5900-35 Participation Form EEPS

OMB Control No. 2060-0528
Expiration Date: 1/31/2022

ENERGY STAR® Participation Form
for Energy Efficiency Program Sponsors:

Partner Name:
Date:
Partner will participate in the program(s) checked below. Please select only those check boxes relevant for
your organization.
Promote ENERGY STAR as an Energy Efficiency Program Sponsor* in the:









Consumer Product Market
Residential New Construction Market (ENERGY STAR Certified Homes)
Existing Residential Market (Sponsor Home Performance with ENERGY STAR Programs)
Existing Residential Market (ENERGY STAR Verified HVAC Installation)
Existing Commercial Buildings Market
New Commercial Buildings Market
Industrial Market

* Such as states, utilities, or regional program coordinators
Please provide the zip codes that your organization serves to benefit from ENERGY STAR resources. Separate
each zip code with a space.
Zip Codes:

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 be 7.4 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.

EPA Form No. 5900-35

ENERGY STAR Participation Form

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OMB Control No. 2060-0528
Expiration Date: 1/31/2022

Partner Name:
Date:

Primary Contact (if different than
Signatory Contact listed in the
Partnership Agreement)

Secondary Contact

Secondary Contact

Secondary Contact

Contact Name
Title
Company
Address
City
State
Zip
Country
Phone
Email

Contact Name
Title
Company
Address
City
State
Zip
Country
Phone
Email

Return completed Participation Form to:

[email protected]
Or
ENERGY STAR
c/o ICF International
1725 Eye Street, NW, Suite 1000
Washington, DC 20006

EPA Form No. 5900-35

ENERGY STAR Participation Form

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