DOE F 220.22 Ceiling Fans

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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) OMB Control Number: 3084-0069 (Expiration Date: December 31, 2022)

Version 5.5

DOE F 220.22

Ceiling Fans

Product Type:

Ceiling Fans

Status of This Certification Sheet

No Data

5.5

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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The party submitting this report is (select one only):

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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.

OMB Control Number: 3084-0069 (Expiration Date: December 31, 2022)

Paperwork Reduction Act Statement

OMB Burden Disclosure Statement

This data is being collected for manufacturers to report required information to the Federal Trade Commission. This information is shared with the public for the purpose of encouraging consumers to comparison shop for energy-efficiency household products. Public reporting burden for this collection of information is estimated to average from 2 minutes per year per basic product model to 15 hours per year per manufacturer, 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 Division of Enforcement, Bureau of Consumer Protection, Federal Trade Commission, 600 Pennsylvania Avenue NW, Washington, DC 20580; and to the Office of Management and Budget (OMB), OIRA, New Executive Office Building, Docket Library Room 10102, 725 17th Street NW, Washington, DC 20503, Attn: Desk Officer for the Federal Trade Commission. 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 required by the Federal Trade Commission; submission through CCMS is optional.

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Sheet 2: Input

Ceiling Fans	Ceiling Fans							Version 5.5		· 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.
5.5
	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".
															By annual report date
Line No.	Status	Manufacturer	Brand Name(s)	Basic Model Number	Individual Model Number Covered by Basic Model	Action	Product Group Code	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	Number of Speed Control Settings	Does the Model Meet the Applicable Performance Standards in 10 CFR Part 430?	Does the Model Meet the Applicable Design Standards in 10 CFR Part 430?	Link to EnergyGuide Label Website (Enter link or, if submitting link later, enter 'By annual report date')	FTC Data Submission - Fan Diameter (Inches)	FTC Data Submission - Wattage Excluding Any Lights	FTC Data Submission - Airflow (Cubic feet per Minute)	FTC Data Submission - Starting Serial Number, Date Code, or Other Means of Identifying the Date of Manufacture		Manufacturer Status	Brand Name(s) Status	Basic Model Number Status	Individual Model Number Covered by Basic Model Status	Action Status	Product Group Code 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	Number of Speed Control Settings Status	Does the Model Meet the Applicable Performance Standards in 10 CFR Part 430? Status	Does the Model Meet the Applicable Design Standards in 10 CFR Part 430? Status	Link to EnergyGuide Label Website (Enter link or, if submitting link later, enter 'By annual report date') Status	FTC Data Submission - Fan Diameter (Inches) Status	FTC Data Submission - Wattage Excluding Any Lights Status	FTC Data Submission - Airflow (Cubic feet per Minute) Status	FTC Data Submission - Starting Serial Number, Date Code, or Other Means of Identifying the Date of Manufacture 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	Very Small-Diameter (VSD), Diameter less than or equal to 12 in.
2	Very Small-Diameter (VSD), Diameter greater than 12 in.
3	Standard
4	Hugger
5	High-Speed Small-Diameter (HSSD)
6	Large-Diameter