaters Copy of TEMPLATE_Residential_Water_Heaters_v4 1.xls Form and Instruction
DOE New Self Cont Comm Refrig Copy of TEMPLATE_Self-Cont_Comm_Refrig_Refrig-Freezer_Freezer_v4 1.xls Form and Instruction
DOE New Traffic Signal Ped Modules Copy of TEMPLATE_Traffic_Signal_Ped_Modules_v4 1.xls Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Compliance Statement Energy/Water Conservation Standards for Appliances	Agency IC Tracking Number:	Ashley Armstrong

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 429

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DOE New	Commercial Packaged Boilers	Copy of TEMPLATE_Commercial_Packaged_Boilers_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Intermed Base Incandes Lamps	Copy of TEMPLATE_Candelabra__Intermed_Base_Incandes_Lamps_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Commercial Prerince Spray Valves	Copy of TEMPLATE_Commercial_Prerinse_Spray_Valves_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Commercial Unit Heaters	Copy of TEMPLATE_Commercial_Unit_Heaters_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Commercial Warm Air Furnaces	Copy of TEMPLATE_Commercial_Warm_Air_Furnaces_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Dehumidifiers	Copy of TEMPLATE_Dehumidifiers_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Flourescent Lamp Ballasts	Copy of TEMPLATE_Flourescent_Lamp_Ballasts_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Illuminated Exit Signs	Copy of TEMPLATE_Illuminated_Exit_Signs_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Refrig Beverage Vending Machine	Copy of TEMPLATE_Refrig_Beverage_Vending_Machines_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Refrigerator Freezers	Copy of TEMPLATE_Refrigerators_Refrigerator-Freezers_Freezers_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Ceiling Fans	Copy of TEMPLATE_Residential_Ceiling_Fans_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Clothes Dryers	Copy of TEMPLATE_Residential_Clothes_Dryers_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Direct Heating Equipment	Copy of TEMPLATE_Residential_Direct_Heating_Equipment_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Dishwashers	Copy of TEMPLATE_Residential_Dishwashers_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Faucets	Copy of TEMPLATE_Residential_Faucets_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Furnaces Boilers	Copy of TEMPLATE_Residential_Furnaces_Boilers_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Gas Cooking Products	Copy of TEMPLATE_Residential_Gas_Cooking_Products_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Pool Heaters	Copy of TEMPLATE_Residential_Pool_Heaters_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Room Air Conditioners	Copy of TEMPLATE_Residential_Room_Air_Conditioners_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Showerheads	Copy of TEMPLATE_Residential_Showerheads_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Small Duct High Velocity AC	Copy of TEMPLATE_Residential_Small_Duct_High_Velocity_AC_HP_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Space Constrained AC	Copy of TEMPLATE_Residential_Space-Constrained_AC_HP_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Torchieres	Copy of TEMPLATE_Residential_Torchieres_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Urinals	Copy of TEMPLATE_Residential_Urinals_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Water Closets	Copy of TEMPLATE_Residential_Water_Closets_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Residential Water Heaters	Copy of TEMPLATE_Residential_Water_Heaters_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Self Cont Comm Refrig	Copy of TEMPLATE_Self-Cont_Comm_Refrig_Refrig-Freezer_Freezer_v4 1.xls	Yes	Yes	Fillable Printable
Form and Instruction	DOE New	Traffic Signal Ped Modules	Copy of TEMPLATE_Traffic_Signal_Ped_Modules_v4 1.xls	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Energy

Subfunction: Energy Conservation and Preparedness

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,916	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,916	2,632	284
Annual IC Time Burden (Hours)	58,320	53,816	4,504
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.