Form 5900-216 Application Accreditation Body

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

United States

ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460
Office of Atmospheric Programs
Application for Recognition of Accreditation Bodies
by EPA under the ENERGY STAR® Program
Version 1.3
This form is an application for recognition of Accreditation Bodies (ABs) by the U.S. EPA under the ENERGY
STAR program. To serve as an EPA-recognized AB for the ENERGY STAR program, please fill out and submit
this form to EPA by following the instructions below. Upon confirmation of EPA recognition, you may begin to
operate as an EPA-recognized AB for the ENERGY STAR program.

Instructions:
1. Read and understand the “Conditions and Criteria for Recognition of Accreditation Bodies for the
ENERGY STAR Program,” the full text of which is included under Section IV.
2. Complete the form. All fields are required unless stated otherwise.
3. Sign the form by either:
a. Inserting your digital signature; or
b. Printing out the form, signing it by hand, and scanning it into PDF format.
4. Email the completed form with the required attachment to: [email protected].
HU

UH

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 7.3 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.

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-216

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

I.

Accreditation Body Information
Organization Name:
Organization URL:
Address 1 (e.g., street address):
Address 2 (e.g., suite #):
City:
State:
Zip/Postal Code:
Country:
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Primary contact first name:
Primary contact last (family) name:
Job title of primary contact:
Email:
Phone:
If mailing address of primary contact is different from the organization
address, please provide it here:
Address 1 (e.g., street address):
Address 2 (e.g., suite #):
City:
State:
Zip/Postal Code:
Country:
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The following secondary contact information section is optional.
Secondary contact first name:
Secondary contact last (family) name:
Job title of secondary contact:
Email:
Phone:
If mailing address of secondary contact is different from the organization
address, please provide it here:
Address 1 (e.g., street address):
Address 2 (e.g., suite #):
City:
State:
Zip/Postal Code:
Country:
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Required Documentation

II.
1B

An electronic copy of the quality management system documentation required in Section 5 of ISO/IEC 17011
is included with this application (check box to confirm).
80B

Comment (optional):
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An up-to-date list of all EPA-recognized laboratories the AB has accredited or will accredit is available at the
following URL:
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Comment (optional):
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(At a minimum, this online list must contain the laboratory name, address, and phone number; the laboratory point
of contact; accreditation effective date; accreditation expiration date (as applicable); and scope of accreditation.)

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-216

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

III.

Declaration:
2B

By checking this box, I declare that I have read and agree to the terms of “Conditions and Criteria for
Recognition of Accreditation Bodies for the ENERGY STAR Program,” and the information submitted via this form
is, to the best of my knowledge, accurate and associated with the Accreditation Body named herein. I understand
that the ENERGY STAR program will associate all information in this form with this Accreditation Body. I
understand that if any of the submitted information is found to be inaccurate, the Accreditation Body will be
removed from the list of EPA-recognized Accreditation Bodies. I understand that intentionally submitting false
information to the U.S. government is a criminal violation of the False Statements Act, Title 18 U.S.C. section
1001.
65B

I further declare that the Accreditation Body named herein will not use any ENERGY STAR mark for any purpose
at any time.
6B

You are required to provide your signature by either:
a. Inserting your digital signature in the box below, or,
b. Printing out the form, signing the signature box below by hand, and scanning the form into PDF format.
Responsible Corporate Official/Signatory:
Printed Name:
Job Title:
Date:

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Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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OMB Control No. 2060-0528
Expiration Date: 1/31/2022

Conditions and Criteria for Recognition of Accreditation Bodies for ENERGY STAR
Laboratory Recognition

IV.
3B

In order to serve as an Accreditation Body (AB) for the ENERGY STAR Laboratory Recognition Program, an AB shall
agree in writing to the following requirements:
General Requirements:
1) Comply at all times with the conditions and criteria for recognition of accreditation bodies for the ENERGY STAR
Laboratory Recognition Program.
2) Operate its accreditation program in accordance with ISO/IEC 17011, “Conformity assessment: General requirements
for accreditation bodies accrediting conformity assessment bodies.”
3) Maintain its status as a signatory to the International Laboratory Accreditation Cooperation (ILAC) Mutual Recognition
Arrangement (MRA). Inform EPA, in writing, within 30 days of any change in signatory status in the ILAC MRA.
4) Within the AB’s assessor training program, include training on the current requirements described in the ENERGY
STAR Laboratory Recognition Requirements. Assessors must be trained prior to performing assessments and
continue to be provided new and refresher courses. As per ISO/IEC 17011, training should be conducted as needed
to ensure the AB maintains a sufficient number of competent personnel given the work performed.
Reporting to EPA:
1) Submit an electronic copy of the quality management system documentation required in Section 5 of ISO/IEC 17011.
2) Participate in meetings with EPA as necessary as part of continual improvement efforts in the enhanced testing
program. During these meetings, the AB will be expected to brief EPA staff on the status of the program, common
deficiencies, and issues related to accreditation of laboratories. EPA and the AB will jointly determine whether the
meeting should take place by telephone or in-person.
3) Report to EPA within 30 days of any major changes that affect the AB’s:
a) Legal, commercial, organizational, or ownership status;
b) Organization and management, e.g., key managerial staff;
c) Policies or procedures, where appropriate;
d) Location;
e) Personnel, facilities, working environment or other resources, where significant;
f) Other such matters that may affect the AB's capability, scope of recognized activities, or compliance with the
ENERGY STAR requirements and relevant technical documents.
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4) Forward any questions related to ENERGY STAR test procedures to EPA for resolution, and abide by the decisions of
EPA relative to the resolution of those questions.
5) Upon request, provide EPA with electronic copies of laboratory accreditation information including:
a) Accreditation effective date;
b) Accreditation expiration date (if applicable);
c) ENERGY STAR-relevant accredited test methods; and,
d) A list of qualified personnel per ENERGY STAR-relevant accredited test methods.
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6) Notify EPA immediately in writing, and update the AB’s website to document any action that adversely affects the
accreditation status of an EPA-recognized accredited laboratory.
7) Upon request, provide EPA with copies of laboratory assessment documentation related to ENERGY STAR testing,
including corrective action plans, and documentation of resolution of deficiencies. Laboratories’ consent to this is a
condition of their recognition by EPA.
Conducting Laboratory Assessments:
1) Assess laboratory operations for compliance with ENERGY STAR Laboratory Recognition Requirements.
a) Upon a satisfactory outcome, attest to the technical competence of laboratories to perform tests required for
ENERGY STAR qualification as outlined in the ENERGY STAR Laboratory Recognition Requirements. This
7B

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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should include ensuring that the list of specific test methods for which the laboratory has been accredited is
included within the laboratory’s scope of accreditation.
b) Notify EPA of any observed test method interpretations that require clarification.
c) Assess documentation demonstrating the impartiality and freedom of laboratory management and personnel from
any undue internal or external commercial, financial or other pressures and influences that may adversely affect
the quality of their work, as required by ISO/IEC 17025.
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NOTE: It is EPA’s expectation that ABs will systematically monitor the impartiality of laboratories on an ongoing
basis. Document review, consistent with the requirements of ISO/IEC 17025, shall include but may not be limited
to the following:
i) organization chart showing that the responsibilities, authorities, and inter-relationships of all personnel who
manage, perform or verify laboratory results are free from influence that may adversely affect the quality of
their work;
ii) dates of internal audits, audit findings, and any corrective actions taken;
iii) any customer complaints and corrective action taken;
iv) original testing records containing sufficient information for repeatability, including the names of staff who
participated;
v) evidence that laboratory employees participate in and regularly pass ethics and compliance audits; and,
vi) evidence that mechanisms for reporting and responding to attempts to exert undue influence on test results
are in place.
2) Conduct complete on-site assessments of each laboratory per the ILAC MRA and ISO/IEC 17011 requirements.
3) Verify that all assessment findings are resolved and corrective actions have been implemented before granting
accreditation to a laboratory.
4) Allow EPA, at its discretion, to witness any assessments performed for compliance with the requirements of the
verification testing program. EPA agrees to jointly determine with the AB when such witnessing will occur so as not to
disrupt the AB’s assessment schedule, and to operate solely as an observer and not participate in any way with the
assessment activities of the AB and/or its assessors.
5) Publish and maintain on the AB’s website an up-to-date directory identifying all EPA-recognized laboratories the AB
has accredited. At a minimum, this directory must include the following information:
a) Laboratory name, address, and phone number;
b) Laboratory point of contact;
c) Accreditation effective date;
d) Accreditation expiration date (as applicable); and,
e) Scope of accreditation.
6) Maintain documentation relevant to the accreditation for at least five years.
7) Assume the responsibility of the laboratory accreditation decision itself; the AB cannot delegate fully or partially the
accreditation decision to another organization.
End of text of “Conditions and Criteria for Recognition of Accreditation Bodies for ENERGY STAR Laboratory Recognition”

Toll-free number: 1-888-STAR-YES

Web site: http://www.energystar.gov
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EPA Form No. 5900-216