Form 5900-216 Application for Recognition for Accreditation Bodies by

OMB Control No. 2060-0528

United States

E NVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Office of Atmospheric Programs

Application for Recognition of Accreditation Bodies by EPA under the ENERGY STAR^® Program

Version 1.3

This form is an application for recognition of Accreditation Bodies (ABs) by the U.S. EPA under the ENERGY STAR program. To serve as an EPA-recognized AB 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 AB for the ENERGY STAR program.

Instructions:

1. Read and understand the “Conditions and Criteria for Recognition of Accreditation Bodies for the ENERGY STAR Program,” the full text of which is included under Section IV.

2. Complete the form. All fields are required unless stated otherwise.

3. Sign the form by either:

   1. Inserting your digital signature; or

   2. Printing out the form, signing it by hand, and scanning it into PDF format.

4. Email the completed form with the required attachment to: [email protected]HU _UH.

I. B₀Accreditation Body Information

Organization Name: U

Organization URL: B_{4 5BU}

Address 1 (e.g., street address): 6_{B 7BU}

Address 2 (e.g., suite #): B_{8 9BU}

City: 10_{B BU}

State: B12 BU13

Zip/Postal Code: 14_{B 15BU}

Country: 16_{B BU17}

Primary contact first name: B_{18 BU19}

Primary contact last (family) name: 20_{B 21BU}

Job title of primary contact: B _23BU

Email: 24B 25BU U

Phone: 26B 27BU U

If mailing address of primary contact is different from the organization 28_B address, please provide it here:

29_BAddress 1 (e.g., street address): BU₃₀

Address 2 (e.g., suite #): 31_{B 32BU}

City: B 34BU

State: 35B 36BU

Zip/Postal Code: 37_{B BU38}

Country: 39_{B 40BU}

The following secondary contact information section is B₄₁ optional.

B₄₂Secondary contact first name: 43_BU

Secondary contact last (family) name: B _BU45

Job title of secondary contact: B_{46 BU47}

Email: B48 49BU U

Phone: B50 BU51 U

If mailing address of secondary contact is different from the organization 52_B address, please provide it here:

53_BAddress 1 (e.g., street address): 54_BU

Address 2 (e.g., suite #): B _56BU

City: B57 58BU

State: 59B 60BU

Zip/Postal Code: 61_{B 62BU}

Country: 63_{B 64BU}

II. 1_BRequired Documentation

80_B An electronic copy of the quality management system documentation required in Section 5 of ISO/IEC 17011 is included with this application (check box to confirm).

Comment (optional): U _U

An up-to-date list of all EPA-recognized laboratories the AB has accredited or will accredit is available at the following URL: U

Comment (optional): U _U

(At a minimum, this online list must contain the laboratory name, address, and phone number; the laboratory point of contact; accreditation effective date; accreditation expiration date (as applicable); and scope of accreditation.) III. Declaration: 2_B

65_B By checking this box, I declare that I have read and agree to the terms of “Conditions and Criteria for

Recognition of Accreditation Bodies for the ENERGY STAR Program,” and the information submitted via this form is, to the best of my knowledge, accurate and associated with the Accreditation Body named herein. I understand that the ENERGY STAR program will associate all information in this form with this Accreditation Body. I understand that if any of the submitted information is found to be inaccurate, the Accreditation Body will be removed from the list of EPA-recognized Accreditation Bodies. 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.

I further declare that the Accreditation Body named herein will not use any ENERGY STAR mark for any purpose B at any time.

You are required to provide your signature by either:

1. Inserting your digital signature in the box below, or,

2. Printing out the form, signing the signature box below by hand, and scanning the form into PDF format. Responsible Corporate Official/Signatory: UU

Printed Name: Job Title: U _U

Date:

IV. Conditions and Criteria for Recognition of Accreditation Bodies for ENERGY STAR 3_B Laboratory Recognition

In order to serve as an Accreditation Body (AB) for the ENERGY STAR Laboratory Recognition Program, an AB shall agree in writing to the following requirements:

General Requirements:

1. Comply at all times with the conditions and criteria for recognition of accreditation bodies for the ENERGY STAR Laboratory Recognition Program.

2. Operate its accreditation program in accordance with ISO/IEC 17011, “Conformity assessment: General requirements for accreditation bodies accrediting conformity assessment bodies.”

3. Maintain its status as a signatory to the International Laboratory Accreditation Cooperation (ILAC) Mutual Recognition Arrangement (MRA). Inform EPA, in writing, within 30 days of any change in signatory status in the ILAC MRA.

4. Within the AB’s assessor training program, include training on the current requirements described in the ENERGY STAR Laboratory Recognition Requirements. Assessors must be trained prior to performing assessments and continue to be provided new and refresher courses. As per ISO/IEC 17011, training should be conducted as needed to ensure the AB maintains a sufficient number of competent personnel given the work performed.

Reporting to EPA:

1. Submit an electronic copy of the quality management system documentation required in Section 5 of ISO/IEC 17011.

2. Participate in meetings with EPA as necessary as part of continual improvement efforts in the enhanced testing program. During these meetings, the AB will be expected to brief EPA staff on the status of the program, common deficiencies, and issues related to accreditation of laboratories. EPA and the AB will jointly determine whether the meeting should take place by telephone or in-person.

3. Report to EPA within 30 days of any major changes that affect the AB’s:

   1. Legal, commercial, organizational, or ownership status; 67_B

   2. Organization and management, e.g., key managerial staff; B₆₈

   3. Policies or procedures, where appropriate; 69_B

   4. Location; B₇₀

   5. Personnel, facilities, working environment or other resources, where significant; 71_B

   6. Other such matters that may affect the AB's capability, scope of recognized activities, or compliance with the B₇₂ ENERGY STAR requirements and relevant technical documents.

4. Forward any questions related to ENERGY STAR test procedures to EPA for resolution, and abide by the decisions of EPA relative to the resolution of those questions.

5. Upon request, provide EPA with electronic copies of laboratory accreditation information including: a) Accreditation effective date; 73_B

2. Accreditation expiration date (if applicable); 74_B

3. ENERGY STAR-relevant accredited test methods; and, 75_B

4. A list of qualified personnel per ENERGY STAR-relevant accredited test methods. B₇₆

6. Notify EPA immediately in writing, and update the AB’s website to document any action that adversely affects the accreditation status of an EPA-recognized accredited laboratory.

7. Upon request, provide EPA with copies of laboratory assessment documentation related to ENERGY STAR testing, including corrective action plans, and documentation of resolution of deficiencies. Laboratories’ consent to this is a condition of their recognition by EPA.

Conducting Laboratory Assessments:

1. Assess laboratory operations for compliance with ENERGY STAR Laboratory Recognition Requirements.

   1. Upon a satisfactory outcome, attest to the technical competence of laboratories to perform tests required for B

ENERGY STAR qualification as outlined in the ENERGY STAR Laboratory Recognition Requirements. This

should include ensuring that the list of specific test methods for which the laboratory has been accredited is included within the laboratory’s scope of accreditation.

2. Notify EPA of any observed test method interpretations that require clarification. B₇₈

3. Assess documentation demonstrating the impartiality and freedom of laboratory management and personnel from 79_B any undue internal or external commercial, financial or other pressures and influences that may adversely affect the quality of their work, as required by ISO/IEC 17025.

NOTE: It is EPA’s expectation that ABs will systematically monitor the impartiality of laboratories on an ongoing basis. Document review, consistent with the requirements of ISO/IEC 17025, shall include but may not be limited to the following:

1. 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;

2. dates of internal audits, audit findings, and any corrective actions taken; iii) any customer complaints and corrective action taken;

4. original testing records containing sufficient information for repeatability, including the names of staff whoparticipated;

5. 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. Conduct complete on-site assessments of each laboratory per the ILAC MRA and ISO/IEC 17011 requirements.

3. Verify that all assessment findings are resolved and corrective actions have been implemented before granting accreditation to a laboratory.

4. Allow EPA, at its discretion, to witness any assessments performed for compliance with the requirements of the verification testing program. EPA agrees to jointly determine with the AB when such witnessing will occur so as not to disrupt the AB’s assessment schedule, and to operate solely as an observer and not participate in any way with the assessment activities of the AB and/or its assessors.

5. Publish and maintain on the AB’s website an up-to-date directory identifying all EPA-recognized laboratories the AB has accredited. At a minimum, this directory must include the following information: a) Laboratory name, address, and phone number;

2. Laboratory point of contact;

3. Accreditation effective date;

4. Accreditation expiration date (as applicable); and,

5. Scope of accreditation.

6. Maintain documentation relevant to the accreditation for at least five years.

7. Assume the responsibility of the laboratory accreditation decision itself; the AB cannot delegate fully or partially the accreditation decision to another organization.

End of text of “Conditions and Criteria for Recognition of Accreditation Bodies for ENERGY STAR Laboratory Recognition”

The public reporting and recordkeeping burden for this collection of information is estimated to average 6.7 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. 5900-216