Zero Energy Ready Home (ZERH) Program

DOE HQ F 413.5
(03/2019)

OMB Control #: 1910-5184
Exp. Date: XX/XX/XXXX

DOE Zero Energy Ready Home
Energy Performance
House Type

DOE Zero Energy Ready Home Builder Partner ID#

Year built

Square footage of Conditioned Space including Basement

Number of Bedrooms

Square footage of Conditioned Space without Basement

Site address (if not available, list the site Lot #)

Registered Builder
Certified Rater

HERS Index without On-site Generation

Date of Rating

HERS Index with On-site Generation

Rating Software

HERS Index of the Target Home using size adjustment factor

Estimated annual energy costs($)

Estimated annual energy use

Estimated annual energy savings

Energy cost rates

Estimated annual emissions reductions

DOE Zero Energy Ready Home Certification
As the certified Rater for this house, I certify this house meets/complies with all mandatory requirments of the DOE Zero Energy
Ready home guidelines, including the following:
Compliance with all ENERGY STAR Qualified Homes Version 3 requirements and checklists
Compliance with Mandatory Fenestration Requirements
Compliance with Mandatory Insulation Requirements
Compliance with Mandatory Duct Location Requirements
Compliance with Mandatory Appliance Requirements
Compliance with Mandatory Lighting Requirements
Compliance with Mandatory Fan Efficiency Requirements
Compliance with Mandatory EPA Indoor airPLUS
Compliance with Mandatory Renewable Energy Ready Solar Electric Requirements
This home was qualified via sampling in lieu of testing, in accordance with allowable sampling provisions as stated in the
DOE Zero Energy Ready Home National Program Requirements

Optional Compliance for Builder Recognition
I further certify that the following also apply to this house:
YES

NO

DON'T Optional Home Builder Commitments for Recognition
KNOW

DOE Zero Energy Ready Home
Optional Compliance for Builder Recognition
I further certify that the following also apply to this house:
YES

NO

DON'T Optional Home Builder Commitments for Recognition
KNOW
Certified under the EPA WaterSense for New Homes Program
Certified under the IBHS Fortified for Safer Living Program
Followed the DOE Zero Energy Ready Home Quality Management Guidelines
The buyer of this home signed a waiver giving DOE Zero Energy Ready Home access to utility bill data for one
year

Public reporting burden for this collection of information is estimated to average 35 minutes 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 (1910-5184), 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 (1910-5184), Washington, DC 20503.

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