5900-226 ENERGY STAR Set-Top Box Service Provider Partner USD

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Overview

Service Providers PURCHASE Req.
Service Providers FLEET Req.

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Sheet 1: Service Providers PURCHASE Req.

	United States
	ENVIRONMENTAL PROTECTION AGENCY
	Washington, D.C. 20460
	ENERGY STAR Set-Top Box Service Provider Partner Purchase Data for Calendar Year 2015
	Office of Atmospheric Programs
PARTNER NAME (Per your Partnership Agreement):
DATE OF SUBMISSION:
SUBMITTED BY (Your name):
IMPORTANT: Please read these instructions carefully before completing this form.
• Please fill out either this sheet (Service Providers PURCHASE Req.) or the other sheet (Service Providers FLEET Req.), but not both.
• Report units of all ENERGY STAR certified models deployed in the U.S. under your ENERGY STAR partnership.
This form is programmed to calculate your total shipments. Therefore, EPA strongly encourages you to fill it out using Microsoft Excel, instead of filling out a printed copy. Estimates of shipments are not accepted. Product Type definitions are available in the Program Requirements at www.energystar.gov/specifications.
Reporting Period: CALENDAR YEAR 2015 (JAN. TO DEC.)
Set-top Box or Displayless Video Gateway Base Type		ENERGY STAR Version 4.1 New Purchases1 (REQUIRED)	TOTAL New Purchases1 (ENERGY STAR + Non-ENERGY STAR) (REQUIRED)
Cable
Satellite
Cable DTA
Multichannel Video Programming Distributor (MVPD) Internet Protocol (IP)
Over-the-top IP
Terrestrial
Total Non-thin Client Boxes		-	-
Total Non-thin Client Box purchases reported in row 30 with multi-room functionality		-	-
Multi-room box purchases deployed with 0 thin client/remote boxes
Multi-room box purchases deployed with 1 thin client/remote box
Multi-room box purchases deployed with 2 thin client/remote boxes
Multi-room box purchases deployed with 3 thin client/remote boxes
Multi-room box purchases deployed with 4 or more thin client/remote boxes
Non-thin Client boxes reported in row 30 that have Deep Sleep Capability
Thin Client/Remote Boxes
Thin Client/Remote boxes reported in row 38 that have Deep Sleep Capability2
Total Boxes		-	-
Total Boxes counted toward Partner Commitments (including premiums for Thin Client/Remote and boxes with Deep Sleep Capability)2		-
1 Purchases shall be counted in the year in which Service Provider takes delivery.
2 Thin Clients and Set-top Boxes with Deep Sleep Capability receive a 50% premium (i.e., count as 1.5 boxes) toward meeting the Service Provider Partner Purchase Requirements. Premiums for Thin Client/Remote boxes and boxes with Deep Sleep Capability cannot be combined for a single Set-top Box. That is, a Thin Client/Remote box with Deep Sleep Capability can receive only one 50% premium (i.e., count as 1.5 boxes) toward meeting the Service Provider Partner Purchase Requirements.
Submission Deadline: March 1, 2016
To ICF International:
Ranette Chrea
ICF International
1725 Eye Street, NW
Suite 1000
Washington, DC 20006
[email protected]
For additional protection of confidential business information, partners may elect to submit the above information to a third party for aggregation prior to submission to EPA. If this path is chosen, the third party must submit to EPA the above table of information containing the summary data received from partners and a list of partners that contributed to the data collection effort. The third party must also submit to EPA the percent of ENERGY STAR certified new purchases for each Service Provider partner according to the following equation: ENERGY STAR New Purchases in 2015/ TOTAL New Purchases in 2015.
Any information submitted to EPA for which a claim of confidentiality is made will be safeguarded according to the Agency's policies set forth in Title 40, chapter 1, part 1, subpart B - Confidentiality of Business Information (see 40 CFR part 2; 41 FR 36902, September 1, 1976; amended by 43 FR 40000, September 8, 1978; 43 FR 42251, September 20, 1978; 44 FR 17674, March 23, 1979).
The public reporting and recordkeeping burden for this collection of information is estimated to average 6.69 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.

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Sheet 2: Service Providers FLEET Req.

	United States
	ENVIRONMENTAL PROTECTION AGENCY
	Washington, D.C. 20460
	ENERGY STAR Set-Top Box Service Provider Partner Fleet Data for Calendar Year 2015
	Office of Atmospheric Programs
PARTNER NAME (Per your Partnership Agreement):
DATE OF SUBMISSION:
SUBMITTED BY (Your name):
IMPORTANT: Please read these instructions carefully before completing this form.
• Please fill out either this sheet (Service Providers FLEET Req.) or the other sheet (Service Providers PURCHASE Req.), but not both.
• Report units of all ENERGY STAR certified models deployed in the U.S. under your ENERGY STAR partnership.
This form is programmed to calculate your total shipments. Therefore, EPA strongly encourages you to fill it out using Microsoft Excel, instead of filling out a printed copy. Estimates of shipments are not accepted. Product Type definitions are available in the Program Requirements at www.energystar.gov/specifications.
Reporting Period: CALENDAR YEAR 2015 (JAN. TO DEC.)
Set-top Box or Displayless Video Gateway Base Type		ENERGY STAR Version 4.1 New Purchases1 in Use (REQUIRED)	ENERGY STAR Version 4.1 Refurbished2 STBs in Use (REQUIRED)	STBs Upgraded3 in the Field to ENERGY STAR Version 4.1 in Use (REQUIRED)	TOTAL STBs in Use (ENERGY STAR + Non-ENERGY STAR) (REQUIRED)
Cable
Satellite
Cable DTA
Multichannel Video Programming Distributor (MVPD) Internet Protocol (IP)
Over-the-top IP
Terrestrial
Total Non-thin Client Boxes		-	-	-	-
Total Non-thin Client Boxes reported in row 29 with multi-room functionality		-	-	-	-
Multi-room boxes in use with 0 thin client/remote boxes
Multi-room boxes in use with 1 thin client/remote box
Multi-room boxes in use with 2 thin client/remote boxes
Multi-room boxes in use with 3 thin client/remote boxes
Multi-room boxes in use with 4 or more thin client/remote boxes
Total Non-thin Client boxes reported in row 29 that have Deep Sleep Capability and are in use
Thin Client/Remote Boxes
Thin Client boxes reported in row 37 that have Deep Sleep Capability and are in use
Total Boxes		-	-	-	-
1 Purchases shall be counted in the year in which Service Provider takes delivery.
2 Refurbished refers to legacy boxes that are taken back by the Service Provider, brought into compliance with ENERGY STAR, and redeployed.
3 Upgraded refers to legacy boxes that are brought into compliance with ENERGY STAR in the field through a software update.
Submission Deadline: March 1, 2016
To ICF International:
Ranette Chrea
ICF International
1725 Eye Street, NW
Suite 1000
Washington, DC 20006
[email protected]
For additional protection of confidential business information, partners may elect to submit the above information to a third party for aggregation prior to submission to EPA. If this path is chosen, the third party must submit to EPA the above table of information containing the summary data received from partners and a list of partners that contributed to the data collection effort. The third party must also submit to EPA the percent of fleet that is ENERGY STAR certified for each Service Provider partner according to the following equation: (ENERGY STAR New Purchases in Use + ENERGY STAR Refurbished STBs in Use + STBs Upgraded in the Field to ENERGY STAR in Use) / TOTAL ENERGY STAR and Non-ENERGY STAR STBs in Use.
Any information submitted to EPA for which a claim of confidentiality is made will be safeguarded according to the Agency's policies set forth in Title 40, chapter 1, part 1, subpart B - Confidentiality of Business Information (see 40 CFR part 2; 41 FR 3690).
EPA Form No. 5900-226 OMB Control No. 2060-0528 The public reporting and recordkeeping burden for this collection of information is estimated to average 17 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.