6100-09 Annual Reporting Form - Retail/Distributor Hard Copy

OMB Control Number 2040-0272
Approval Expires 06/30/2013

Retailer/Distributor Annual Reporting 2013
WaterSense Retailer/Distributor Partners: Please complete and submit this form to U.S. Environmental Protection Agency (EPA) contractor Eastern
Research Group, Inc. (ERG) by February 15, 2013.
Note on Confidentiality of Data: Sensitive business information may be claimed confidential under 40 CFR Part 2, Subpart B. ERG has an EPA-approved
security plan in place to protect confidential business information from unauthorized disclosure. All data submitted as confidential will be handled as such. All
data will be presented to EPA in aggregate.
®

Please send a completed hard copy of this form to the address below by February 15, 2013.
Mail: EPA WaterSense Annual Reporting, c/o ERG
2300 Wilson Boulevard, Suite 350
Arlington, VA 22201

Phone: Call (866) 987-7367 if you have any questions about
how to complete or submit this form.

Do NOT submit this form via email or fax.
Section I: General Information
Retailer/Distributor Name on Partnership Agreement: ___________________________________________________________
If you do not yet have a partnership agreement, please contact the WaterSense Helpline at (866) 987-7367 to complete one.

Contact Name (for questions regarding this form): ______________________________________________________________
Please provide a U.S. contact, if possible.

Email:________________________________________________________ Phone:_______________________________

Please continue to the next page.

EPA Form Number 6100-09. The public reporting and record keeping burden for this collection of information is estimated to average five 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 annual data form to this address.

Retailer/Distributor Name on Partnership Agreement: _________________________________________________________________________________

Section II: Tank-Type Toilets
Please provide the following information for all tank-type toilets sold in the United States for the period between January 1, 2012, and December 31, 2012. If
your company does not sell or distribute toilets, please leave this section blank.
Please report the number of units (e.g., individual toilets) sold rather than the number of models or model lines sold.
For the purpose of annual reporting, a combination toilet is defined as a tank and bowl that are sold together as a unit (may be one-piece or two-piece). To
avoid double counting, only report product sales data in the “Tanks” and “Bowls” columns if these components are NOT already counted as part of
a product in the Combination column.
U.S. Total

(Please submit EXACT sales data; do not round.)

All Tank-Type Toilets
Combination
1.

Total number of tank-type toilets sold?

Tanks
(NOT sold as part of a
combination)

Bowls
(NOT sold as part of a
combination)

Claim as confidential?

 Yes  No

Note: Count ALL tank-type toilets sold,
including both WaterSense labeled and
non-WaterSense labeled toilets.
2.

Total number of high-efficiency tank-type
toilets sold with an effective flush volume
of 1.28 gpf or less?

 Yes  No

Notes: Count both WaterSense labeled
and non-WaterSense labeled toilets that
meet this criterion.
3.

Total number of WaterSense labeled tanktype toilets sold?

 Yes  No

Please include any clarifications regarding your data here:

2

Retailer/Distributor Name on Partnership Agreement: _________________________________________________________________________________

Section III: Lavatory Faucets
Please provide the following information for all lavatory faucets sold in the United States for the period between January 1, 2012, and December 31, 2012. If
your company does not sell or distribute faucets, please leave this section blank.
Please report the number of units (e.g., individual faucets) sold rather than the number of models or model lines sold. Please only include data on lavatory
faucets sold for private use (e.g., for installation in homes or hotel/hospital guest rooms).
Do NOT include the following in any row below:
• Faucets sold for commercial use (e.g., public restrooms, typically with flow rates of 0.5 gpm or less).
• Faucets sold for kitchen sink use.
• Data on lavatory faucet accessories (e.g., faucet flow restrictors, flow regulators, aerator devices, and laminar devices). Complete Section IV: Lavatory

Faucet Accessories if you are reporting sales of lavatory faucet accessories.

All Lavatory Faucets
1.

U.S. Total
(Please submit EXACT sales data; do not round.)

Total number of lavatory faucets sold?

Claim as confidential?
 Yes  No

Note: Count ALL lavatory faucets sold, including
both WaterSense labeled and non-WaterSense
labeled lavatory faucets.
2.

Total number of high-efficiency lavatory faucets
sold with a certified flow rate that falls between a
minimum of 0.8 gpm at 20 psi and a maximum of
1.5 gpm at 60 psi?

 Yes  No

Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucets that meet
these criteria.
3.

Total number of WaterSense labeled lavatory
faucets sold?

 Yes  No

Please include any clarifications regarding your data here:

3

Retailer/Distributor Name on Partnership Agreement:

Section IV: Lavatory Faucet Accessories
Please provide the following information for all lavatory faucet accessories sold in the United States for the period between January 1, 2012, and
December 31, 2012. If your company does not sell or distribute lavatory faucet accessories, please leave this section blank.
Please report the number of units (e.g., individual faucet accessories) sold rather than the number of models or model lines sold. When multiple products in this
product category are sold together as part of a kit, please count the individual units. Please only include data on lavatory faucet accessories sold for private
use (e.g., for installation in homes or hotel/hospital guest rooms).
Do NOT include the following in any row below:
• Faucet accessories sold for commercial use (e.g., public restrooms, typically with flow rates of 0.5 gpm or less).
• Faucet accessories sold for kitchen sink use.
• Data on lavatory faucets. Complete Section III: Lavatory Faucets if you are reporting sales of lavatory faucets.

All Lavatory Faucet Accessories
1.

U.S. Total
(Please submit EXACT sales data; do not round.)

Total number of lavatory faucet accessories sold?

Claim as confidential?
 Yes  No

Note: Count ALL lavatory faucet accessories sold,
including both WaterSense labeled and nonWaterSense labeled lavatory faucet accessories.
2.

Total number of lavatory faucet accessories with a
certified flow rate that falls between a minimum of
0.8 gpm at 20 psi and a maximum of 1.5 gpm at 60
psi sold?

 Yes  No

Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucet accessories
that meet these criteria.
3.

Total number of WaterSense labeled lavatory faucet
accessories sold?

 Yes  No

Please include any clarifications regarding your data here:

4

Retailer/Distributor Name on Partnership Agreement: _________________________________________________________________________________

Section V: Flushing Urinals
Please provide the following information for all flushing urinal valves sold in the United States for the period between January 1, 2012, and December 31,
2012. If your company does not sell or distribute flushing urinals, please leave this section blank.
Please report the number of units (e.g., individual flushing urinals) shipped rather than the number of models or model lines sold. For the purposes of annual
reporting, a urinal system is a valve and fixture that are sold together as a unit. To avoid double counting, only report product sales data in the “Flushing
Urinal Valves” and “Flushing Urinal Fixtures” columns if these components are NOT already counted as a product in the “Flushing Urinal Systems”
column.
U.S. Total
(Please submit EXACT sales data; do not round.)
All Flushing Urinals

1.

Flushing Urinal
Systems

Total number of flushing urinals sold?

Flushing Urinal Valves
(NOT sold as part of a
system)

Flushing Urinal Fixtures
(NOT sold as part of a
system)

Claim as confidential?

 Yes  No

Note: Count ALL flushing urinals sold,
including both WaterSense labeled and
non-WaterSense labeled flushing urinals.
2.

Total number of high-efficiency flushing
urinals sold with average maximum water
consumption of 0.5 gpf or less?

 Yes  No

Note: Count both WaterSense labeled
and non-WaterSense labeled flushing
urinals that meet this criterion.
3.

Total number of WaterSense labeled
flushing urinals sold?

 Yes  No

Please include any clarifications regarding your data here:

5

Retailer/Distributor Name on Partnership Agreement: _________________________________________________________________________________

Section VI: Showerheads
Please provide the following information for all showerheads sold in the United States for the period between January 1, 2012, and December 31, 2012. If
your company does not sell or distribute showerheads, please leave this section blank.
Please report the number of units (e.g., individual showerheads) sold rather than the number of models or model lines sold. Please count showerheads
packaged in trim kits as one showerhead. Please only include data on fixed or hand-held showerheads sold.
Do NOT include data on any of the following in the rows below:
• Body sprays, which are defined as “a shower device for spraying water onto a bather other than from the overhead position.”
• Multiple showerheads, unless the showerheads are provided in combination in a single device intended to be connected to a single shower outlet.

All Showerheads
1.

U.S. Total
(Please submit EXACT sales data; do not round.)

Total number of showerheads sold?

Claim as confidential?
 Yes  No

Note: Count ALL showerheads sold, including both
WaterSense labeled and non-WaterSense labeled
showerheads.
2.

Total number of showerheads with a maximum flow
rate of 2.0 gpm or less sold?

 Yes  No

Note: Count both WaterSense labeled and nonWaterSense labeled showerheads that meet this
criterion.
3.

Total number of WaterSense labeled showerheads
sold?

 Yes  No

Please include any clarifications regarding your data here:

6

Retailer/Distributor Name on Partnership Agreement: _________________________________________________________________________________

Section VII: Irrigation Controllers
Please provide the following information for irrigation controllers sold in the United States for the period between January 1, 2012, and December 31, 2012.
If your company does not sell or distribute irrigation controllers, please leave this section blank.
Please report the number of units (e.g., individual controllers) sold rather than the number of models or model lines sold. For weather-based irrigation
controllers, please include data on add-on, plug-in, and standalone controllers.

All Controllers
1

Total number of clock timer controllers sold?

U.S. Total

(Please submit EXACT sales

data; do not round.)

Claim as
confidential?
 Yes  No

Note: Clock timer controllers are not currently eligible for the WaterSense label.
2

Total number of soil moisture sensors sold?

 Yes  No

Note: Soil moisture sensors are not currently eligible for the WaterSense label.
3

Total number of weather-based controllers sold?

 Yes  No

Note: Count ALL weather-based controllers sold, including both WaterSense labeled and nonWaterSense labeled controllers.
4

Total number of WaterSense labeled weather-based controllers sold?

 Yes  No

Please include any clarifications regarding your data here:

7