DOE F 220.83 EPS- Spare and Service Part Sales Exempt from Level VI S

OMB Control Number: 1910-1400 (Expiration Date: XXXXXX XX, XXXX)											Version 5.x
DOE F 220.83
External Power Supplies - Spare and Service Part Sales Exempt from Level VI Standards			External Power Supplies - Spare and Service Part Sales Exempt from Level VI Standards						Status of This Certification Sheet	No Data
5.x
									Status of Template	No Data
Each Importer and U.S. Manufacturer of external power supplies that are exempt from energy conservation standards pursuant to 10 CFR Part 430.32(w)(2) must, annually no later than September 1st, submit a report providing the total number of exempt external power supplies sold as spare and service parts, if the total exceeds 1,000 across all models. This party is the "Reporter" on this form. This report may be submitted by the Importer or U.S. Manufacturer or by a Third Party Representative. This party is the "Submitter" on this form.
	Reporter - Party Legally Obligated to Report Sales						Submitter - Party Submitting This Report
	The party responsible for reporting is (select one only):						The party submitting this report is (select one only):
			Please enter required data							Please enter required data
	Reporter Contact Information						Third Party Representative Contact Information, if Applicable
Full Legal Name of Individual				Please enter required data		Full Legal Name of Individual				Please enter required data
Full Legal Name of Company				Please enter required data		Full Legal Name of Company				Please enter required data
Complete Company Mailing Address				Please enter required data		Complete Company Mailing Address				Please enter required data
Phone Number				Please enter required data		Phone Number				Please enter required data
Email Address				Please enter required data		Email Address				Please enter required data
	Number of units of external power supplies exempt from energy conservation standards pursuant to 10 CFR Part 430.32(w)(2) sold during the most recent 12-calendar-month period ending on July 31							Please enter required data. Entry must be an integer greater than 0.
	Beginning month and year of 12-calendar-month period for which the number sold represents							Please enter the required data. Entry must be in the MM/YYYY format.
	Ending month and year of 12-calendar-month period for which the number sold represents							Please enter the required data. Entry must be in the MM/YYYY format.
	Compliance Statement
	Select one of the options for 'Submitter - Party Submitting This Report' above
	Submitter Signature (Type your Full Legal Name)			Please enter required data				Date (MM/DD/YYYY)		Please enter required data
	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.