DOE F 220.9 Residential Clothes Washers Appendix J

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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) OMB Control Number: 3084-0069 (Expiration Date: April 30, 2027)

Version 5.x

DOE F 220.9

Residential Clothes Washers

Product Type:

Residential Clothes Washers

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

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

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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

Please enter required data

Complete Company Mailing Address

Please enter required data

Complete Company Mailing Address

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Phone Number

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Phone Number

Please enter required data

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)

Please enter required data

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.

OMB Control Number: 3084-0069 (Expiration Date: April 30, 2027)

Paperwork Reduction Act Statement

OMB Burden Disclosure Statement

This data is being collected for manufacturers to report required information to the Federal Trade Commission. This information is shared with the public for the purpose of encouraging consumers to comparison shop for energy-efficiency household products. Public reporting burden for this collection of information is estimated to average from 2 minutes per year per basic product model to 15 hours per year per manufacturer, 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 Division of Enforcement, Bureau of Consumer Protection, Federal Trade Commission, 600 Pennsylvania Avenue NW, Washington, DC 20580; and to the Office of Management and Budget (OMB), OIRA, New Executive Office Building, Docket Library Room 10102, 725 17th Street NW, Washington, DC 20503, Attn: Desk Officer for the Federal Trade Commission. 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 required by the Federal Trade Commission; submission through CCMS is optional.

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Sheet 2: Headers

Residential Clothes Washers Appendix J - v5.x

Column Headers:

Status

Manufacturer

Brand Names(s)

Basic Model Number

Individual Model 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

Energy Efficiency Ratio (pounds per kilowatt hour per cycle)

Clothes Container Capacity (cubic feet)

Water Efficiency Ratio (pounds per gallon per cycle)

Corrected Remaining Moisture Content (%)

Type of Control System

Type of Loading

In the cells below, enter the name of the Cycle and the Temperature Setting corresponding to each of the applicable cycle selections used for the Energy Test. For each row, an entry must be made in at least one of the columns.

Test Cloth Lot Number

Link to EnergyGuide Label Website (Enter link or, if submitting link later, enter 'By annual report date')

Cold/Cold

Warm/Cold #1

Warm/Cold #2

Warm/Warm #1

Warm/Warm #2

Hot/Cold

Extra Hot/Cold

Pop-Up Headers

Status

Manufacturer

Brand Names(s)

Basic Model Number

Individual 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

Energy Efficiency Ratio

Clothes Container Capacity

Water Efficiency Ratio

Corr'd Remain'g Moisture Content

Control System Type

Type of Loading

Cold/Cold

Warm/Cold #1

Warm/Cold #2

Warm/Warm #1

Warm/Warm #2

Hot/Cold

Extra Hot/Cold

Test Cloth Lot Number

Link to EnergyGuide Label

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 the Individual Model Number covered by the Basic Model in the cells below.

Enter one of following in cells below: N new model 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 5 in the cells below. See the Product Group Code worksheet for details on product group codes.

Enter the sample size (number of units tested) in the cells below. 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.

Enter the Energy Efficiency Ratio in pounds per kilowatt hour per cycle. This should be a decimal number greater than zero.

Enter the Clothes Container Capacity in cubic feet in the cells below. This should be a decimal number greater than zero.

Enter the Water Efficiency Ratio in pounds per gallon per cycle. This should be a decimal number greater than zero.

Enter the Corrected Remaining Moisture Content expressed as a percentage in the cells below. This should be a percentage greater than 0 and less than or equal to 100.

Enter the type of control system (automatic or semi-automatic).

Enter the the type of loading ('top-loading' or 'front-loading') in the cells below.

If the Cold/Cold cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

If the Warm/Cold #1 cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

If the Warm/Cold #2 cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

If the Warm/Warm #1 cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

If the Warm/Warm #2 cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

If the Hot/Cold cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

If the Extra Hot/Cold cycle is used for the Energy Test, enter the name of the Cycle and the Temperature Setting in the cells below.

Enter the Test Cloth Lot Number used for certification testing in the cells below.

Per 16CFR305, enter URL for EnergyGuide label. May be URL for label, link to PDF download, or link to database with label. Entry must begin with http://, https://, ftp:// or sftp:// or if URL will be submitted later, enter 'By annual report date'.

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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	Automatic, top-loading, ultra-compact (less that 1.6 ft3 capacity)
2	Automatic, top-loading, standard-size (1.6 ft3 or greater capacity)
3	Automatic, front-loading, compact (less than 3.0 ft3 capacity)
4	Automatic, front-loading, standard-size (3.0 ft3 or greater capacity)
5	Semi-automatic clothes washers