DOE F 220.52 Distributuion Transformers Medium Voltage Dry Type

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Overview

Certification
Input
Product Group Codes

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Sheet 1: Certification

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

Version 5.2

DOE F 220.52

Medium-Voltage, Dry-Type Distribution Transformers Based on kVA Grouping

Product Type:

Medium-Voltage, Dry-Type Distribution Transformers Based on kVA Grouping

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.

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Certifier Contact Information

Third Party Representative Contact Information, if Applicable

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Phone Number

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Email Address

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Compliance Statement

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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.

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Sheet 2: Input

Medium-Voltage, Dry-Type Distribution Transformers Based on kVA Grouping	Medium-Voltage, Dry-Type Distribution Transformers Based on kVA Grouping							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.
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".
Line No.	Status	Manufacturer	Brand Name(s)	Least Efficient Model Number in kVA Grouping	Most Efficient Model Number in kVA Grouping	Action	Product Group Code	Sample Size (Number of Units Tested)	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	Is Certification Based on the use of an Alternative Efficiency Determination Method (AEDM)?	kVA Rating	Is the Insulation Type "Medium-Voltage, Dry-Type"?	Number of Phases	Basic Impulse Insulation Level (BIL) Group Rating (kVA)	Represented Efficiency of Least Efficient Model in kVA Grouping (%)	Represented Efficiency of Most Efficient Model in kVA Grouping (%)		Manufacturer Status	Brand Name(s) Status	Least Efficient Model Number in kVA Grouping Status	Most Efficient Model Number in kVA Grouping Status	Action Status	Product Group Code Status	Sample Size (Number of Units Tested) 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	Is Certification Based on the use of an Alternative Efficiency Determination Method (AEDM)? Status	kVA Rating Status	Is the Insulation Type "Medium-Voltage, Dry-Type"? Status	Number of Phases Status	Basic Impulse Insulation Level (BIL) Group Rating (kVA) Status	Represented Efficiency of Least Efficient Model in kVA Grouping (%) Status	Represented Efficiency of Most Efficient Model in kVA Grouping (%) 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	Medium-Voltage, Dry-Type Distribution Transformers Based on kVA Grouping