5900-217 Application for Recognition of Accredited Laborator

OMB Control No. 2060-0528

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

Office of Atmospheric Programs

Application for Recognition of Accredited Laboratories
by EPA under the ENERGY STAR® Program
This form is an application for recognition of laboratories by the U.S. EPA ENERGY STAR program. To
serve as an EPA-recognized, accredited laboratory 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, accredited laboratory for the ENERGY STAR program.
First party laboratories that are granted EPA recognition are not required to participate in a supervised
manufacturer test lab (SMTL) program as defined in Appendix A of the "Conditions and Criteria for
Recognition of Certification Bodies." Certification bodies are encouraged to take EPA recognition into
account when assessing a laboratory's competence.

Instructions:
1. Read and understand the “Conditions and Criteria for Recognition of Laboratories for the ENERGY STAR
Program,” the full text of which is included under Section VI.
2. Complete the form. All fields are required unless stated otherwise.
3. Sign the form by either:
a. Inserting your digital signature; or
b. Printing out the form, signing it by hand, and scanning it into PDF format.
4. Email the completed form with the required attachments to: [email protected].

Web site: http://www.energystar.gov
1 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

I.

Laboratory Information
Laboratory Name:
Laboratory URL:
Address 1 (e.g., street address):

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

City:

State:

Zip/Postal Code:

Country:

Primary contact first name:

Primary contact last name:

Job title of primary contact:

Email:

Phone:

If mailing address of primary contact is different from the organization

address, please provide it here:

Address 1 (e.g., street address):

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

City:

State:

Zip/Postal Code:

Country:

The following secondary contact information section is optional.
Secondary contact first name:

Secondary contact last (family) name:

Job title of secondary contact:

Email:

Phone:

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

Address 1 (e.g., street address):

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

City:

State:

Zip/Postal Code:

Country:

II.

Is the Laboratory 1st party (i.e., manufacturer-owned)?

Yes /

No

If yes, please provide the name of the ENERGY STAR product brand owner partner and/or manufacturer:
ENERGY STAR Product Brand Owner Partner name:
Manufacturer name (if different from ENERGY STAR partner):

Web site: http://www.energystar.gov
2 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

III.

General Requirements: Consistent with “Conditions and Criteria for Recognition of Laboratories for the ENERGY
STAR Program,” an EPA-recognized, accredited laboratory must maintain accreditation to ISO/IEC 17025,
“General requirements for the competence of testing and calibration laboratories,” by an EPA-recognized
Accreditation Body.
a. Name of EPA-recognized Accreditation Body:
b. Laboratory accreditation effective date:
c.

Laboratory accreditation expiration date (if applicable):

d.

A digital copy of the Laboratory’s accreditation certificate and scope of accreditation is included with
this application (check box to confirm).
Comment (optional):

Web site: http://www.energystar.gov
3 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

IV.

Scope of Accreditation: Below, please select each ENERGY STAR product category for which your lab is
accredited to test products pursuant to ENERGY STAR qualification. Since EPA-recognition is per product
category, EPA will recognize your Laboratory only for products the test methods of which are listed on your Scope
of Accreditation.
If you are expanding your recognition please resubmit this form with all ENERGY STAR product categories for
which you wish to maintain EPA-recognition or apply for EPA-recognition. (Note: EPA will recognize laboratories for
testing Windows, Doors, and Skylights through the National Fenestration Rating Council (www.nfrc.org). For Storm
Windows, please use this form.)

ENERGY STAR Product Categories
Appliances
Clothes Dryers

Dishwashers

Clothes Washers

Refrigerators and/or Freezers

Commercial Clothes Washers

Optional: Connected Functionality

Heating and Cooling
Boilers

Geothermal Heat Pumps

Central Air Conditioners and Air-Source Heat Pumps

Light Commercial HVAC

Commercial Packaged Boilers

Room Air Cleaners and Purifiers

Commercial Water Heaters

Room Air Conditioners

Connected Thermostats

Optional: Connected Functionality

Dehumidifiers

Residential Water Heaters – Solar

Furnaces

Residential Water Heaters – Non-Solar

Electronics and Office Equipment
Audio/Video

Displays

Computers

Enterprise Servers

Data Center Storage

Imaging Equipment

Large Network Equipment

Telephony

Small Network Equipment

Televisions

Set-top Boxes & Cable Boxes

Uninterruptible Power Supplies

Web site: http://www.energystar.gov
4 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

Lighting and Fans
Lamps

Luminaires

Residential Ceiling Fans

Decorative Light Strings

Ceiling Fan Light Kits

Residential Ventilating Fans

Commercial Food Service
Commercial Coffee Brewers

Commercial Hot Food Holding Cabinets

Commercial Dishwashers

Commercial Ice Machines

Commercial Fryers

Commercial Combination Ovens

Commercial Griddles

Commercial Convection Ovens

Commercial Rack Ovens

Commercial Steam Cookers

Commercial Refrigerators and Freezers

Home Building Materials
Storm Windows

Other
Pool Pumps

Vending Machines

Optional: Connected Functionality
Lab-grade Refrigerators/Freezers

Water Coolers
Electrical Vehicle Supply Equipment

Web site: http://www.energystar.gov
5 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

V.

Declaration:
By checking this box, I declare that I have read and agree to the terms of “Conditions and Criteria for
Recognition of Laboratories for the ENERGY STAR Program,” and the information submitted via this form is, to
the best of my knowledge, accurate and associated with the laboratory named herein. I understand that the
ENERGY STAR program will associate all information in this form with this laboratory. I understand that if any of
the submitted information is found to be inaccurate, the laboratory will be removed from the list of EPA-recognized
Laboratories. 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 Laboratory named herein will not use any ENERGY STAR mark for any purpose at any
time.
You are required to provide your signature by either:
a. Inserting your digital signature in the box below, or,
b. Printing out the form, signing the signature box below by hand, and scanning the form into PDF format.
Chief Executive/Signatory:
Printed Name:
Job Title:
Date:

Conditions and Criteria for Recognition of Laboratories for the
ENERGY STAR Program

VI.

In order to serve as an EPA-recognized accredited1 laboratory for the ENERGY STAR program, a laboratory shall agree
in writing to comply at all times with the following requirements:
General Requirements:
1) Maintain accreditation to ISO/IEC 17025, “General requirements for the competence of testing and calibration
laboratories,” by an EPA-recognized Accreditation Body (AB). Noteworthy elements of ISO/IEC 17025 include
requirements that laboratories shall:
a) Have a policy that sets out quality objectives, commitments and operational procedures;
b) Employ experienced personnel who have the education and training needed to conduct the tests;
c) Have the physical plant facilities and test equipment needed for proper testing;
d) Ensure that measuring equipment is accurate and calibrated and that calibration records are maintained;
e) Maintain a record of all original observations, test data and calculations; and,
f)

Maintain arrangements to ensure the freedom of laboratory management and personnel from any undue internal
or external commercial, financial or other pressures and influences that may adversely affect the quality of their
work.
NOTE: It is EPA’s expectation that laboratories will consistently maintain the impartiality of product testing.
Demonstration of impartiality, consistent with the requirements of ISO/IEC 17025, shall include but may not be
limited to the following:

1
As an alternative to maintaining accreditation to ISO/IEC 17025, the laboratory may participate in an EPA-recognized Certification Body’s supervised or
witnessed manufacturers’ testing laboratory program (SMTL/WMTL). Please refer to Appendix A of “Conditions and Criteria for Recognition of
Certification Bodies for the ENERGY STAR Program” for details regarding this option.

Web site: http://www.energystar.gov
6 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

i)

ii)
iii)
iv)
v)
vi)

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;
dates of internal audits, audit findings, and any corrective actions taken;
any customer complaints and corrective action taken;
original testing records containing sufficient information for repeatability, including the names of staff who
participated;
evidence that laboratory employees participate in and regularly pass ethics and compliance audits; and,
evidence that mechanisms for reporting and responding to attempts to exert undue influence on test results
are in place.

2) Develop and maintain separate laboratory test procedures for each accredited ENERGY STAR test method that detail
how testing will be conducted utilizing the laboratory’s test facilities, fixtures, equipment and personnel.
3) Notify EPA/DOE immediately of any attempt to hide or exert undue influence over test results.
4) Have recorded in its Scope of Accreditation its specific competence to carry out the test methods as outlined in the
ENERGY STAR program for which the laboratory intends to test products.2
NOTE: To decrease the burden to laboratories and accreditation bodies, EPA will not require laboratories to
update their Scopes of Accreditation when an ENERGY STAR specification is revised. However, EPA will require
that the laboratory ensures its methods remain consistent with the test methods described in the program
requirements of the currently effective version of the specification. Further, major changes in test method, for
example, when a specification revision calls for a different test method altogether from the preceding specification
version, will necessitate a Scope of Accreditation update to reflect the newly required test method.
5) Allow EPA or an EPA-appointed representative, at its discretion, to witness any testing performed for qualification or
verification of qualification to the requirements of the ENERGY STAR program. EPA or its appointed representative
agrees to operate solely as an observer and not participate in any way with the testing activities of the laboratory.
Inter-laboratory Comparison Testing:
1) Agree to participate in relevant and available inter-laboratory comparison testing (ILC) when EPA/DOE deems it
necessary.
2) Carry out ILC in accordance with normal testing/calibration and reporting procedures, unless otherwise specified in
the instructions from the proficiency test provider.
3) Submit to EPA/DOE upon request:
a) The results of ILC;
b) The analysis of those results; and,
c) Detailed corrective action responses for any outlying or unacceptable results.
Reporting:
1) Submit to EPA a digital copy of the accreditation certificate and scope of accreditation. This shall include at a
minimum:
a) Accreditation effective date;
b) Accreditation expiration date (if applicable); and,
c) ENERGY STAR-relevant accredited test methods.
2) Authorize the laboratory’s AB to share with EPA copies of assessment documentation related to ENERGY STAR
testing, including corrective action plans and deficiency resolutions.
3) Report to both EPA and the laboratory’s AB within 30 days of any major changes that affect the laboratory’s:
a) Legal, commercial, organizational, or ownership status;
b) Organization and management, e.g., key managerial staff;
c) Policies or procedures, where appropriate;
d) Location;
e) Personnel, facilities, working environment or other resources, where significant; and,
f) Other such matters that may affect the laboratory's capability, scope of recognized activities, or compliance with
the ENERGY STAR requirements and relevant technical documents.
Web site: http://www.energystar.gov
7 of 8
EPA Form No. 5900-217

OMB Control No. 2060-0528

4) Forward any questions related to ENERGY STAR test methods to EPA for resolution, and abide by the decisions of
EPA relative to the resolution of those questions.
End of text of “Conditions and Criteria for Recognition of Laboratories for the ENERGY STAR Program”
The public reporting and recordkeeping burden for this collection of information is estimated to average 7.3 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.

Web site: http://www.energystar.gov
8 of 8
EPA Form No. 5900-217