5900-253 Ineligible Product Form

										Expiration Date: 1/31/2022
										OMB Control No. 2060-0528
List of products not eligible for ENERGY STAR
All fields are required.
Please input only new ineligible products. Products you have previously reported via this form must not be included (except in the case of a new attempt to certify such a product).
When complete, please save and submit this document along with the laboratory test report, if applicable, and any supporting documentation to [email protected].
ENERGY STAR Manufacturing Partner	ENERGY STAR Product Manufacturer Organization ID	Brand name	Tested model name	Tested model number	Reason product is ineligible for ES (please attach lab test report or any supporting documentation)	Date CB notified manufacturer of ineligibility	ENERGY STAR specification	ENERGY STAR Specification Version	Date Tested	If family/series, additional models represented	Notes
United States ENVIRONMENTAL PROTECTION AGENCY Washington, DC 20460 Office of Atmospheric Programs
EPA Form No. 5900-253
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0528). Responses to this collection of information are voluntary (Section103(g) of the Clean Air Act). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to 5.2 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.