DOE F 413.25 Tool Data Collection Form

Home Energy Scoring Tool

OMB Control #: 1910-5148
DOE HQ F 413.25
Exp. Date.: 7/31/2023

Data Collection Form
Location Information
Address: _______________________________________ City: ____________________ State: _____ Zip: _________
Assessment Type: Initial / Final / QA / Alternative EEM (Energy Efficiency Measures) / Test / Corrected / Mentor /
Preconstruction
Assessment Date: ____________________ Assessor: _________________________________________________
Comments: ____________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Home Details
Year Built: _______________ # of Bedrooms: 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
Average Ceiling Height (ft): 6 / 7 / 8 / 9 / 10 / 11 / 12

# of Stories Above Grade: 1 / 2 / 3 / 4

Conditioned Floor Area (sq ft): ____________________

Direction Faced by Front of House: N / NE / E / SE / S / SW / W / NW

Air Tightness
Was a Blower Door test conducted on this house?: Yes / No
Air Leakage rate: _______________ cfm50

Roof / Attic 1

Has the house been professionally air sealed?: Yes / No

Attic 1 Area (sq ft): ______________________

Roof Construction: Standard Roof / with Radiant Barrier / with Rigid Foam Sheathing
Exterior Finish: Composition Shingles or Metal / Wood Shakes / Clay Tile / Concrete Tile / Tar & Gravel
Insulation Level (applied to roof): R-0 / R-11 / R-13 / R-15 / R-19 / R-21 / R-27/ R-30
Roof Color: White / Light / Medium / Medium Dark / Dark / Cool Color: ______ (reflectivity)

Attic or Ceiling Type: Unconditioned Attic / Conditioned Attic / Cathedral Ceiling
Attic Floor Insulation: R-0 / R-3 / R-6 / R-9 / R-11 / R-19 / R-21 / R-25 / R-30 / R-38 / R-44 / R-49 / R-60

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Roof / Attic 2

Attic 2 Floor Area (sq ft): ______________________

Roof Construction: Standard Roof / with Radiant Barrier / with Rigid Foam Sheathing
Exterior Finish: Composition Shingles or Metal / Wood Shakes / Clay Tile / Concrete Tile / Tar & Gravel
Insulation Level (applied to roof): R-0 / R-11 / R-13 / R-15 / R-19 / R-21 / R-27 / R-30
Roof Color: White / Light / Medium / Medium Dark / Dark / Cool Color: __________ (reflectivity)

Attic or Ceiling Type: Unconditioned Attic / Conditioned Attic / Cathedral Ceiling
Attic Floor Insulation: R-0 / R-3 / R-6 / R-9 / R-11 / R-19 / R-21 / R-25 / R-30 / R-38 / R-44 / R-49 / R-60

Foundation 1

Foundation 1 Area (sq ft): _______________________

Type: Slab-on-Grade / Unconditioned Basement / Conditioned Basement / Unvented Crawlspace /
Vented Crawlspace
Floor Insulation over Basement or Crawlspace: R-0 / R-11 / R-13 / R-15 / R-19 / R-21 / R-25 / R-30 / R-38
Foundation Wall Insulation: R-0 / R-5 (slab only) / R-11 (bsmt/crawl wall) / R-19 (bsmt/crawl wall)

Foundation 2

Foundation 2 Area (sq ft): _______________________

Type: Slab-on-Grade / Unconditioned Basement / Conditioned Basement / Unvented Crawlspace /
Vented Crawlspace

Floor Insulation over Basement or Crawlspace: R-0 / R-11 / R-13 / R-15 / R-19 / R-21 / R-25 / R-30 / R-38
Foundation Wall Insulation: R-0 / R-5 (slab only) / R-11 (bsmt/crawl wall) / R-19 (bsmt/crawl wall)

Walls
Is this home a Townhouse or Duplex?: Yes / No

Position of Unit: Middle / Right / Left

Wall Characteristics: Front or All (circle one)
Construction: Wood Frame / Wood Frame with rigid foam sheathing / Wood Frame with Optimum Value Engineering
(OVE) / Structural Brick / Concrete Block or Stone / Straw Bale
Exterior Finish: Wood Siding, Fiber Cement, Composite Shingle or Masonite Siding / Stucco / Vinyl Siding / Aluminum
Siding / Brick Veneer / none
Wall Insulation: R-0 / R-3 / R-6 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21 / R-27 / R-33 / R-38

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Skylights: Yes or No (circle one):
Total Skylight Area (sq. ft.): __________ Number of Panes: Single-pane / Double-pane / Triple-pane
Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar-control low-E / Solar-control low-E, argon gas fill / Insulating low-E / Insulating low-E,
argon gas fill
-OR- Actual window specifications = U-Factor (from 0.01 – 5.00): _________ SHGC (from 0.0 – 1.0): ______

Window Area (sq. ft.):
Front: _______________

Back: ________________ Right Side: ______________

Window Characteristics: Front or All (circle one)

Left Side: _______________

Solar Screens: Yes / No

Panes: Single-pane / Double-pane / Triple-pane
Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar-control low-E / Solar-control low-E, argon gas fill / Insulating low-E / Insulating low-E,
argon gas fill
-OR- Actual window specifications = U-Factor (from 0.01 – 5.00): __________ SHGC (from 0.0 – 1.0): ________

>BACK<
Wall Characteristics: Back
Construction: Wood Frame / Wood Frame with Rigid Foam Sheathing / Wood Frame with Optimum Value Engineering
(OVE) / Structural Brick / Concrete Block or Stone / Straw Bale
Exterior Finish: Wood Siding, Fiber Cement, Composite Shingle or Masonite Siding / Stucco / Vinyl Siding / Aluminum
Siding / Brick Veneer
Wall Insulation: R-0 / R-3 / R-6 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21 / R-27 / R-33 / R-38

Window Characteristics: Back

Solar Screens: Yes / No

Panes: Single-pane / Double-pane / Triple-pane
Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar-control low-E / Solar-control low-E, argon gas fill / Insulating low-E / Insulating low-E,
argon gas fill
-OR- Actual window specifications = U-Factor (from 0.01 – 5.00): __________ SHGC (from 0.0 – 1.0): ________

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>RIGHT SIDE<
Wall Characteristics: Right Side (facing house)
Construction: Wood Frame / Wood Frame with Rigid Foam Sheathing / Wood Frame with Optimum Value Engineering
(OVE) / Structural Brick / Concrete Block or Stone / Straw Bale
Exterior Finish: Wood Siding, Fiber Cement, Composite Shingle or Masonite Siding / Stucco / Vinyl Siding / Aluminum
Siding / Brick Veneer
Wall Insulation: R-0 / R-3 / R-6 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21 / R-27 / R-33 / R-38

Window Characteristics: Right Side (facing house)

Solar Screens: Yes / No

Panes: Single-pane / Double-pane / Triple-pane
Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar-control low-E / Solar-control low-E, argon gas fill / Insulating low-E / Insulating low-E,
argon gas fill
-OR- Actual window specifications = U-Factor (from 0.01 – 5.00): __________ SHGC (from 0.0 – 1.0): ________

>LEFT SIDE<
Wall Characteristics: Left Side (facing house)
Construction: Wood Frame / Wood Frame with Rigid Foam Sheathing / Wood Frame with Optimum Value Engineering
(OVE) / Structural Brick / Concrete Block or Stone / Straw Bale
Exterior Finish: Wood Siding, Fiber Cement, Composite Shingle or Masonite Siding / Stucco / Vinyl Siding / Aluminum
Siding / Brick Veneer
Wall Insulation: R-0 / R-3 / R-6 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21 / R-27 / R-33 / R-38

Window Characteristics: Left Side (facing house)

Solar Screens: Yes / No

Panes: Single-pane / Double-pane / Triple-pane
Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar-control low-E / Solar-control low-E, argon gas fill / Insulating low-E / Insulating low-E,
argon gas fill
-OR- Actual window specifications = U-Factor (from 0.01 – 5.00): __________ SHGC (from 0.0 – 1.0): ________

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System 1

% of floor area served: ____________________

Heating (System 1)
Type of Heating 1 System: None / Central gas furnace / Room (through-the-wall) gas furnace / Gas boiler / Propane (LPG)
central furnace / Propane (LPG) wall furnace / Propane (LPG) boiler / Oil furnace / Oil Boiler / Electric furnace / Electric
heat pump / Electric baseboard heater / Ground coupled heat pump / Minisplit (ductless) heat pump / Electric boiler /
Wood Stove / Pellet Stove
Heating System 1 Efficiency:
Do you know the actual heating system efficiency?: Yes / No*
*You can use the Assessor Calculator to determine the approximate efficiency!
Efficiency Value (AFUE or HSPF): __________________ OR Year Installed: _____________________

Cooling (System 1)
Type of Cooling 1 System: None / Central air conditioner / Room air conditioner / Electric heat pump / Minisplit (ductless)
heat pump / Ground coupled heat pump / Direct evaporative cooling
Cooling System 1 Efficiency:
Do you know the actual cooling system efficiency?: Yes / No*
*You can use the Assessor Calculator to determine the approximate efficiency!
Efficiency Value (SEER or EER): __________________ OR Year Installed: _____________________

Duct (System 1)
Duct Location 1 (#1): Conditioned Space / Unconditioned basement / Vented crawlspace / Unvented crawlspace /
Unconditioned attic
Percentage of Ducts in this location: __________ Are ducts sealed?: Yes / No Are ducts insulated?: Yes / No
Duct Location 1 (#2): Conditioned Space / Unconditioned basement / Vented crawlspace / Unvented crawlspace /
Unconditioned attic
Percentage of Ducts in this location: __________ Are ducts sealed?: Yes / No Are ducts insulated?: Yes / No
Duct Location 1 (#3): Conditioned Space / Unconditioned basement / Vented crawlspace / Unvented crawlspace /
Unconditioned attic
Percentage of Ducts in this location: __________ Are ducts sealed?: Yes / No Are ducts insulated?: Yes / No

System 2

% of floor area served: ____________________

Heating (System 2)
Type of Heating 2 System: None / Central gas furnace / Room (through-the-wall) gas furnace / Gas boiler / Propane (LPG)
central furnace / Propane (LPG) wall furnace / Propane (LPG) boiler / Oil furnace / Oil Boiler / Electric furnace / Electric
heat pump / Electric baseboard heater / Ground coupled heat pump / Minisplit (ductless) heat pump / Electric boiler /
Wood Stove / Pellet Stove

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Heating System 2 Efficiency:
Do you know the actual heating system efficiency?: Yes / No*
*You can use the Assessor Calculator to determine the approximate efficiency!
Efficiency Value (AFUE or HSPF): __________________ OR Year Installed: _____________________
Cooling (System 2)
Type of Cooling 2 System: None / Central air conditioner / Room air conditioner / Electric heat pump / Minisplit (ductless)
heat pump / Ground coupled heat pump / Direct evaporative cooling
Cooling System 2 Efficiency:
Do you know the actual cooling system efficiency?: Yes / No*
*You can use the Assessor Calculator to determine the approximate efficiency!
Efficiency Value (SEER or EER): __________________ OR Year Installed: _____________________
Duct (System 2)
Duct Location 2 (#1): Conditioned Space / Unconditioned basement / Vented crawlspace / Unvented crawlspace /
Unconditioned attic
Percentage of Ducts in this location: __________ Are ducts sealed?: Yes / No Are ducts insulated?: Yes / No
Duct Location 2 (#2): Conditioned Space / Unconditioned basement / Vented crawlspace / Unvented crawlspace /
Unconditioned attic
Percentage of Ducts in this location: __________ Are ducts sealed?: Yes / No Are ducts insulated?: Yes / No
Duct Location 2 (#3): Conditioned Space / Unconditioned basement / Vented crawlspace / Unvented crawlspace /
Unconditioned attic
Percentage of Ducts in this location: __________ Are ducts sealed?: Yes / No Are ducts insulated?: Yes / No

Hot Water:
Water Heater Type: Electric Storage / Natural Gas Storage / LPG Storage / Oil Storage / Electric Instantaneous / Gas
Instantaneous / Propane Instantaneous / Electric Heat Pump
Hot Water System Efficiency:
Do you know the actual water heater energy factor?: Yes (EF) / Yes (UEF) / No*
*You can use the Assessor Calculator to determine the approximate energy factor (EF)!
Energy Factor (between 0.0 – 1.0): ___________________ OR Year Installed: _____________________

Photovoltaic (PV) System
Year Installed: ___________
# of Panels: ____________

Direction Panels Face: N / NE / E / SE / S / SW / W / NW
or

DC Capacity: __________________

Notes:

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Assessment Checklist
General Info:

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Upper Floor
 Square feet
 Ceiling Height
 Skylights?
 Windows

Year
# of bedrooms
Blower door test?
Professionally air sealed?
Window specs?

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Main Floor
 Square feet
 Ceiling Height
 Skylights?
 Windows
 Walls & insulation

Outside

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House Orientation
# of stories
Roof: Predominant exterior finish
 Color

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Walls: Same type on all sides?
 Construction type
 Exterior finish

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Windows: Same on all sides?
 Panes
 Frame
 Glazing

Inside

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Attic
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Roof Construction
Insulation type & amount
Air sealed?
Air handler present? Type and
year
 Ducts?: Insulated? Sealed?

Home Energy Score – Data Collection

Crawlspace - insulation type & amount
 Ducts?: Insulated? Sealed?
Basement – Conditioned?
 Square feet
 Ceiling Height
 Windows
 Walls & insulation

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

HVAC Equipment
 Type?
 Year or SN?
Water Heater
 Type?
 Year or SN?

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PV
 Age
 Orientation
 # of Panels or Capacity

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Window Dimensions:
Front
Back

Right

Left

Layout:

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to facilitate participation in U.S. Department of Energy’s Home Energy Score program. The data you
supply will be used for generating and managing Home Energy Scores and the Score’s associated data.
Public reporting burden for this collection of information is estimated to average one (1) hour 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, Information Collection Management Program (1910-5184), U.S. Department of Energy, 1000
Independence Ave SW, Washington, DC 20585; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction
Project (1910-5184), 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 required for producing Home Energy Scores.

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