DOE HQ F 413.41 50001 Ready Energy Performance Improvement Report

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Overview

Instructions
Report
Energy Conversions

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Sheet 1: Instructions

DOE HQ F 413.41 OMB Control Number - 1910-5177 Expiration Date - ______________

DOE HQ F 413.41 OMB Control Number - 1910-5177 Expiration Date - _____________

The 50001 Ready Energy Performance Improvement Report is provided to report energy data for recognition through the U.S. Department of Energy’s 50001 Ready Program. This report has three sections: 1) project information, 2) energy consumption, and 3) energy performance improvement. Sites seeking first time 50001 Ready recognition only need to complete sections 1 and 2. Sites seeking subsequent recognition must complete all 3 sections. Information is entered on the Report tab. Please see the 50001 Ready Navigator or contact the 50001 Ready Help Desk for additional guidance.

Reporting Form Field

Instructions

1) Project Information

50001 Ready Project Name:

Provide the name of the project as it appears in the 50001 Ready Navigator.

Project Zip Code:

Provide the zip code of the site included in the 50001 Ready Navigator project.

Company Contact Name:

Provide the name of the person with the organization who is responsible and knowledgeable of this information.

Company Contact Title:

Title of the person within the organization who is responsible and knowledgeable of this information.

Date Report Completed:

Date that the form was filled out in MM/DD/YYYY format.

Number of Buildings at Site:

Number of buildings at the site (50001 Ready Navigator project). A building is a structure totally enclosed by walls extending from the foundation to the roof, containing over 1,000 square feet of floorspace. (source CBECS terminology)

Total Square Footage of Buildings at Site:

Provide the total square footage for the buildings included in the, "Number of Buildings at Site," value.

2) Energy Consumption

Current Reporting Period:

Identify the reporting period beginning and ending dates in the MM/DD/YYYY format. This is required for all 50001 Ready recognition requests. Note: For the first time 50001 Ready recognition requests, the Current Reporting Period is a consecutive 12-month time span that can be established with a starting date up to 25 months prior to the 50001 Ready recognition request date. This allowance is provided to accommodate sites that report energy consumption data to other programs. Sites are highly encouraged to establish the Current Reporting Period so that it ends as close to the 50001 Ready recognition request date as possible. Note: For subsequent 50001 Ready requests, the Current Reporting Period is the 12-month period that follows immediately after the Prior Reporting Period. If there is a significant gap between 50001 Ready Recognitions (e.g. a year or more) contact the 50001 Ready Help Desk for guidance on establishing a new Reporting Period.

Site Energy Consumed (MMBtu):

Provide the site energy (also known as delivered energy) consumed, by fuel type for the baseline and reporting periods. Exclude energy used as a feedstock. The "Energy Conversion" tab provides multiplier values and a built in calculator to convert typical energy units to MMBtu. This is required for all 50001 Ready recognition requests.

Primary Energy Consumed (MMBtu):

Primary energy is the site energy consumed plus the energy required to produce and deliver the energy products to the company’s sites. DOE requires that energy data be reported in terms of primary energy for electricity and imported derived energy sources. For electricity, the program uses a multiplier of 3.0 for conversion from site to primary energy consumption. Primary Energy Consumed values are automatically calculated by the spreadsheet.

Total Site Energy Consumed (MMBtu):

This number is calculated by the spreadsheet.

Total Primary Energy Consumed (MMBtu):

This number is calculated by the spreadsheet.

3) Energy Performance Improvement

Prior Reporting Period:

Identify the prior reporting period beginning and ending dates in the MM/DD/YYYY format. Note: This is not required for first time 50001 Ready recognition requests. Note: For subsequent 50001 Ready recognition requests, The Prior Reporting Period is the same 12-month period as the Current Reporting Period for the pervious 50001 Ready recognition.

Method Used to Determine Energy Performance Improvement:

Identify the method used to determine energy performance improvement. See the 50001 Ready Navigator for additional details on the approved methods. This is not required for first time 50001 Ready recognition requests.

Energy Performance Improvement Value:

Provide the energy performance improvement value as a percentage of current reporting period energy consumption. While it is preferred to have this value reported in terms of primary energy consumption if an energy performance improvement value is only available in terms of site energy please use that. This is not required for first time 50001 Ready recognition requests.

Optional Energy Intensity Calculator

If the Energy Intensity method is used to report energy performance improvement in terms of an Energy Use Intensity (EUI), the Optional Energy Intensity Calculator may be used if desired. In addition to Current Reporting Period energy consumption, please enter Prior Reporting Period energy consumption for each energy source into the Optional Energy Intensity Calculator. Enter units of output (e.g. number of widgets produced) or total building floor area (ft2) for the Current and Prior Reporting Periods to auto-calculate an energy performance improvement value in the section to the right titled Units of Output or Total Building Area. Please enter a numeric value only. If calculating EUI based on total building area, then the total building floor area entered into cell E13 can be re-entered into cell I87 for the Output or Total Building Floor Area, and the input for cell I90 will be the total building area for the prior year.

OMB DISCLOSURE STATEMENT

This data is being collected to facilitate delivery of technical assistance and other program services. The data you supply will be used to evaluate the effectiveness of investments in energy management systems and to improve the usefulness of Federal technical assistance and recognition programs.

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, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project OMB control number 1910-5177, 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 OMB control number 1910-5177, Washington, DC 20503.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

Submission of this data is voluntary.

v18.EP.02.24

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Sheet 2: Report

1) Project Information

DOE HQ F 413.41

(Required for all 50001 Ready recognition requests)

OMB Control Number - 1910-5177

Expiration Date: ______________

50001 Ready Project Name:

Project Zip Code:

Company Contact Name:

Company Contact Title:

Date Report Completed:

Number of Buildings at Site:

Total Square Footage of Buildings at Site:

2) Energy Consumption

(Required for all 50001 Ready recognition requests)

Begin

End

12 Month Current Reporting Period:

(in mm/dd/yyyy format)

Note: For the first time 50001 Ready recognition requests, the Current Reporting Period is a consecutive 12-month time

span that can be established with a starting date up to 25 months prior to the 50001 Ready recognition request date.

This allowance is provided to accommodate sites that report energy consumption data to other programs.

Sites are highly encouraged to establish the Current Reporting Period so that it ends as close to the 50001 Ready

recognition request date as possible.

Note: For subsequent 50001 Ready requests, the Current Reporting Period is the 12-month period that follows

immediately after the Prior Reporting Period. If there is a significant gap between 50001 Ready Recognitions (e.g. a

year or more) contact the 50001 Ready Help Desk for guidance on establishing a new Reporting Period.

Reporting Period

Reporting Period

Energy Consumed (MMBtu):

Site Energy

Primary Energy

Grid Purchased Electricity:

-

Onsite Renewable Electricity:

-

Natural Gas:

-

Propane:

-

Diesel, Kerosene, or other Light Fuel Oil (#1, 2, & 4):

-

Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C):

-

Coal:

-

Coke:

-

Blast Furnace Gas:

-

Wood Waste:

-

Wood:

-

Purchased/District Steam (originating from a fueled boiler):

-

Purchased/District Steam (originating from an electric boiler):

-

Purchased/District Hot Water (originating from a fueled hot water heater):

-

Purchased/District Hot Water (originating from an electric hot water heater):

-

Purchased/District Chilled Water (originating from a steam driven water chiller):

-

Purchased/District Chilled Water (originating from an electric water chiller):

-

Other Gas (please specify):

-

Other Liquid (please specify):

-

Other Solid (please specify):

-

-

Total Site Energy Consumed, (MMBtu):

-

-

3) Energy Performance Improvement

(Required only for subsequent year 50001 Ready recognition requests)

Begin

End

12 Month Prior Reporting Period:

(in mm/dd/yyyy format)

Note: This is not required for first time 50001 Ready recognition requests.

Note: For subsequent 50001 Ready recognition requests, the Prior Reporting Period is the same 12-month period

as the Current Reporting Period for the pervious 50001 Ready recognition.

Method Used to Determine Energy Performance Improvement (select one):

Energy Intensity:

The Optional Energy Intensity Calculator is also available for your use. Based on primary energy.

EnPI Lite Output File:

Better Plants Annual Report:

Better Buildings Challenge Annual Report:

50001 Ready Energy Report for Portfolio Manager:

DOE 50001 Ready Partner with approved M&V Process (Partner name):

Energy Performance Improvement Value:

Insert the year-on-year percentage improvement value calculated using the selected method.

Note: Please report energy improvement value based on primary energy if available, otherwise please use a value based on site energy.

Optional Energy Intensity Calculator

Prior Reporting Period

Prior Reporting Period

Site Energy Consumed (MMBtu):

Site Energy

Primary Energy

Grid Purchased Electricity:

-

Onsite Renewable Electricity:

-

Natural Gas:

-

Propane:

-

Diesel, Kerosene, or other Light Fuel Oil (#1, 2, & 4):

-

Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C):

-

Units of Output or Total Building Area

Coal:

-

Coke:

-

Blast Furnace Gas:

-

Output or total building

Wood Waste:

-

area for Current

Wood:

-

Reporting Period

Purchased/District Steam (originating from a fueled boiler):

-

Output or total building

Purchased/District Steam (originating from an electric boiler):

-

area for Prior

Purchased/District Hot Water (originating from a fueled hot water heater):

-

Reporting Period

Purchased/District Hot Water (originating from an electric hot water heater):

-

Energy intensity

#DIV/0!

Purchased/District Chilled Water (originating from a steam driven water chiller):

-

improvement value

Purchased/District Chilled Water (originating from an electric water chiller):

-

Other Gas (please specify):

-

Other Liquid (please specify):

-

Other Solid (please specify):

-

-

Total Site Energy Consumed, (MMBtu):

-

-

OBM DISCLOSURE STATEMENT

This data is being collected to facilitate delivery of technical assistance and other program services. The data you supply will be used to evaluate the effectiveness of investments in energy management systems and to improve the usefulness of Federal technical assistance and recognition programs.

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, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project OMB control number 1910-5177, 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 OMB control number 1910-5177, Washington, DC 20503.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

Submission of this data is voluntary.

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Sheet 3: Energy Conversions

DOE HQ F 413.41

OMB Control Number - 1910-5177

Expiration Date: ______________

Conversions of common energy units to MMBtu

Original Unit

Enter Energy Value

Multiply by

Resulting Energy in MMBTU

MMBtu

Electricity

kWh

0.003412

0

MMBtu

MWh

3.412

0

MMBtu

Natural Gas

therm

0.1

0

MMBtu

decatherm

1.000

0

MMBtu

Cf (1 cf)

0.001

0

MMBtu

Ccf (100 cu ft)

0.103

0

MMBtu

Mcf (1000 cu ft)

1.027

0

MMBtu

Gasoline

gallons

0.114

0

MMBtu

Diesel

gallons

0.137

0

MMBtu

Coal

short ton

19.27

0

MMBtu

Coke

short ton

25.370

0

MMBtu

Blast Furnace Gas

Ccf (10 cu ft)

0.0093

0

MMBtu

kBtu to MMBtu

kBtu

0.0010

0

MMBtu

Reporting metric used in Energy Star Portfolio Manager

OMB DISCLOSURE STATEMENT

This data is being collected to facilitate delivery of technical assistance and other program services. The data you supply will be used to evaluate the effectiveness of investments in energy management systems and to improve the usefulness of Federal technical assistance and recognition programs.

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, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project OMB control number 1910-5177, 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 OMB control number 1910-5177, Washington, DC 20503.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

Submission of this data is voluntary.