DOE F 540.11 Better Buildings Implementation Model Form

OMB Control No. 1910-5141

Exp. Date 10/31/2022

DOE F 540.11

Background: The U.S. Department of Energy defines an “implementation model” as a replicable pathway for implementing approaches to overcome organizational barriers to decarbonization, energy efficiency, and/or water or waste reduction. The following framework is a tool to help you document and develop the approaches your organization took to create a durable solution in overcoming a specific barrier. Text provided by partners may be edited for clarity, as well as to match the third-person perspective of existing solutions on the program’s website. Final versions will be reviewed and approved by the partner before being published.

Partners are encouraged to review implementation model case studies that have been posted to the Better Buildings Solution Center for ideas and inspiration.

Organization Name: Click here to enter text.

Version Date: Click here to enter text.

Overview (1-2 sentences per question)

1. What barrier did you address that other organizations may also face?

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2. What solution was implemented to address this barrier?

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3. What measurable outcomes were achieved?

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4. Introduction (100 words or less)

• Provide a brief overview of why this effort was important to your organization (i.e., in support of one or more organization-wide sustainability goals).

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Approach & Execution

5. Policies: What policies or plans helped address the barrier?

• Describe the policies or plans that helped drive action, impact organizational structure, influence operations, and increase buy-in (which might include sustainability or climate policies or plans at the organization, local, state, or federal levels).

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6. Processes: How were the policies or plans implemented?

• Describe the processes (actions taken) to implement the policies or plans, including how the solution was financed. What barriers to implementation were experienced, and was anything surprising about how the plan unfolded?

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7. What outreach and/or communications activities were part of the effort?

• Outreach efforts include initiatives to gain internal approval and garner support for/market your approach.

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Measuring Success

8. How does the organization measure the success of the solution?

The following elements may inform your response:

• Success Metrics (e.g., reduction of tonnes CO₂e, kBtu or kBtu/square feet, gallons or gallons/square feet etc.)

• Dedicated Resources (the resources, if any, that are needed to make the assessment; e.g., staff, funding, IT, etc.)

• Continuous Improvement (how the assessment is being used within the organization to evaluate impact or to push continuous improvement)

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9. Expected annual cost savings

What are the cost savings and return on investment (ROI) associated with implementing the approach?

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Tools/Resources

10. Provide any materials and tools that were used or created to meet your desired outcome including:

Planning (comprehensive action plans or guidance documents)

• Documents/spreadsheets

• Forms

• Templates

• Presentations

• Outreach materials

Include all tools/resources as attachments that you are willing to let others use, as opposed to links. Please redact any proprietary or sensitive information.

11. Other

If applicable, include any notable information about the following:

• Partnerships (engaging outside organizations in your efforts to maximize reach and effectiveness)

• Financing (new or innovative initiatives or legislation leveraged to make this approach possible)

• Data Management (platforms or processes employed to collect and track information, or quantify the approach)

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This data is being collected to support the Department of Energy Better Buildings Initiative. The data you supply will be used for developing best practices to facilitate reductions in energy intensity by commercial, manufacturing, and community organizations.

Public reporting burden for this collection of information is estimated to average 2 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, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (1910-5141), 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 (1910-5141), 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 voluntary.

This data is being collected to support the Department of Energy Better Buildings Initiative. The data you supply will be used for developing best practices to facilitate reductions in energy intensity by commercial, manufacturing, and community organizations.

Public reporting burden for this collection of information is estimated to average 2 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, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (1910-5141), 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 (1910-5141), 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 voluntary.

Learn more at betterbuildingssolutioncenter.energy.gov/solutions