DOE F 220.65 NEMA Design B General Purpose Electric Motors (Manufactu

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Overview

Certification
Attachment
Instructions

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Sheet 1: Certification

DOE F 220.65 (Expiration Date: February 3, 2014)
NEMA Design B General Purpose Electric Motors (Manufactured on or after December 19, 2010)		Product Type:	NEMA Design B General Purpose Electric Motors (Manufactured on or after December 19, 2010)	Version 4.2
4.2
Please complete both this "Certification" worksheet and the "Attachment" worksheet
(See the "Instructions" worksheet for assistance in completing this form)
�		Please enter required data below	Status of Certification worksheet
APPENDIX C TO SUBPART B OF PART 431—COMPLIANCE CERTIFICATION
Certification of Compliance With Energy Efficiency Standards for Electric Motors (Office of Management and Budget Control Number: 1910–1400).
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1.		Name and Address of Company (the ‘‘company’’):
		Company Name (required):		Please enter required data
		Address 1 (required):		Please enter required data
		Address 2:
		City, State ZIP (required):		Please enter required data
2.		Name(s) to be Marked on Electric Motors to Which this Compliance Certification Applies:
		1 (required):		Please enter required data
		2:
		3:
		4:
		5:
3.		If manufacturer or private labeler wishes to receive a unique Compliance Certification number for use with any particular brand name, trademark, or other label name, fill out the following two items:
	A.	List each brand name, trademark, or other label name for which the company requests a Compliance Certification number:
		1:
		2:
		3:
		4:
		5:
	B.	List other name(s), if any, under which the company sells electric motors (if not listed in item 2 above):
		1:
		2:
		3:
		4:
		5:
4.		This Compliance Certification reports on and certifies compliance with requirements contained in 10 CFR Part 431 (Energy Conservation Program for Certain Commercial and Industrial Equipment) and Part C of the Energy Policy and Conservation Act (Pub. L. 94–163), and amendments thereto. It is signed by a responsible official of the above named company. Attached and incorporated as part of this Compliance Certification is a Listing of Electric Motor Efficiencies. For each rating of electric motor* for which the Listing specifies the nominal full load efficiency of a basic model, the company distributes no less efficient basic model with that rating and all basic models with that rating comply with the applicable energy efficiency standard.
		*For this purpose, the term ‘‘rating’’ means one of the combinations of an electric motor’s horsepower (or standard kilowatt equivalent), number of poles, and open or enclosed construction, with respect to which § 431.25 of 10 CFR Part 431 prescribes nominal full load efficiency standards.
		Person to Contact for Further Information:
		Name (required):		Please enter required data
		Address (required):		Please enter required data
		Telephone Number (required):		Please enter required data
		Facsimile Number (required):		Please enter required data
		If any part of this Compliance Certification, including the Attachment, was prepared by a third party organization under the provisions of 10 CFR 431.36, the company official authorizing third party representations:
		Name:
		Address:
		Telephone Number:
		Facsimile Number:
		Third Party Organization:
Responsible Person at that Organization:
		Address:
		Telephone Number:
		Facsimile Number:
		All required determinations on which this Compliance Certification is based were made in conformance with the applicable requirements in 10 CFR Part 431, subpart B. All information reported in this Compliance Certification is true, accurate, and complete. The company is aware of the penalties associated with violations of the Act and the regulations thereunder, and is also aware of the provisions contained in 18 U.S.C. 1001, which prohibits knowingly making false statements to the Federal Government.
		Name (required):		Please enter required data
		Date (required):		Please enter required data
		Title (required):		Please enter required data
		Firm or Organization (required):		Please enter required data
Please also complete the
"ATTACHMENT TO CERTIFICATION OF COMPLIANCE WITH ENERGY EFFICIENCY STANDARDS FOR ELECTRIC MOTORS: LISTING OF ELECTRIC MOTOR EFFICIENCIES"
in the worksheet "Attachment"

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Sheet 2: Attachment

NEMA Design B General Purpose Electric Motors (Manufactured on or after December 19, 2010)		Product Type:		Version 4.2
4.2
Please complete both this "Attachment" worksheet and the "Certification" worksheet
(See the "Instructions" worksheet for assistance in completing this form)
ATTACHMENT TO CERTIFICATION OF COMPLIANCE WITH ENERGY EFFICIENCY STANDARDS FOR ELECTRIC MOTORS: LISTING OF ELECTRIC MOTOR EFFICIENCIES
				Overall Status of Attachment worksheet			No Data
�	Date:
			Type date in the box above
�	Name of Company:
			Type name of company in the box above
		� Listing of Electric Motor Efficiencies
	· Please enter your data in the columns shaded in gray below, using a separate line for each basic model. · Click on the column heading or any cell for instructions on how to complete that cell. · 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".
	Line No.	Motor Horsepower	Number of Poles	Open or Enclosed Motor	Least Efficient Basic Model - (Model Number(s))	Nominal Full Load Efficiency	*	Status		Motor Horsepower Status	Number of Poles Status	Open or Enclosed Motor Status	Least Efficient Basic Model Status	Nominal Full Load Efficiency Status	* Status
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Sheet 3: Instructions

NEMA Design B General Purpose Electric Motors (Manufactured on or after December 19, 2010)

Instructions for CCMS Certification

4.2

Use the "Tab" key and arrows on your keyboard to navigate through the fillable fields in the template. If all required fields have been completed the "Overall Status" indicator on the top left of the form will show "ok." Call 505-412-4120 for additional assistance.

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Step 1

On the Certification Sheet - Complete all appropriate fields. "Pink" fields indicate required data entry.

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Step 2

On the Certification Sheet - Insure all required fields are completed via the Status indicator

Instructions for CCMS Attachment

Use your mouse, the "Tab" key and arrows on your keyboard to navigate through the fillable fields in the template. If all fields have been completed correctly the "Overall Status" indicator on the top right corner of the template will show "ok." If this indicator reads "Error," look for incomplete/incorrect field entry explanations by comparing the mirrored cells on the right of your template screen with your report entries. Call 505-412-4120 for additional assistance.

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Step 3

Enter today's date

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Step 4

Enter your company name in the cell above "Type name of company in the box above."

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Step 5

Starting on line No. 1, begin entering applicable data in each field. When you have chosen a field, an instruction box will display. Each template has different product type standards. Although all product template instructions are similar, your product template may display different data entry fields from the examples below. If the status at the end of the line reads "Error," review your data to verify entries. Lines with an "ok" status have been completed correctly.

Enter One Only On Each Row

Line No.

Motor Horsepower

Standard Kilowatt Equivalent

Number of Poles

Open or Enclosed Motor

Least Efficient Basic Model - (Model Number(s))

Nominal Full Load Efficiency

*

Status

1

3

2

open

123ABC

90

ok

2

5.5

4

345ABC

90

Error

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Step 6

Save the template to a local drive for safekeeping. You will upload this template later to DOE via the CCMS application.

Notes:

1)

A horsepower at or above the midpoint between the two consecutive horsepowers shall be rounded up to the higher of the two horsepowers.

2)

A horsepower below the midpoint between the two consecutive horsepowers shall be rounded down to the lower of the two horsepowers.

Basic Model means all units of a given type of electric motor (or class thereof) manufactured by a single manufacturer, and which (i) have the same rating, (ii) have electrical design characteristics that are essentially identical, and (iii) do not have any differing physical or functional characteristics that affect energy consumption or efficiency.

Rating means one of the combinations of an electric motor’s horsepower (or standard kilowatt equivalent), number of poles, and open or enclosed construction, with respect to which §431.25 of 10 CFR Part 431 prescribes nominal full load efficiency standards.