5900-217 Application for Recognition for Certification Bodies by

OMB Control No. 2060-0528
Approval Expires 03/31/2011

United States

ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460
Office of Atmospheric Programs
Application for Recognition of Accredited Laboratories
by EPA under the ENERGY STAR® Program
Version 1.3
This form is an application for recognition of laboratories by the U.S. EPA ENERGY STAR program. To serve as
an EPA-recognized, accredited laboratory for the ENERGY STAR program, please fill out and submit this form to
EPA by following the instructions below. Upon confirmation of EPA recognition, you may begin to operate as an
EPA-recognized, accredited laboratory for the ENERGY STAR program.

Instructions:
1. Read and understand the “Conditions and Criteria for Recognition of Laboratories for the ENERGY STAR
Program,” the full text of which is included under Section VI.
2. Complete the form. All fields are required unless stated otherwise.
3. Sign the form by either:
a. Inserting your digital signature; or
b. Printing out the form, signing it by hand, and scanning it into PDF format.
4. Email the completed form with the required attachments to:
[email protected].

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-217

OMB Control No. 2060-0528
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I.

Laboratory Information
Laboratory Name:
Laboratory URL:
Address 1 (e.g., street address):
Address 2 (e.g., suite #):
City:
State:
Zip/Postal Code:
Country:
Primary contact first name:
Primary contact last name:
Job title of primary contact:
Email:
Phone:
If mailing address of primary contact is different from the organization
address, please provide it here:
Address 1 (e.g., street address):
Address 2 (e.g., suite #):
City:
State:
Zip/Postal Code:
Country:
The following secondary contact information section is optional.
Secondary contact first name:
Secondary contact last (family) name:
Job title of secondary contact:
Email:
Phone:
If mailing address of secondary contact is different from the organization
address, please provide it here:
Address 1 (e.g., street address):
Address 2 (e.g., suite #):
City:
State:
Zip/Postal Code:
Country:

II.

Is the laboratory 1st party (i.e., manufacturer-owned)?

Yes /

No

If yes, please provide the name of the ENERGY STAR partner/manufacturer and describe the nature of
the relationship:
Partner/manufacturer name:          
Nature of relationship between the 1st party laboratory and partner/manufacturer:

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-217

OMB Control No. 2060-0528
Approval Expires 03/31/2011

III.

General Requirements: Consistent with “Conditions and Criteria for Recognition of Laboratories for the
ENERGY STAR Program,” an EPA-recognized, accredited laboratory must maintain accreditation to ISO/IEC
17025, “General requirements for the competence of testing and calibration laboratories,” by an EPA-recognized
Accreditation Body.
a. Name of EPA-recognized Accreditation Body:          
b. Laboratory accreditation effective date:
c.

Laboratory accreditation expiration date (if applicable):

d.

A digital copy of the laboratory’s accreditation certificate and scope of accreditation is included with
this application (check box to confirm).
Comment (optional):          

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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OMB Control No. 2060-0528
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IV.

Scope of Accreditation: Below, please select each ENERGY STAR product category for which your lab is
accredited to test products pursuant to ENERGY STAR qualification. Since EPA-recognition is per product
category, EPA will recognize your laboratory only for products the test methods of which are listed on your
Scope of Accreditation. If in the future you wish to test products not checked below, please resubmit this form
with the additional products checked, and your updated Scope of Accreditation.
* Note: EPA will recognize laboratories for testing Windows, Doors, and Skylights through the National
Fenestration Rating Council (www.nfrc.org).

ENERGY STAR Product Categories
Appliances

Home Electronics

Clothes Washers

Audio/Video

Dishwashers

Set-top Boxes & Cable Boxes

Refrigerators and/or Freezers

Telephony

Water Coolers

Televisions

HVAC

Battery Charging Systems (BCSs)

Information Technology

Boilers
Central Air Conditioners and Air-Source Heat Pumps

Computers

Dehumidifiers

Displays

Furnaces

Imaging Equipment

Geothermal Heat Pumps

Computer Servers

Light Commercial HVAC

Enterprise Storage

Residential Ceiling Fans

Uninterruptible Power Supplies

Residential Ventilating Fans

Small Network Equipment

Lighting

Residential Water Heaters
Room Air Cleaners and Purifiers

Decorative Light Strings

Room Air Conditioners

Solid State Lighting Luminaires
Residential Light Fixtures (Outdoor)

Climate Controls

Commercial Food Service

Residential Light Fixtures (Indoor)

Commercial Dishwashers

Compact Fluorescent Lamps

Commercial Fryers

GU 24 Lamps

Commercial Griddles

Integral LED Lamps (Omnidirectional/Directional)

Commercial Hot Food Holding Cabinets

Integral LED Lamps (Decorative only)

Commercial Ice Machines

Lamps (other than CFL, GU 24, or Integral LED)

Commercial Ovens

Ballasts
LED package, module or array (IES LM-80-2008)

Commercial Refrigerators and Freezers
Commercial Steam Cookers
Pre-Rinse Spray Valves

Home and Building Envelope
Roof Products

Other
New Refrigerated Beverage Vending Machines
Rebuilt Refrigerated Beverage Vending Machines
Lab-grade Refrigerators/Freezers

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-217

OMB Control No. 2060-0528
Approval Expires 03/31/2011

V.

Declaration:
By checking this box, I declare that I have read and agree to the terms of “Conditions and Criteria for
Recognition of Laboratories for the ENERGY STAR Program,” (text begins on next page) and the information
submitted via this form is, to the best of my knowledge, accurate and associated with the laboratory named
herein. I understand that the ENERGY STAR Program will associate all information in this form with this
laboratory. I understand that if any of the submitted information is found to be inaccurate, the laboratory will be
removed from the list of EPA-recognized, accredited laboratories. I understand that intentionally submitting false
information to the U.S. government is a criminal violation of the False Statements Act, Title 18 U.S.C. section
1001.
You are required to provide your signature by either:
a. Inserting your digital signature in the box below, or,
b. Printing out the form, signing the signature box below by hand, and scanning the form into PDF format.
Chief Executive/Signatory:          
Printed Name:          
Job Title:
Date:          

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-217

OMB Control No. 2060-0528
Approval Expires 03/31/2011

VI.

Conditions and Criteria for Recognition of Laboratories for the ENERGY STAR Program

In order to serve as an EPA-recognized accredited1 laboratory for the ENERGY STAR program, a laboratory shall agree
in writing to comply at all times with the following requirements:
General Requirements:
1) Maintain accreditation to ISO/IEC 17025, “General requirements for the competence of testing and calibration
laboratories,” by an EPA-recognized Accreditation Body (AB). Noteworthy elements of ISO/IEC 17025 include
requirements that laboratories shall:
a) Have a policy that sets out quality objectives, commitments and operational procedures;
b) Employ experienced personnel who have the education and training needed to conduct the tests;
c) Have the physical plant facilities and test equipment needed for proper testing;
d) Ensure that measuring equipment is accurate and calibrated and that calibration records are maintained;
e) Maintain a record of all original observations, test data and calculations; and,
f)

Maintain arrangements to ensure the freedom of laboratory management and personnel from any undue internal
or external commercial, financial or other pressures and influences that may adversely affect the quality of their
work.
NOTE: It is EPA’s expectation that laboratories will consistently maintain the impartiality of product testing.
Demonstration of impartiality, consistent with the requirements of ISO/IEC 17025, shall include but may not be
limited to the following:
i) organization chart showing that the responsibilities, authorities, and inter-relationships of all personnel who
manage, perform or verify laboratory results are free from influence that may adversely affect the quality of
their work;
ii) dates of internal audits, audit findings, and any corrective actions taken;
iii) any customer complaints and corrective action taken;
iv) original testing records containing sufficient information for repeatability, including the names of staff who
participated;
v) evidence that laboratory employees participate in and regularly pass ethics and compliance audits; and,
vi) evidence that mechanisms for reporting and responding to attempts to exert undue influence on test results
are in place.

2) Develop and maintain separate laboratory test procedures for each accredited ENERGY STAR test method that detail
how testing will be conducted utilizing the laboratory’s test facilities, fixtures, equipment and personnel.
3) Notify EPA/DOE immediately of any attempt to hide or exert undue influence over test results.
4) Have recorded in its Scope of Accreditation its specific competence to carry out the test methods as outlined in the
ENERGY STAR program for which the laboratory intends to test products.2
NOTE: To decrease the burden to laboratories and accreditation bodies, EPA will not require laboratories to
update their Scopes of Accreditation when an ENERGY STAR specification is revised. However, EPA will require
that the laboratory ensures its methods remain consistent with the test methods described in the program
requirements of the currently effective version of the specification. Further, major changes in test method, for
example, when a specification revision calls for a different test method altogether from the preceding specification
version, will necessitate a Scope of Accreditation update to reflect the newly required test method.

1

As an alternative to maintaining accreditation to ISO/IEC 17025, the laboratory may participate in an EPA-recognized Certification Body’s supervised or
witnessed manufacturers’ testing laboratory program (SMTL/WMTL). Please refer to Appendix A of “Conditions and Criteria for Recognition of
Certification Bodies for the ENERGY STAR Program” for details regarding this option.

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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OMB Control No. 2060-0528
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5) Allow EPA or an EPA-appointed representative, at its discretion, to witness any testing performed for qualification or
verification of qualification to the requirements of the ENERGY STAR program. EPA or its appointed representative
agrees to operate solely as an observer and not participate in any way with the testing activities of the laboratory.
Inter-laboratory Comparison Testing:
1) Agree to participate in relevant and available inter-laboratory comparison testing (ILC) when EPA/DOE deems it
necessary.
2) Carry out ILC in accordance with normal testing/calibration and reporting procedures, unless otherwise specified in
the instructions from the proficiency test provider.
3) Submit to EPA/DOE upon request:
a) The results of ILC;
b) The analysis of those results; and,
c) Detailed corrective action responses for any outlying or unacceptable results.
Reporting:
1) Submit to EPA a digital copy of the accreditation certificate and scope of accreditation. This shall include at a
minimum:
a) Accreditation effective date;
b) Accreditation expiration date (if applicable); and,
c) ENERGY STAR-relevant accredited test methods.
2) Authorize the laboratory’s AB to share with EPA copies of assessment documentation related to ENERGY STAR
testing, including corrective action plans and deficiency resolutions.
3) Report to both EPA and the laboratory’s AB within 30 days of any major changes that affect the laboratory’s:
a) Legal, commercial, organizational, or ownership status;
b) Organization and management, e.g., key managerial staff;
c) Policies or procedures, where appropriate;
d) Location;
e) Personnel, facilities, working environment or other resources, where significant; and,
f) Other such matters that may affect the laboratory's capability, scope of recognized activities, or compliance with
the ENERGY STAR requirements and relevant technical documents.
4) Forward any questions related to ENERGY STAR test methods to EPA for resolution, and abide by the decisions of
EPA relative to the resolution of those questions.
End of text of “Conditions and Criteria for Recognition of Laboratories for the ENERGY STAR Program”

The public reporting and recordkeeping burden for this collection of information is estimated to average 4.2 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
form to this address.

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-217