DOE F 220.57 Refrigerated Bottled or Canned Beverage Vending Machines

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Overview

Certification
Input
Product Description
Instructions

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Sheet 1: Certification

DOE F 220.57 (Expiration Date: February 3, 2014)
Refrigerated Bottled or Canned Beverage Vending Machines	Product Type:	Refrigerated Bottled or Canned Beverage Vending Machines	Version 4.2
4.2
		Status of This Certification Sheet	No Data
		Overall Status of Template	No Data
	Submitter Information
	I am a(n) (check one only):
			Please enter required data
	The third-party representative includes industry organizations submitting on behalf of their members, foreign manufacturers who do not import and are submitting on behalf of their importers, private labelers submitting on behalf of an importer or domestic manufacturers, third-party testing organizations submitting on behalf of a manufacturer, etc.
	Submitter Information (Required for all submissions):
	Company Name:		Please enter required data
	Company Address:		Please enter required data
	Contact Name:		Please enter required data
	Contact Telephone Number:		Please enter required data
	Contact Fax Number:		Please enter required data
	Contact email address:		Please enter required data
	For importers, the U.S. Customs and Border Protection importer identification number (OPTIONAL):
	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 company on whose behalf you are certifying. Note: Please complete an additional template if you are certifying on behalf of more than five companies.
	If you are a Third-Party Representative, for how many companies on whose behalf are you certifying? (Maximum of 5)
	1. Company Name:
	Company Address:
	Responsible Person at Company:
	Telephone Number:
	Fax Number:
	Email Address:
	Select all that apply (at least one):
	For Importer - U.S. Customs and Border Protection importer identification number (OPTIONAL):
	For Private Labeler - Provide all of the brand name(s):
	2. Company Name:
	Company Address:
	Responsible Person at Company:
	Telephone Number:
	Fax Number:
	Email Address:
	Select all that apply (at least one):
	For Importer - U.S. Customs and Border Protection importer identification number (OPTIONAL):
	For Private Labeler - Provide all of the brand name(s):
	3. Company Name:
	Company Address:
	Responsible Person at Company:
	Telephone Number:
	Fax Number:
	Email Address:
	Select all that apply (at least one):
	For Importer - U.S. Customs and Border Protection importer identification number (OPTIONAL):
	For Private Labeler - Provide all of the brand name(s):
	4. Company Name:
	Company Address:
	Responsible Person at Company:
	Telephone Number:
	Fax Number:
	Email Address:
	Select all that apply (at least one):
	For Importer - U.S. Customs and Border Protection importer identification number (OPTIONAL):
	For Private Labeler - Provide all of the brand name(s):
	5. Company Name:
	Company Address:
	Responsible Person at Company:
	Telephone Number:
	Fax Number:
	Email Address:
	Select all that apply (at least one):
	For Importer - U.S. Customs and Border Protection importer identification number (OPTIONAL):
	For Private Labeler - Provide all of the brand name(s):
	Certification
	Compliance Statement
	SELECT SUBMITTER TYPE AT THE TOP OF THIS WORKSHEET
	Type your full name to signify compliance (required):		Please enter required data
	Enter your email address (required):		Please enter required data
	Date (MM/DD/YYYY) (required):		Please enter required data
	OMB Control Number: 1910-1400
	Paperwork Reduction Act Statement
	OMB Burden Disclosure Statement
	This data is being collected for manufacturers to certify compliance to DOE's energy conservation, water conservation, or design standards. The data you supply will be used by the Department to monitor compliance with the energy conservation, water conservation, and design standards and testing requirements for the consumer products and commercial and industrial equipment mandated by the Energy Policy and Conservation Act, as amended. Public reporting burden for this collection of information is estimated to average 20 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 (1910-1400), 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 (1910-1400), Washington, DC 20503. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Submission of this data is mandatory.

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Sheet 2: Input

Refrigerated Bottled or Canned Beverage Vending Machines	Product Type:		Refrigerated Bottled or Canned Beverage Vending Machines					Version 4.2
4.2
	Status of This Input Sheet		No Data		Overall Status of Template		No Data
Certification Report
· Please enter your data in the columns shaded in gray below, using a separate line for each model. · 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 with the entry. · 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.																			The cells below provide an explanation for "Errors".			The cells below provide an explanation for "Errors".			The cells below provide an explanation for "Errors".			The cells below provide an explanation for "Errors".		The cells below provide an explanation for "Errors".			The cells below provide an explanation for "Errors".		The cells below provide an explanation for "Errors".
Line No.	Status	Manu-facturer	For Third-Party Representatives, Company Number From Certification Sheet	Brand Name(s)	Basic Model Number	Individual Model Number Covered by Basic Model	Action	Product Class	Sample Size (Number of Units Tested)	Is the Certification for this Basic Model Based on a Waiver of DOE's Test Procedure Requirements?	Date of Test Procedure Waiver, if Applicable	Is the Certification based upon any Exception Relief from an Applicable Standard by DOE's Office of Hearing and Appeals?	Date of Exception Relief, if Applicable	Maximum Daily Energy Consumption (kWh/day)	Refrigerated Volume (V) (cubic feet)	Ambient Temperature (Degrees F)	Ambient Relative Humidity (%)		Manu-facturer Status	For Third-Party Representatives, Company Number From Certification Sheet Status	Brand Name(s) Status	Basic Model Number Status	Individual Model Number Covered by Basic Model Status	Action Status	Product Class Status	Sample Size (Number of Units Tested) Status	Is the Certification for this Basic Model Based on a Waiver of DOE's Test Procedure Requirements? Status	Date of Test Procedure Waiver, if Applicable Status	Is the Certification based upon any Exception Relief from an Applicable Standard by DOE's Office of Hearing and Appeals? Status	Date of Exception Relief, if Applicable Status	Maximum Daily Energy Consumption (kWh/day) Status	Refrigerated Volume (V) (cubic feet) Status	Ambient Temperature (Degrees F) Status	Ambient Relative Humidity (%) Status
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Sheet 3: Product Description

The following is a description of each product class:
Product Class	Product Class Description
1	Equipment Class A - A refrigerated bottled or canned beverage vending machine that is fully cooled, and is not a combination vending machine.
2	Equipment Class B - Any refrigerated bottled or canned beverage vending machine not considered to be Class A, and is not a combination vending machine.

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Sheet 4: Instructions

Refrigerated Bottled or Canned Beverage Vending Machines		Instructions for CCMS Reporting Certification & Templates
4.2
		You are currently on the Instructions sheet. Please refer to these instructions when completing the Certification and Input sheets.
	Use your mouse, the "Tab" key and/or arrows on your keyboard to navigate through the fillable fields in both the Certification and Input sheets. If all fields have been completed correctly, the "Status" indicators on the top of the Certification sheet and the top of the Input sheet will show "OK" in green. - If these indicators read "Error" in red on the Certification sheet, look for an explanation in the column to the right of the entry field. - If these indicators read "Error" in red on the Input sheet, look for explanations about incomplete/incorrect field entries by looking in the mirrored cells to the far right of the sheet.
	Please go to https://www.regulations.doe.gov/contact-us if you have any questions about the regulations or need help with the template.
	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):
		Domestic Manufacturer
		Importer
		Third-Party Representative
		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. Customs and Border Protection importer identification number (OPTIONAL):
		If you are not a Third-Party Representative, skip to the Compliance Statement (Step 3)
		Step 2	Enter the Third Party Representative Information
		- Third Party Representatives should enter data on the companies for which they are reporting. - Enter the number of companies for which you are reporting on this copy of the template in the box on the Certification sheet similar to the one shown below. - On each copy of the template, you may report for no more than five companies. - If you need to report for more than five companies, complete as many separate copies of the template as are necessary.
		If you are a Third-Party Representative, for how many companies on whose behalf are you certifying? (Maximum of 5)
		- For each of the Companies that you are reporting on in this template, you will need to fill out a full section as shown below.
	1.	Company Name:
		Company Address:
		Responsible Person at Company:
		Telephone Number:
		Fax Number:
		Email Address:
		Select all that apply (at least one):	Domestic Manufacturer
			Importer - OPTIONAL: Provide U.S. Customs and Border Protection importer identification number below
			Private Labeler - Provide all of the brand name(S) below
		For Importer - U.S. Customer and Border Protection importer identification number (OPTIONAL):
		For Private Labeler - Provide all of the brand name(s):
		Step 3	Compliance Statement
		- The Compliance Statement will be different depending on whether you are a Domestic Manufacturer, Importer, or a Third-Party Representative. - Review the statement carefully and then, in order to signify compliance, complete the information in the spaces provided below the statement.
		Type your full name to signify compliance (required):
		Enter your email address (required):
		Date (MM/DD/YYYY) required:
	Please click on the tab for the Input Sheet at the bottom of the page:
	TEMPLATE INSTRUCTIONS
		Step 1	Filling out the Template
		- Starting on line No. 1, begin entering applicable data in each field. - Enter a separate line of data for each individual model. - If you need more than the number of lines available in the template, complete as many additional copies of the template as are necessary. - At any time you may click on a column heading for a complete explanation of what to enter in each cell. - If the status at the beginning of the line reads "Error," review your data to verify entries and check the explanation table to the right of the data entry table for a description of the error. - Click on the Product Description tab to see a description of the product classes and to determine what number should be entered in the Product Class field for each line.
		Step 2	Completed template
		- Lines with an "ok" status have been completed correctly. Be sure your "Overall Status of Template" and "Status of This Input Sheet" reflects "OK" status as expected. - Save the template to a local drive for safekeeping. You will upload this template later to DOE via the CCMS application.