DOE 220.23 Ceiling Fan Light Kits

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Overview

Certification
Input
Product Group Codes

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Sheet 1: Certification

OMB Control Number: 1910-1400 (Expiration Date: September 30, 2024)

Version 5.2

DOE F 220.23

Ceiling Fan Light Kits with Sockets for Medium Screw Base Lamps or with Pin-Based Sockets for Fluorescent Lamps

Product Type:

Ceiling Fan Light Kits with Sockets for Medium Screw Base Lamps or with Pin-Based Sockets for Fluorescent Lamps

Status of This Certification Sheet

No Data

5.2

Overall Status of Template

No Data

Click here for instructions for completing this form

Each Importer and U.S. Manufacturer is legally required to certify the compliance of the products it imports, produces, assembles or manufactures. This party is the "Certifier" on this form. This certification may be submitted by the Importer or U.S. manufacturer or by a Third Party Representative. This party is the "Submitter" on this form.

Certifier - Party Legally Obligated to Certify Compliance

Submitter - Party Submitting This Report

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Certifier Contact Information

Third Party Representative Contact Information, if Applicable

Full Legal Name of Individual

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Full Legal Name of Individual

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Full Legal Name of Company

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Full Legal Name of Company

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Complete Company Mailing Address

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Complete Company Mailing Address

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Phone Number

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Phone Number

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Email Address

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Email Address

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Compliance Statement

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Submitter Signature (Type your Full Legal Name)

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Date (MM/DD/YYYY)

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OMB Control Number: 1910-1400 (Expiration Date: September 30, 2024)

Paperwork Reduction Act Statement

OMB Burden Disclosure Statement

This data is being collected for manufacturers to certify compliance to DOE's energy conservation, water conservation, or design standards. The data you supply will be used by the Department to monitor compliance with the energy conservation, water conservation, and design standards and testing requirements for the consumer products and commercial and industrial equipment mandated by the Energy Policy and Conservation Act, as amended. Public reporting burden for this collection of information is estimated to average 35 hours 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, Records Management Division, IM-23, Paperwork Reduction Project (1910-1400), 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 (1910-1400), 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 mandatory.

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Sheet 2: Input

Ceiling Fan Light Kits with Sockets for Medium Screw Base Lamps or with Pin-Based Sockets for Fluorescent Lamps	Ceiling Fan Light Kits with Sockets for Medium Screw Base Lamps or with Pin-Based Sockets for Fluorescent Lamps							Version 5.2		· Please enter your data in the columns shaded in gray below, using a separate line for each model. · Click on the column heading for instructions on how to complete cells in that column. · Cells highlighted in yellow indicate an "Error." "Error" means that information is missing or there is an issue with the entry. · If the "Status" for a row is "Error," you can see an explanation in the columns to the far right.
5.2
	Status of This Input Sheet		No Data	Overall Status of Template		No Data
	Certification Report			Click here for instructions for completing this form														The cells below provide an explanation for "Errors".					The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".		The cells below provide an explanation for "Errors".
													Complete the columns below to certify compliance with the standards for which compliance is required prior to January 21, 2020.			Alternatively, complete the column below to certify compliance with the standards for which compliance is required on or after January 21, 2020.
Line No.	Status	Manufacturer	Brand Name(s)	Basic Model Number	Individual Model Number Covered by Basic Model	Action	Product Group Code	Sample Size (Number of Units Tested)	Is the Certification for this Basic Model Based on a Waiver of DOE's Test Procedure Requirements?	Date of Test Procedure Waiver, if Applicable	Is the Certification based upon any Exception Relief from an Applicable Standard by DOE's Office of Hearing and Appeals?	Date of Exception Relief, if Applicable	Rated Wattage per Lamp (watts)	System Efficacy per Lamp (lumens/watt)	Length of Lamp (inches) (For Pin-Based Fluorescent Lamps)	Does the Model Meet the Applicable Standards in 10 CFR Part 430.32(s)(6)?		Manufacturer Status	Brand Name(s) Status	Basic Model Number Status	Individual Model Number Covered by Basic Model Status	Action Status	Product Group Code Status	Sample Size (Number of Units Tested) Status	Is the Certification for this Basic Model Based on a Waiver of DOE's Test Procedure Requirements? Status	Date of Test Procedure Waiver, if Applicable Status	Is the Certification based upon any Exception Relief from an Applicable Standard by DOE's Office of Hearing and Appeals? Status	Date of Exception Relief, if Applicable Status	Rated Wattage per Lamp (watts) Status	System Efficacy per Lamp (lumens/watt) Status	Length of Lamp (inches) (For Pin-Based Fluorescent Lamps) Status	Does the Model Meet the Applicable Standards in 10 CFR Part 430.32(s)(6)? Status
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Sheet 3: Product Group Codes

The following is a description of each product group code:
Product Group Code	Product Group Code Description
1	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (Bare Lamps of Less than 15 watts each)
2	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (Bare Lamps of Greater than or Equal to 15 watts each)
3	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (Covered Lamps with No Reflector of Less than 15 watts each)
4	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (Covered Lamps with No Reflector of Greater than or Equal to 15 watts each and Less than 19 watts each)
5	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (Covered Lamps with No Reflector of Greater than or Equal to 19 watts each and Less than 25 watts each)
6	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (Covered Lamps with No Reflector of Greater than or Equal to 25 watts each)
7	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (With Reflector and Less than 20 watts each)
8	Ceiling Fan Light Kit with Sockets for Medium Screw Base Lamps (With Reflector and Greater than or Equal to 20 watts each)
9	Ceiling Fan Light Kit with Pin-Based Sockets for Fluorescent Lamps of any length that are Less than 30 Total Listed Lamp Watts
10	Ceiling Fan Light Kit with Pin-Based Sockets for Fluorescent Lamps that are no more than 24 inches in length and Greater than or Equal to 30 Total Listed Lamp Watts
11	Ceiling Fan Light Kit with Pin-Based Sockets for Fluorescent Lamps that are greater than 24 inches in length and Greater than or Equal to 30 Total Listed Lamp Watts