DOE HQ F 413.11 Zero Energy Ready Home Qualified Instructor Application

DOE HQ F 413.11
(03/2015)

OMB Control #: 1910-NEW
Exp. Date: xx/xx/xxxx

Zero Energy Ready Home Qualified Instructor Application Form
First and Last Name
Training Territory (identify by state(s),
not by region)
Organization Name
Professional Title
Phone Number
Email
Mailing Address

Complete a brief biography (no more than 250 words) highlighting your experience in new home
construction, building science, and/or training:

REMINDER: If you are a Rater and would like to become a ZERH Trainer, DOE requests that you are also registered
with the program as a Verifier Partner. The Verifier Partner agreement can be completed at the following link:
http://www4.eere.energy.gov/buildings/residential/register/
Public reporting burden for this collection of information is estimated to average 5.5 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
Office of the Chief Information Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910-XXXX), U.S. Department of Energy, 1000
Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-XXXX),
Washington, DC

20503.