6100-09 Annual Reporting Form - Manufacturer WBIC

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General Information

Irrigation Controller Manufacturer - Annual Reporting

Manufacturer Name on Partnership Agreement * Please select...

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Contact Name(s)
Please provide U.S. contacts if possible. This information is for internal use only; WaterSense will not share contact
information.

Name *
Email *
Telephone *
Contact Type * Please select...

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Primary Contact
Reporting
Technical

To select multiple options: - Using Windows, hold Ctrl key and select

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multiple options with mouse. - Using a Mac, hold Command key and select multiple options with mouse.
Contact Update? * Please select...
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Name
Email
Telephone
Contact Type Please select...
Primary Contact
Reporting
Technical

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Contact Update? Please select...

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Please update your interests and preferences to receive more specific communications from WaterSense.

WaterSense Labeled Product Availability and Program Feedback
Information on WaterSense's impact on the marketplace is vital to the continued success of the program. Please
provide data on product availability and promotion.
1a. Are you promoting your WaterSense labeled products to consumers or other stakeholders? * 
 Yes
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 No
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1b. Please estimate the number of consumers reached in 2012 (e.g., through circulars, via the Web, etc.) *
Please enter a number without commas.
1c. Please indicate how you are promoting your WaterSense labeled products. *
Please select...
 To select multiple options: - Using Windows, hold Ctrl key and select
On product packaging
On the product itself
Brochures and other marketing materials 

multiple options with mouse. - Using a Mac, hold Command key and select multiple options with mouse.
Other description *
1d. Do you mention WaterSense or include the WaterSense promotional label or partner logo on your:
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Please select...
Print advertising
Broadcast advertising
Web advertising

with mouse. - Using a Mac, hold Command key and select multiple options with mouse.

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1e. Are you working with retailers and/or distributors to promote your WaterSense labeled products? *
 Yes 
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


 No
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Which retailers/distributors are you working with?
2. Did your company participate in any WaterSense promotional campaigns last year? *
Please select...
 To select multiple options: - Using Windows, hold Ctrl key and select
Fix a Leak Week 2012
We're for Water
Peak water season outreach

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multiple options with mouse. - Using a Mac, hold Command key and select multiple options with mouse.
Other description *
Please elaborate on your company's participation *
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3. Where can consumers find your WaterSense labeled products?
Markets (e.g., city, state, or region) *
Retailer/distributor company names *
4. On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? *
Please select... 

How has the WaterSense label added value? *

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5. On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense partner website?* *
Please select... 

6. In the past year, how often have you visited the WaterSense partner website?* Please select...
7. Please provide suggestions for improving the WaterSense program (e.g., general tools/materials,
webinar topics, communications, Helpline, websites etc.) *

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On the following page, you will be asked to review your responses. You must select "confirm" at the bottom
of the following page to submit the online portion of your Annual Reporting Form to WaterSense. You
will then be automatically directed to instructions for accessing an interactive PDF form to submit your product
shipment data in accordance with our confidential business information procedures.

Please note that you may need to try different printer settings or print as a PDF to print the full online report for
your records. We apologize for any inconvenience.

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Your Annual Reporting Form will not be complete until WaterSense receives both your online and hard
copy reporting forms.
Need assistance with this form?

OMB Control Number 2040-0272
Approval Expires 06/30/2013
EPA Form Number 6100-09. The public reporting and record keeping burden for this collection of
information is estimated to average three 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 Avenue, NW,
Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the
completed form to this address.

file://C:\Documents and Settings\aauerbach\Desktop\Forms\to do\wbic-manu-AR.html

2/13/2013