DOE HQ F 413.10 Zero Energy Ready Home Utility Bill Data Collection

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

DOE HQ F 413.10
(03/2015)

Utility Bill Data Collection
Energy Use
Annual Electric Use in from utility bill
Annual Natural Gas Use (specify units) from utility bill

Annual Propane Use (specify units) from utility bill

Annual Oil Use from utility bill (specify units)

_______________________________kWh
_______________________________
Units________________
 Not applicable
_______________________________
Units________________
 Not applicable
_______________________________
Units________________
 Not applicable

Timeframe
Month and year home was purchased
__/____
Months reported in annual cost above (e.g. Mar-Feb)
_________________________________
Property Information
HERS Index
_____
Square Footage
_____
Address
__________________________________________________________________
Builder Name
__________________________________________________________________
 I certify that the DOE Zero Energy Ready Home program may use this information in general
reporting of program successes.

Public reporting burden for this collection of information is estimated to average 1 hour 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-XXXX), 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-XXXX), Washington, DC

20503.