5900-206 ENERGY STAR Set-Top Boxes Unit Shipment Data Collec

United States
ENVIRONMENTAL PROTECTION AGENCY
Washington, D.C. 20460
ENERGY STAR Set Top Boxes Partner Unit Shipment Data for Calendar Year 2018
Office of Atmospheric Programs
PARTNER NAME (Per your Partnership Agreement):					← Partner Name incomplete
SUBMITTED BY (Your name):					← Submitted By incomplete
IMPORTANT: Please read these instructions carefully before completing this form.
• Report shipments to or within the U.S. of all models certified under your ENERGY STAR partnership.
• To ensure no double counting occurs, do not report shipments of products certified under another company’s partnership, even if you are the Original Equipment Manufacturer of those products. As a reminder, any product sold under a brand name your company owns or licenses must be certified under your ENERGY STAR partnership.
This form is programmed to calculate your total shipments. Therefore, EPA strongly encourages you to complete it 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.
If you shipped zero ENERGY STAR certified models to or within the U.S. in 2018, please check here and leave the table below blank.					← Check box indicating zero shipments OR report shipments
Reporting Period: CALENDAR YEAR 2018 (JAN. 1 TO DEC. 31)
Set-top Box Base Type	ENERGY STAR U.S. Unit Shipments to Consumers or Retailers1 (REQUIRED)	ENERGY STAR U.S. Unit Shipments to Service Providers that are ENERGY STAR Partners (REQUIRED)	ENERGY STAR U.S. Unit Shipments to Service Providers that are not ENERGY STAR Partners2 (REQUIRED)
Cable
Satellite
Cable DTA
Multichannel Video Programming Distributor (MVPD) Internet Protocol (IP)
Over-the-top IP
Thin Client/Remote
Total Boxes	-	-	-
1 This column shall include units that may be purchased without signing up for a service plan from a Service Provider. Other set-top boxes available at retail but not operable without a service agreement shall be reported in the "Service Providers that are ENERGY STAR Partners" column.
2 Manufacturing Partners can sell or distribute ENERGY STAR certified and labeled units to non-ENERGY STAR Service Provider Partners if they continue to meet ENERGY STAR eligibility criteria in all possible hardware and software configurations.
Submission Deadline: March 1, 2019
Please submit by mail or email to:	Or	To CTA:
Matt Bugajski		Bobby Baumler
ICF		[email protected]
1725 Eye Street, NW
Suite 1000
Washington, DC 20006
[email protected]
Do not submit form to both CTA and ICF
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.
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).
EPA Form No. 5900-206 OMB Control No. 2060-0528 EPA plans to use the data only for program evaluations. EPA will release this information only as aggregated data and only to the extent required by law.
The public reporting and recordkeeping burden for this collection of information is estimated to average 17.5 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.