Form DOE F 413.16 DOE F 413.16 Membership Form

DOE HQ F 413.16

OMB Control #:  1910-5184

Exp. Date:  7/31/2023

BETTER BUILDINGS RESIDENTIAL NETWORK

The Better Buildings Residential Network connects energy efficiency programs and partners to share best practices and learn from one another to increase the number of homes that are energy efficient. Residential Network membership is open to all organizations that are committed to accelerating the pace of home energy upgrades.

Better Buildings Residential Network Benefits

As the Better Buildings Residential Network convener, the U.S. Department of Energy is committed to providing the following benefits to Network members:

• Tools, templates, resources, and proven solutions shared by members.

• Opportunities to be featured in newsletters, media, websites, case studies, and lessons learned materials.

• Voluntary member initiatives that address common challenges and opportunities (e.g., incentives).

• Updates on the latest news and residential energy efficiency trends.

Residential Network Member Commitments

Sales of services and commercial messages are not appropriate during any Residential Network meeting, call, or on any forum, discussion list, or online area. The signatory acknowledges that the U.S. Department of Energy (DOE) and Better Buildings Residential Network names or likeness may not be used in any way that implies endorsement of a private company, service, or product. The Better Buildings Residential Network name may be used to reference an entity’s membership (e.g., within a newsletter, on a website). For example, you can note that your organization is a “U.S. Department of Energy Better Buildings Residential Network Member” alongside other partnerships or affiliations.

As an authorized representative of this organization, I agree that the organization will:

• Assign an organizational representative as the primary point of contact for the Better Buildings Residential Network.

• Invite all relevant members of the organization to participate in Residential Network activities and Peer Exchange Calls.

• Share the organization’s successes with DOE and other members of the Residential Network.

• Provide DOE with an annual update of the organization’s residential energy upgrades and information about the benefits associated with those upgrades.*

• Abide by the commitments outlined above.

Primary Contact:	Date:
Organization Name:

*Home Performance with ENERGY STAR Sponsors meet this obligation through those initiatives.

Membership Form (continued)

Organization Information

Address:
City/State/Zip:
Website:	LinkedIn Page:
Facebook Page:	Blog(s):
Social Media Handles (e.g., Twitter, Pinterest, etc.):

Primary Contact Information

Name:			Title:
Telephone:	Email:
Subscribe to Peer Exchange Call information:	☐	Yes	☐	No
Subscribe to Network View newsletter:	☐	Yes	☐	No

Additional Organization Contacts

Contact 1

Name:			Title:
Telephone:	Email:
Subscribe to Peer Exchange Call information:	☐	Yes	☐	No
Subscribe to Network View newsletter:	☐	Yes	☐	No

Contact 2

Name:			Title:
Telephone:	Email:
Subscribe to Peer Exchange Call information:	☐	Yes	☐	No
Subscribe to Network View newsletter:	☐	Yes	☐	No

Contact 3

Name:			Title:
Telephone:	Email:
Subscribe to Peer Exchange Call information:	☐	Yes	☐	No
Subscribe to Network View newsletter:	☐	Yes	☐	No

Membership Form (continued)

Additional Organization Information

Type of organization (Check all that apply)

☐	Consultant/Advisor	☐	Nonprofit organization
☐	Contractor/Trade ally	☐	Program administrator or implementer
☐	Financial institution	☐	Retailer
☐	Foundation	☐	University
☐	Government - Local	☐	Utility
☐	Government - State	☐	Other:
☐	Manufacturer

Are you already a DOE Partner or Sponsor in one of the following? (Check if applicable)

☐	Better Buildings Alliance Member	☐	Building America Team Member
☐	Better Buildings Challenge Partner or Ally	☐	Home Energy Score Partner
☐	Better Buildings Neighborhood Program Grant Recipient	☐	Home Performance with ENERGY STAR Participating Contractor
☐	Better Buildings Neighborhood Program Partner	☐	Home Performance with ENERGY STAR Sponsor

Role in the marketplace (Check all that apply)

☐	Hands-on, in buildings	☐	Conduct research
☐	Program design and implementation	☐	Involved in training
☐	Develop, manufacture, and/or distribute products and materials	☐	Advise others
		☐	Other:
Does your organization directly facilitate or complete residential energy efficiency upgrades?				☐ Yes	☐ No

How did you hear about the Better Buildings Residential Network?

Newsletter:				☐	From a Residential Network Member or other word of mouth (please list contact’s name):
☐	Better Buildings newsletter			☐	DOE or other website:
☐	Other DOE or non-DOE newsletter:			☐	Other:
May we use your company logo on websites and printed material for reports and presentations?
☐ Yes		☐ No	If yes, please send a logo with this membership form.

What topics would you like to see the Residential Network address?

Learn more at betterbuildings.energy.gov/bbrn

This data is being collected to organize a network of residential energy efficiency programs and partners to engage the market via an ongoing basis to facilitate more effective planning, operating, and evaluation of their programs, based on experiences from DOE grantees and partners, Home Performance with ENERGY STAR® Sponsors, and others so they benefit from past lessons learned and not operating in isolation, as well as for DOE to be aware of changes in the market in the form of new opportunities and early warning signals. The data you supply will be used for gaining information about actors in the field, their impact, needs, and ideas to inform DOE functions, identification of gaps, development of tools and resources and programming.

Public reporting burden for this collection of information is estimated to average 15 minutes 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 voluntary.