DOE F 220.43 Commerical Instantaneous Water Heaters and Hot Water Sup

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Overview

Certification
Headers
Product Group Code

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Sheet 1: Certification

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

Version 5.x

DOE F 220.43

Commercial Instantaneous Water Heaters and Gas-Fired and Oil-Fired Hot Water Supply Boilers

Product Type:

Commercial Instantaneous Water Heaters and Gas-Fired and Oil-Fired Hot Water Supply Boilers

Status of This Certification Sheet

No Data

5.x

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

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Certifier Contact Information

Third Party Representative Contact Information, if Applicable

Full Legal Name of Individual

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Full Legal Name of Individual

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Full Legal Name of Company

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Full Legal Name of Company

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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

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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.

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Sheet 2: Headers

Commercial Instantaneous WH and Hot Water Supply Boilers - v5.x

For Commercial Electric, Gas-Fired, and Oil-Fired Instantaneous Water Heaters and Hot Water Supply Boilers, Complete the Applicable Cells Below

Enter Information in Only One of the Two Columns in Each Row

Does the Manufacturer Elect the Witness Test Option for Verification Testing? (If Applicable)

Is the Rated Storage Volume Greater than 140 Gallons? (if Applicable)

Is the Tank Surface Area Thermally Insulated to at Least R-12.5? (if Applicable)

Is a Standing Pilot Light Used? (if Applicable)

Does the Basic Model Have a Flue Damper or Fan Assisted Combustion? (if Applicable)

Thermal Efficiency (%)

Standby Loss (Btu/hour) (If Applicable)

Rated Input (Btu/hour), if Applicable

Standby Loss (%/hour) (If Applicable)

Is the Rated Input Rate Greater Than 12kW? (if Applicable)

Is the Ratio of Input Rate per Gallon of Stored Water Not Less than 4,000 Btu/h? (if Applicable)

Does the Basic Model Include a Storage Tank with a Storage Volume >= 10 Gallons? (If Applicable)

Method used to Measure Storage Volume ("W" for Weight-Based Test or "C" for Calculation-Based Method) (If Applicable)

Supplemental Testing Instructions PDF Filename (Optional)

Complete the Cells Below Only for Equipment that Does Not Meet the Definition of Storage-Type Instantaneous Water Heaters

For Residential-Duty Commercial Electric Instantaneous Water Heaters, Complete the Cells Below

Column Headers:

Status

Manufacturer

Brand Name(s)

Basic Model Number

Individual Model Number Covered by Basic Model

Private Model Number Covered by Basic Model

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)?

Name of AEDM (If Applicable)

Measured or Rated Storage Volume (gallons) (as applicable)

Will the Water Heater Initiate Main Burner Operation Based on a Temperature-controlled Call for Heating that is Internal to the Water Heater?

Is the Water Heater Equipped with an Integral Pump Purge Functionality?

Default Duration of the Pump Off Delay (minutes) (If Applicable)

Uniform Energy Factor (UEF)

Maximum Gallons per Minute (gpm)

Recovery Efficiency (%)

Pop-Up Headers

Status

Manufacturer

Brand Name(s)

Basic Model Number

Individual Model Number

Private Model Number

Action

Product Group Code

Sample Size

Certification Based on Waiver?

Date of Waiver, if Applicable

Cert. Based on Exception Relief?

Date of Relief, if Applicable

Certification Based on an AEDM?

Name of AEDM, if Applicable

Measured or Rated Storage Volume

Witness Test Option?

Storage Vol >140gal? (if appl)

Insulation >= R-12.5? (if appl)

Standing Pilot Light? (if appl)

Damper/Ass'd Combus'n? (if appl)

Thermal Efficiency

Standby Loss (if Appl)

Rated Input (Btu/hour)

Standby Loss (if Appl)

Rated Input >12 kW? (if Appl)

Ratio Not <4,000 Btu/h? (if App)

Included Storage Tank >=10 Gal?

Storage Volume Measurement

Testing Instructions Filename

Main Burner Operation

Integral Pump Purge

Pump Off Delay

Uniform Energy Factor

Maximum Gallons Per Minute

Recovery Efficiency

Pop-Up Contents

The cells below show whether there are any issues with the data on that line. If the status is "ok," there are no issues. If the status is "Error," there are issues with the data. See columns to the right for an indication of the issues with the data.

Enter the Manufacturer name in the cells below.

Enter the Brand Name(s) in the cells below.

Enter the Basic Model Number in the cells below.

Enter either the Individual Model Number Covered by the Basic Model in the cells below or the Private Model Number Covered by the Basic Model in the next column, but not both.

Enter either the Private Model Number Covered by the Basic Model in the cells below or the Individual Model Number Covered by the Basic Model in the previous column, but not both.

Enter one of following in cells below: N new model ETO engineered to order D discontinued model C correction to previous CCMS submission E submit report on existing (carryover) model F failed Industry Certification Program

Enter an integer between 1 and 13 in the cells below. See the Product Group Codes worksheet for details on product group codes.

Enter the sample size (number of units tested) in the cells below. If the answer to the AEDM question is yes, the entry should be 0, otherwise this should be an integer greater than zero.

Answer whether the certification for the basic model was based on a waiver of DOE's test procedure requirements in the cells below. An affirmative answer can be either 'yes' or 'y' and a negative answer can be either 'no' or 'n'. .

If you enter 'yes' under "Is the certification for this basic model based on a waiver of DOE's test procedure requirements?", enter the date of the waiver in the cells below. The entry should be in the M/D/YYYY format. .

Answer whether the certification was based upon any exception relief from an applicable standard by DOE's Office of Hearing and Appeals in the cells below. An affirmative answer can be either 'yes' or 'y' and a negative answer can be either 'no' or 'n'.

If you enter 'yes' under "Is the certification based upon any exception relief from an applicable standard by DOE's Office of Hearing and Appeals?", enter the date of the exception relief in the cells below. The entry should be in the M/D/YYYY format.

Answer whether the certification was based on the use of an Alternative Efficiency Determination Method. See §429.70 for information on AEDM requirements. An affirmative answer can be either 'yes' or 'y', a negative answer can be either 'no' or 'n'.

If you enter 'yes' under "Is Certification Based on the use of an Alternative Efficiency Determination Method (AEDM)?", enter the name of the AEDM in the cells below.

Enter Measured or Rated Storage Volume in gallons below. For models >140 gallons, entry is optional if the tank insulation is >=R-12.5, no standing pilot light is used, and it has a flue damper or fan assisted combustion.

For basic models rated with an AEDM, answer whether the manufacturer elects the witness test option for verification testing in the cells below (max. 10% of basic models) An affirmative answer can be 'yes' or 'y' and a negative answer can be 'no' or 'n'.

For models with a storage capacity greater than 140 gallons ONLY, answer whether the rated storage volume is greater than 140 gallons in the cells below. An affirmative answer can be 'yes' or 'y' and a negative answer can be 'no' or 'n'.

For models with a storage capacity greater than 140 gallons ONLY, answer whether the tank surface area is thermally insulated to at least R-12.5 in the cells below. An affirmative answer can be 'yes' or 'y' and a negative answer can be 'no' or 'n'.

For gas and oil-fired models with a storage capacity greater than 140 gallons ONLY, answer whether a standing pilot light is used in the cells below. An affirmative answer can be 'yes' or 'y' and a negative answer can be 'no' or 'n'.

For gas/oil-fired models w/ storage capacity greater than 140 gallons ONLY, answer whether the basic model has a flue damper or fan assisted combustion in the cells below. An affirmative answer can be 'yes' or 'y', a negative answer can be 'no' or 'n'.

Enter the Thermal Efficiency in percent in the cells below. This should be a percentage greater than zero and less than or equal to 100. For electric models, entry should be 98 (per Appendix D to Subpart G of 10 CFR Part 431).

For gas/oil-fired models >=10 gal only, enter Standby Loss in Btu/h below. Entry should be >0. For models >140 gal, entry is optional if tank insulation is >=R-12.5, no standing pilot light is used, & it has a flue damper or fan assisted combustion.

For Gas/Oil-Fired Inst. WHs & Hot Water Supply Boilers only, enter Rated Input in Btu/hour. Entry should be >0. For models >140 gal., entry optional if tank insul. >=R-12.5, no standing pilot light used, and has flue damper or fan assisted combustion.

For electric models >=10 gal only, enter Standby Loss in %/h below. The entry should be >0. For models >140 gal, entry is optional if tank insulation is >=R-12.5.

For Electric Instantaneous WHs only, enter whether the rated input rate is greater than 12 kW in the cells below. An affirmative answer can be 'yes' or 'y', a negative answer can be 'no' or 'n'.

For Electric Instantaneous WHs only, enter whether the Ratio of Input Rate per Gallon of Stored Water Not Less than 4,000 Btu/h in the cells below. An affirmative answer can be 'yes' or 'y', a negative answer can be 'no' or 'n'.

For models w/storage CAPACITY>=10 gal only, does WH include a storage TANK w/storage VOLUME >=10 gal? Heat exchanger volume not included. Hot water supply boilers should enter 'no'. Affirmative answer can be 'yes' or 'y', negative can be 'no' or 'n'.

For models with a storage TANK < 10 gallons only, enter the method used to measure the storage volume. Enter "W" if the weight-based test was used or "C" if the calculation-based method was used.

If elected, enter the name of the PDF file containing the supplemental testing instructions. The first 7 characters of the filename must be in the form of "DOExxxx" where "xxxx" is a four-digit numerical code assigned to the manufacturer.

Answer whether the water heater will initiate main burner operation based on a temperature-controlled call for heating that is internal to the water heater. An affirmative answer can be 'yes' or 'y' and a negative answer can be 'no' or 'n'.

Answer whether the water heater is equipped with integral pump purge functionality? An affirmative answer can be 'yes' or 'y' and a negative answer can be 'no' or 'n'.

If the water heater is equipped with integral pump purge functionality, enter the default duration of the pump off delay in minutes. This should be a decimal greater than or equal to 0.

Enter the Uniform Energy Factor in the cells below. This should be a decimal number greater than zero.

Enter the Maximum Gallons per Minute in the cells below. This should be a decimal number greater than zero.

Enter the Recovery Efficiency in percent in the cells below. This should be a percentage greater than zero.

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Sheet 3: Product Group Code

The following is a description of each product group code:
Product Group Code	Product Group Code Description
1	Commercial Electric Instantaneous Water Heaters with Storage Capacity < 10 gallons
2	Commercial Electric Instantaneous Water Heaters with Storage Capacity >= 10 Gallons & <= 140 Gallons
3	Commercial Electric Instantaneous Water Heaters with Storage Capacity > 140 Gallons
4	Commercial Gas-Fired Instantaneous Water Heaters & Hot Water Supply Boilers with Storage Capacity < 10 Gallons
5	Commercial Gas-Fired Instantaneous Water Heaters & Hot Water Supply Boilers with Storage Capacity >= 10 Gallons & <= 140 Gallons
6	Commercial Gas-Fired Instantaneous Water Heaters & Hot Water Supply Boilers with Storage Capacity > 140 Gallons
7	Commercial Oil-Fired Instantaneous Water Heaters & Hot Water Supply Boilers with Storage Capacity < 10 Gallons
8	Commercial Oil-Fired Instantaneous Water Heaters & Hot Water Supply Boilers with Storage Capacity >= 10 Gallons & <= 140 Gallons
9	Commercial Oil-Fired Instantaneous Water Heaters & Hot Water Supply Boilers with Storage Capacity > 140 Gallons
10	Residential-Duty Commercial Electric Instantaneous Water Heaters with Input > 12 kW & <= 58.6 kW, Storage Capacity <= 2 Gallons, & Very Small Draw Pattern
11	Residential-Duty Commercial Electric Instantaneous Water Heaters with Input > 12 kW & <= 58.6 kW, Storage Capacity <= 2 Gallons, & Low Draw Pattern
12	Residential-Duty Commercial Electric Instantaneous Water Heaters with Input > 12 kW & <= 58.6 kW, Storage Capacity <= 2 Gallons, & Medium Draw Pattern
13	Residential-Duty Commercial Electric Instantaneous Water Heaters with Input > 12 kW & <= 58.6 kW, Storage Capacity <= 2 Gallons, & High Draw Pattern