6100-09 Annual Reporting Form - Promotional

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Promotional - Annual Reporting

Section I: General Information
Organization Name * Please select...
Contact Name *
Email
Telephone
Format (xxx xxx xxxx)
Contact Update? g
c New primary contact for WaterSense
d
e
f
c
d
e
f
g

6

Email and/or telephone update

Please update your interests and preferences to receive more specific communications from WaterSense.
If water provider, population served
Please enter a number without commas.
Is the area you serve currently experiencing water shortages? * n
j Yes n
k
l
m
j No
k
l
m
Do you anticipate that the area you serve will experience water shortages in the next 5 years? * n
j Yes n
k
l
m
j No
k
l
m

Section II: Promotional Activities
Please indicate what types of WaterSense promotional activities you conducted last year and what you plan to implement in 2013.

2012 2013
Website promotion with link to WaterSense

c
d
e
f
g

c
d
e
f
g

Coverage on social media outlets (e.g., Facebook, Twitter)

c
d
e
f
g

c
d
e
f
g

Print advertising

c
d
e
f
g

c
d
e
f
g

Television/radio advertising

c
d
e
f
g

c
d
e
f
g

Newsletter or trade journal article

c
d
e
f
g

c
d
e
f
g

Consumer handouts

c
d
e
f
g

c
d
e
f
g

Public signage

c
d
e
f
g

c
d
e
f
g

Exhibit at public fair, conferences, events

c
d
e
f
g

c
d
e
f
g

Bill insert

c
d
e
f
g

c
d
e
f
g

Workshop for consumers

c
d
e
f
g

c
d
e
f
g

Workshop/training for contractors

c
d
e
f
g

c
d
e
f
g

Presentation(s) to schools, community groups, etc.

c
d
e
f
g

c
d
e
f
g

Promotion of WaterSense irrigation partners

c
d
e
f
g

c
d
e
f
g

Recruitment of new WaterSense partners

c
d
e
f
g

c
d
e
f
g

Incentive programs (e.g., tax-free holidays, rebates, giveaways)

c
d
e
f
g

c
d
e
f
g

Promotion of new homes

c
d
e
f
g

c
d
e
f
g

Promotion of We're for Water

c
d
e
f
g

c
d
e
f
g

Promotion of Fix a Leak Week

c
d
e
f
g

c
d
e
f
g

Promotion of Shower Better

c
d
e
f
g

c
d
e
f
g

Other
c
d
e
f
g
c
d
e
f
g
If your organization participated in or hosted WaterSense promotional activities or events, please describe your activities (e.g.,
We're for Water, Fix a Leak Week, WaterSense labeled product demonstration, etc.)
5
6

Did you use any WaterSense marketing materials in 2012 (e.g., bill stuffers, brochures, fact sheets)? Are there any other tools or
materials you would like to see WaterSense develop in 2013?
5

6

Describe any other ways you promoted or educated the public about WaterSense in 2012.

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5

6

Add your 2012 activities to our WaterSense in Action Partner Story page so others can learn from your success!

Section III: WaterSense Program Feedback
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... 6
How has WaterSense added value? *
5
5
6
6

On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense partner website? * Please select... 6
In the past year, how often have you visited the partner website? * Please select...
6
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 organization size. Are you planning to apply for an award this year? *
j No
k
l
m
j Yes n
k
l
m
n
Help us improve the awards program by telling us why you're not interested in applying for an award. *
5
6

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.) *
5
6

Section IV: Incentive Programs
If you offer rebate and incentive programs, please fill out the section below. If not, click "Next Page" at the bottom of the page.
For each product type below, please provide the type of incentive and quantity issued between January 1, 2012, and December 31, 2012.
If you have a tracking sheet, feel free to attach it to this form.

Tracking Sheet Upload (Optional)

Browse...

# Non-WaterSense
# WaterSense
Type of Incentive
Incentives Issued** Incentives Issued

Toilets

# Combined
(WaterSense and
Non-WaterSense)
Incentives Issued

Please select... 6 Please enter a number Please enter a number Please enter a number

without commas.
Bathroom Sink
Please select...
Faucets

6

without commas.

without commas.

Please enter a number Please enter a number Please enter a number
without commas.
without commas.
without commas.

Faucet
Accessories

Please select... 6 Please enter a number Please enter a number Please enter a number

Showerheads

Please select... 6 Please enter a number Please enter a number Please enter a number

without commas.

without commas.

without commas.

without commas.

without commas.

without commas.

Other Incentive Type

Page 3 of 3
Flushing
Please select...
Urinals
Weather-Based
Irrigation
Please select...
Controllers
Irrigation
Professionals

6

6

Please enter a number Please enter a number Please enter a number
without commas.
without commas.
without commas.
Please enter a number Please enter a number Please enter a number
without commas.
without commas.
without commas.

Please select... 6 Please enter a number Please enter a number Please enter a number

without commas.

without commas.

without commas.

** Products must be independently certified to meet EPA criteria in order to earn the WaterSense label. E.g., not all ≤ 1.28 gpf (high-efficiency) toilets are
WaterSense labeled, only those tested and certified as such. Please refer to the WaterSense labeled product list at www.epa.gov/watersense.

If you are planning to offer rebates in 2013, please complete our Incentive and Rebate Form to make sure you are listed on the Rebate
Finder on the WaterSense website.

Section IV: Incentive Programs Continued
For each type of product below, please provide the type of incentive and quantity issued between January 1, 2012, and December 31,
2012. If you have a tracking sheet, feel free to attach it to the previous page.
Product Type

Other

Incentive Type

# Non-WaterSense
Incentives Issued

Other Incentive Type

Please select... 6 Please enter a number

without commas.

Other

Please select... 6 Please enter a number

without commas.

Other

Please select... 6 Please enter a number

without commas.

Other

Please select... 6 Please enter a number

without commas.

Other

Please select... 6 Please enter a number

without commas.

Other

Please select... 6 Please enter a number

without commas.

Add
more
products

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.
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Approval Expires 06/30/2013
EPA Form Number 6100-09. The public reporting and record keeping burden for this collection of
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information, the accuracy of the provided burden estimates, and any suggested methods for minimizing
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