6100-09 Annual Reporting Form - Builder

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Section I: General Information

Builder - Annual Reporting

Organization Name * Please select...
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Contact Name *
Email
Telephone
Format (xxx xxx xxxx)
Contact Update? 
 New primary contact for WaterSense
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Email and/or telephone update

Please update your interests and preferences to receive more specific communications from WaterSense.

Section II: New Homes Information
Total number of homes built in 2012: *
commas.
Number of homes built in 2012 that earned the WaterSense label: *
Please enter a number without commas.
Markets (county, state) where you build homes: *

Please enter a number without

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What are your typical landscaping* practices on standard (non-WaterSense labeled) new homes (e.g.
native plants, water-efficient features, turf limits, permeable pavers, etc.): *
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For WaterSense labeled new homes, what do you typically landscape*? Please select...

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*includes the use of turf or sod

Section III: Promotional Activities
Describe how your company promoted WaterSense in 2012 (e.g., We're for Water, community outreach,
signage in homes promoting WaterSense, advertising, etc.) *
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Did you work with other WaterSense partners in 2012? If so, please describe your activities.
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To help WaterSense plan for the future, please describe how you plan to promote WaterSense in 2013. *
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Section IV: WaterSense Program Feedback

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In the interest of serving you better, EPA would like to learn more about your opinions and information needs
regarding the WaterSense program. Please complete the following section to provide feedback to EPA.
On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? *
Please select... 

How has WaterSense added value? *

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On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense partner website? *
Please select... 

In the past year, how often have you visited the partner website? * Please select...
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By completing your annual reporting form, you will be eligible to apply for a 2013 WaterSense Partner
of the Year award. WaterSense encourages all partners to apply regardless of company size. Are you
interested in applying for an award this year? *
 Yes 
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 No
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Help us improve the awards program by telling us why you're not interested in applying for an award. *
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Please go to the awards page for application materials and instructions. Award application materials will be
available on the WaterSense partner website by February 1.
Please provide suggestions for improving the WaterSense program (e.g., tools/materials, webinar topics,
communications, Helpline, websites, etc.) *
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On the following page, you will be asked to review your responses. You must select "confirm" at the bottom of
the following page to submit your Annual Reporting Form to WaterSense.
Please note, you may need to try different printer settings or print as a PDF to print the full report for your
records. We apologize for any inconvenience.
Need assistance with this form?

OMB Control Number 2040-0272
Approval Expires 06/30/2013
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 Avenue, NW, Washington, D.C. 20460. Include the
OMB control number in any correspondence. Do not send the completed form to this address.