Compliance Statement Energy/Water Conservation Standards for Appliances

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Certification
DOE F 220.29 (Expiration Date: February 3, 2014)
Class A ExternaProduct Type: Class A ExternVersion 4.3
4.3

Status of This No Data

Submitter
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Overall Status No Data

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Co 2
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Submitter Information
I am a(n) (check one only):
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Please enter required data

The third-party representative includes industry organizations submitting on behalf of their members, foreign
Submitter Information (Required for all submissions):
Company Name:
Company Address:
Contact Name:
Contact Telephone Number:
Contact Fax Number:
Contact email address:
For importers, the U.S. Cust

Please enter required data
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Please enter required data
Please enter required data
Please enter required data

Third Party-Representatives (If Submitter is not a Third-Party Representative, skip to Certification
If the submitter is a third-party representative, provide the following information on each
If you are a Third-Party Rep

0

1.
Company Name:
Company Address:
Responsible Person at Comp
Telephone Number:
Fax Number:

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Certification

Co 3

Co 4

Co 5

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on behalf of their members, foreign manufacturers who do not import and are submitting on behalf of their importers, private labelers sub

ive, skip to Certification
ation on each company on whose behalf you are certifying. Note: Please complete an additional template if you are certifying on behalf of

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Certification

heir importers, private labelers submitting on behalf of an importer or domestic manufacturers, third-party testing organizations submittin

te if you are certifying on behalf of more than five companies.

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Certification

arty testing organizations submitting on behalf of a manufacturer, etc.

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Input

Class A External
Class APower
ExternSupplies
Product Type:
Other Than Switch-Selectable Single-Voltage External Power Supplies - Design Family
4.3
Status of This Input Sheet
No Data
Overall Status of Template

Certification Report
· Please enter your data in the columns shaded in gray below, using a separate line for each design family
· Click on the column heading for instructions on how to complete cells in that column.
· Cells highlighted in yellow indicate an "Error." "Error" means that information is missing or there is an issue wi
· 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.

Line No.

ForStatus
Third-Party Representatives,
Manu-facturer Company
Individual
Number
Brand
Individual
Model
Name(s)
From
Numbers
Model
Certification
Number
Covered
Sheet
with
by Each
Highest
Design
Voltage
Family
in Each Design
1
2
3
4
5

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Input

upplies - Design Family

Version 4.3
No Data

e for each design family.
lumn.
s missing or there is an issue with the entry.
the right of the Status column.
bmission.

el Number with Lowest Voltage Action
for Each Design
Is
Product
the Certification
Family
Class Sample
for thisSize
Design
(Number
FamilyofBased
Units
Date on
Tested)
of Test
a Waiver
Procedure
of DOE's
Waiver,
Test Procedure
if Applicable
Requir

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Input

Certified Ratings of Highest Voltage EPS within Design Family
Certified Ratings of Lowest Vo

ption
Is this
Relief
an AC-to-AC
from Date
an Applicable
EPS
of Exception
that is
Standard
designed
Relief,by
ifto
Applicable
DOE's
be connected
Office of to
Hearing
Average
a security
No-Load
and
Active
or
Appeals?
Mode
life
Mode
safety
Power
Efficiency
alarm
Consumption
Nameplate
or(%)
surveillance
(watts)
Output
system
(IfPower
Applicable)
component?
(watts)

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Input

Certified Ratings of Lowest Voltage EPS within Design Family

ut Current (amps)Average
If Missing
No-Load
Active
From
Mode
Mode
Nameplate
Power
Efficiency
Consumption
Nameplate
(%) Output
(watts)
Output
Current
(IfPower
Applicable)
(amps)
(watts)
If Missing From Nameplate

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The following is a description of each product class:
Product
Class

Product Class Description

1

Nameplate output less than 1 watt

2

Nameplate output from 1 watt to not more than 51 watts

3

Nameplate output greater than 51 watts but not more than 250 watts

Instructions

Class A External Power Suppl
Instructions for CCMS Reporting Certification & Templates
4.3
You are currently on the Instructions sheet. Please refer to these instructions when completi

Use your mouse, the "Tab" key and/or arrows on your keyboard to navigate through the fillable fields in bo
- If these indicators read "Error" in red on the Certification sheet, look for an explanation in the column to
- If these indicators read "Error" in red on the Input sheet, look for explanations about incomplete/incorre
Please go to https://www.regulations.doe.gov/contact-us if you have any questions about the regulations

Please click on the tab for the Certification Sheet at the bottom of the page:

CERTIFICATION INSTRUCTIONS
Step 1

Enter the Submitter Information - required for all submissions.

Submitter Information
I am a(n) (check one only):

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