DOE F 220.93 Uninterruptible Power Supplies

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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 220.93

Uninterruptible Power Supplies

Product Type:

Uninterruptible Power Supplies

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

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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: Input

Uninterruptible Power Supplies	Uninterruptible Power Supplies						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".			The cells below provide an explanation for "Errors".
												Per paragraph (a) of section 4.2.1. of Appendix Y to Subpart B of Part 430, "VFD represents the highest possible input dependency, followed by VI and then VFI". When certifying multi-mode UPS basic models, this hierarchy should be followed and supported input dependency modes should not be repeated in the columns below.					Complete the Cells Below for All UPS Basic Models. For Multi-Mode UPS Basic Models, the Information Entered Below Should Reflect the Lowest Input Dependency Mode.								For Multi-Mode Uninterruptible Power Supplies ONLY, Complete the Cells Below for the Highest Input Dependency Mode. Otherwise, Leave Blank.																								Status for All UPS Basic Models. For Multi-Mode UPS Basic Models, the Staus Reflects the Lowest Input Dependency Mode.								Status for Highest Input Dependency Mode for Multi-Mode Uninterruptible Power Supplies ONLY.
Line No.	Status	Manufacturer	Brand Name(s)	Basic Model Number	Individual Model Number Covered by Basic Model	Action	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	Supported Input Dependency Mode (Lowest if Multi-Mode)	Highest Supported Input Dependency Mode, if Applicable	Third Supported Input Dependency Mode, if Applicable	Rated Input Voltage (Volts)	Rated Output Voltage (Volts)	Product Group Code	Active Power (Watts)	Apparent Power in Volt-Amperes (VA)	Efficiency at 100% of the Reference Test Load	Efficiency at 75% of the Reference Test Load	Efficiency at 50% of the Reference Test Load	Efficiency at 25% of the Reference Test Load, if Applicable	Average Load Adjusted Efficiency	Product Group Code	Active Power (Watts)	Apparent Power in Volt-Amperes (VA)	Efficiency at 100% of the Reference Test Load	Efficiency at 75% of the Reference Test Load	Efficiency at 50% of the Reference Test Load	Efficiency at 25% of the Reference Test Load, if Applicable	Average Load Adjusted Efficiency		Manufacturer Status	Brand Name(s) Status	Basic Model Number Status	Individual Model Number Covered by Basic Model Status	Action 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	Supported Input Dependency Mode (Lowest if Multi-Mode) Status	Highest Supported Input Dependency Mode, if Applicable Status	Third Supported Input Dependency Mode, if Applicable Status	Rated Input Voltage (Volts) Status	Rated Output Voltage (Volts) Status	Product Group Code Status	Active Power (Watts) Status	Apparent Power in Volt-Amperes (VA) Status	Efficiency at 100% of the Reference Test Load Status	Efficiency at 75% of the Reference Test Load Status	Efficiency at 50% of the Reference Test Load Status	Efficiency at 25% of the Reference Test Load, if Applicable Status	Average Load Adjusted Efficiency Status	Product Group Code Status	Active Power (Watts) Status	Apparent Power in Volt-Amperes (VA) Status	Efficiency at 100% of the Reference Test Load Status	Efficiency at 75% of the Reference Test Load Status	Efficiency at 50% of the Reference Test Load Status	Efficiency at 25% of the Reference Test Load, if Applicable Status	Average Load Adjusted Efficiency Status
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Sheet 3: Product Group Codes

The following is a description of each product group code:
Product Group Code	UPS Type	Rated Output Power (also referred to as "Active Power")
1	VFD Uninterruptible Power Supplies	0 W < P <= 300 W
2	VFD Uninterruptible Power Supplies	300 W < P <= 700 W
3	VFD Uninterruptible Power Supplies	P > 700 W
4	VI Uninterruptible Power Supplies	0 W < P <= 300 W
5	VI Uninterruptible Power Supplies	300 W < P <= 700 W
6	VI Uninterruptible Power Supplies	P > 700 W
7	VFI Uninterruptible Power Supplies	0 W < P <= 300 W
8	VFI Uninterruptible Power Supplies	300 W < P <= 700 W
9	VFI Uninterruptible Power Supplies	P > 700 W