DOE F 220.17 General Service Incandescent Lamps

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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 220.17

General Service Incandescent Lamps

Product Type:

General Service Incandescent 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

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Full Legal Name of Company

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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

General Service Incandescent Lamps	General Service Incandescent 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".
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	ILAC Accreditation Body's Identification Number or Other ILAC-Approved Identification	Has the Basic Model Been in Production For 7 Months or Greater?	Production Dates for Sample (MUST USE M/YYYY FORMAT)							12-Month Average Rated Wattage (Watts)	12-Month Average Rated Lifetime (Hours)	12-Month Average Color Rendering Index (CRI)		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	ILAC Accreditation Body's Identification Number or Other ILAC-Approved Identification Status	Has the Basic Model Been in Production For 7 Months or Greater? Status	Production Dates for Sample (MUST USE M/YYYY FORMAT) Status							12-Month Average Rated Wattage (Watts) Status	12-Month Average Rated Lifetime (Hours) Status	12-Month Average Color Rendering Index (CRI) Status
															Production Date 1 - M/YYYY Format	Production Date 2 - M/YYYY Format	Production Date 3 - M/YYYY Format	Production Date 4 - M/YYYY Format	Production Date 5 - M/YYYY Format	Production Date 6 - M/YYYY Format	Production Date 7 - M/YYYY Format																		Production Date 1 - M/YYYY Format Status	Production Date 2 - M/YYYY Format Status	Production Date 3 - M/YYYY Format Status	Production Date 4 - M/YYYY Format Status	Production Date 5 - M/YYYY Format Status	Production Date 6 - M/YYYY Format Status	Production Date 7 - M/YYYY Format 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	General Service Incandescent Lamps with Rated Lumen Ranges of 1490 to 2600 lumens
2	Modified Spectrum General Service Incandescent Lamps with Rated Lumen Ranges of 1118 to 1950 lumens
3	General Service Incandescent Lamps with Rated Lumen Ranges of 1050 to 1489 lumens
4	Modified Spectrum General Service Incandescent Lamps with Rated Lumen Ranges of 788 to 1117 lumens
5	General Service Incandescent Lamps with Rated Lumen Ranges of 750 to 1049 lumens
6	Modified Spectrum General Service Incandescent Lamps with Rated Lumen Ranges of 563 to 787 lumens
7	General Service Incandescent Lamps with Rated Lumen Ranges of 310 to 749 lumens
8	Modified Spectrum General Service Incandescent Lamps with Rated Lumen Ranges of 232 to 562 lumens