Form DOE F 220.94 DOE F 220.94 Ceiling Fan Light Kits

Compliance Statement Energy/Water Conservation Standards for Appliances

220.94 TEMPLATE_Ceiling_Fan_Light_Kits_v5.2.xlsx

Manufacturers

OMB:

Document [xlsx]
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Overview

Certification
Input
Product Group Codes

Sheet 1: Certification
OMB Control Number: 1910-1400 (Expiration Date: XXXXXX XX, XXXX)









Version 5.2
DOE F 220.94











Ceiling Fan Light Kits
Product Type: Ceiling Fan Light Kits 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





The party responsible for certification is (select one only):




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






Please enter required data



Please enter required data




















Certifier Contact Information




Third Party Representative Contact Information, if Applicable

















Full Legal Name of Individual
Please enter required data
Full Legal Name of Individual
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Full Legal Name of Company
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Full Legal Name of Company
Please enter required data

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











Select one of the options for 'Submitter - Party Submitting This Report' above















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: XXXXXX XX, XXXX)
























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.

Sheet 2: Input
Ceiling Fan Light Kits Ceiling Fan Light Kits 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.




















































The maximum number of models of lamps and/or SSLs available in this template is 5. If a basic model of Ceiling Fan Light Kit has more than 5 models of lamps and/or SSLs, please contact us at: https://www.regulations.doe.gov/ccms/contact-us.





























































































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". 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". 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". The cells below provide an explanation for "Errors". The cells below provide an explanation for "Errors".








































































































































































Line No. Status Manufacturer of Light Kit Brand Name(s) of Light Kit Basic Model Number of Light Kit Individual Model Number Covered by Basic Model Action Is Light Kit Packaged with Lamps or SSLs Sufficient to Fill All Sockets? If Applicable, Do All Basic Models of Lamps with Pin Based Sockets for Fluorescent Lamps Have Electronic Ballasts? First Basic Model of Lamp or SSL Second Basic Model of Lamp or SSL, if Applicable Third Basic Model of Lamp or SSL, if Applicable Fourth Basic Model of Lamp or SSL, if Applicable Fifth Basic Model of Lamp or SSL, if Applicable
Manufacturer of Light Kit Status Brand Name(s) of Light Kit Status Basic Model Number of Light Kit Status Individual Model Number Covered by Basic Model Status Action Status Is Light Kit Packaged with Lamps or SSLs Sufficient to Fill All Sockets? Status If Applicable, Do All Basic Models of Lamps with Pin Based Sockets for Fluorescent Lamps Have Electronic Ballasts? Status First Basic Model of Lamp or SSL Second Basic Model of Lamp or SSL Third Basic Model of Lamp or SSL Fourth Basic Model of Lamp or SSL Fifth Basic Model of Lamp or SSL
Brand Name(s) of Lamp or SSL Basic Model Number of Lamp or SSL Product Group Code Sample Size (Number of Units Tested) Lumen Output (lm) Efficacy (lm/W) If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only, Enter Data in the Cells Below Brand Name(s) of Lamp or SSL Basic Model Number of Lamp or SSL Product Group Code Sample Size (Number of Units Tested) Lumen Output (lm) Efficacy (lm/W) If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only, Enter Data in the Cells Below Brand Name(s) of Lamp or SSL Basic Model Number of Lamp or SSL Product Group Code Sample Size (Number of Units Tested) Lumen Output (lm) Efficacy (lm/W) If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only, Enter Data in the Cells Below Brand Name(s) of Lamp or SSL Basic Model Number of Lamp or SSL Product Group Code Sample Size (Number of Units Tested) Lumen Output (lm) Efficacy (lm/W) If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only, Enter Data in the Cells Below Brand Name(s) of Lamp or SSL Basic Model Number of Lamp or SSL Product Group Code Sample Size (Number of Units Tested) Lumen Output (lm) Efficacy (lm/W) If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only, Enter Data in the Cells Below
Brand Name(s) of Lamp or SSL Status Basic Model Number of Lamp or SSL Status Product Group Code Status Sample Size (Number of Units Tested) Status Lumen Output (lm) Status Efficacy (lm/W) Status If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? Status For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only Brand Name(s) of Lamp or SSL Status Basic Model Number of Lamp or SSL Status Product Group Code Status Sample Size (Number of Units Tested) Status Lumen Output (lm) Status Efficacy (lm/W) Status If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? Status For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only Brand Name(s) of Lamp or SSL Status Basic Model Number of Lamp or SSL Status Product Group Code Status Sample Size (Number of Units Tested) Status Lumen Output (lm) Status Efficacy (lm/W) Status If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? Status For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only Brand Name(s) of Lamp or SSL Status Basic Model Number of Lamp or SSL Status Product Group Code Status Sample Size (Number of Units Tested) Status Lumen Output (lm) Status Efficacy (lm/W) Status If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? Status For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only Brand Name(s) of Lamp or SSL Status Basic Model Number of Lamp or SSL Status Product Group Code Status Sample Size (Number of Units Tested) Status Lumen Output (lm) Status Efficacy (lm/W) Status If Applicable, Was the Lamp Basic Model Tested by a Laboratory Accredited as Required Under Section 430.25? Status For Basic Models that are Compact Fluorescent Lamps with a Medium Screw Base Only
Lumen Maintenance at 1,000 Hours (%) Lumen Maintenance at 40% of Lifetime (%) Is Lumen Maintenance at 40% of Lifetime Estimated? Lifetime (hours) Is Lifetime Estimated? Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Rapid Cycle Stress Testing (Number of Units Passed) Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Lumen Maintenance at 1,000 Hours (%) Lumen Maintenance at 40% of Lifetime (%) Is Lumen Maintenance at 40% of Lifetime Estimated? Lifetime (hours) Is Lifetime Estimated? Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Rapid Cycle Stress Testing (Number of Units Passed) Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Lumen Maintenance at 1,000 Hours (%) Lumen Maintenance at 40% of Lifetime (%) Is Lumen Maintenance at 40% of Lifetime Estimated? Lifetime (hours) Is Lifetime Estimated? Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Rapid Cycle Stress Testing (Number of Units Passed) Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Lumen Maintenance at 1,000 Hours (%) Lumen Maintenance at 40% of Lifetime (%) Is Lumen Maintenance at 40% of Lifetime Estimated? Lifetime (hours) Is Lifetime Estimated? Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Rapid Cycle Stress Testing (Number of Units Passed) Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Lumen Maintenance at 1,000 Hours (%) Lumen Maintenance at 40% of Lifetime (%) Is Lumen Maintenance at 40% of Lifetime Estimated? Lifetime (hours) Is Lifetime Estimated? Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Rapid Cycle Stress Testing (Number of Units Passed) Is Number of Units Passed in Rapid Cycle Stress Testing Estimated?
Lumen Maintenance at 1,000 Hours (%) Status Lumen Maintenance at 40% of Lifetime (%) Status Is Lumen Maintenance at 40% of Lifetime Estimated? Status Lifetime (hours) Status Is Lifetime Estimated? Status Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Status Rapid Cycle Stress Testing (Number of Units Passed) Status Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Status Lumen Maintenance at 1,000 Hours (%) Status Lumen Maintenance at 40% of Lifetime (%) Status Is Lumen Maintenance at 40% of Lifetime Estimated? Status Lifetime (hours) Status Is Lifetime Estimated? Status Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Status Rapid Cycle Stress Testing (Number of Units Passed) Status Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Status Lumen Maintenance at 1,000 Hours (%) Status Lumen Maintenance at 40% of Lifetime (%) Status Is Lumen Maintenance at 40% of Lifetime Estimated? Status Lifetime (hours) Status Is Lifetime Estimated? Status Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Status Rapid Cycle Stress Testing (Number of Units Passed) Status Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Status Lumen Maintenance at 1,000 Hours (%) Status Lumen Maintenance at 40% of Lifetime (%) Status Is Lumen Maintenance at 40% of Lifetime Estimated? Status Lifetime (hours) Status Is Lifetime Estimated? Status Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Status Rapid Cycle Stress Testing (Number of Units Passed) Status Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? Status Lumen Maintenance at 1,000 Hours (%) Status Lumen Maintenance at 40% of Lifetime (%) Status Is Lumen Maintenance at 40% of Lifetime Estimated? Status Lifetime (hours) Status Is Lifetime Estimated? Status Sample Size for Rapid Cycle Stress Testing (Number of Units Tested) Status Rapid Cycle Stress Testing (Number of Units Passed) Status Is Number of Units Passed in Rapid Cycle Stress Testing Estimated? 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
Fluorescent Lamps 1 Pin-Based Fluorescent Lamps
2 Compact Fluorescent Lamps with a Medium Screw Base
3 General Service Fluorescent Lamps
4 Other Compact Fluorescent Lamps (e.g., Candelabra Base CFL)
5 Other Fluorescent Lamps
Incandescent Lamps 6 General Service Incandescent Lamps
7 Candelabra or Intermediate Base Incandescent Lamps
8 Incandescent Reflector Lamps
9 Other Incandescent Lamps
SSL 10 Integrated LED Lamps
11 Non-Consumer-Replaceable SSL
12 Consumer-Replaceable SSL
All Other 13 All Other Lamps
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