DOE F 220.100 Air Cleaners

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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 5.0

DOE F 220.100

Air Cleaners

Product Type:

Air Cleaners

Status of This Certification Sheet

No Data

5.0

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):

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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

Select one of the options for 'Submitter - Party Submitting This Report' above

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

Air Cleaners v5.0

Column Headers:

Status

Manufacturer

Brand Name(s)

Basic Model Number

Individual 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

Smoke Clean Air Delivery Rate (CADR) (cfm)

Dust CADR (cfm)

PM2.5 CADR (cfm)

Annual Energy Consumption (kWh/yr)

Integrated Energy Factor (PM2.5 CADR per watt)

Effective Room Size (square feet)

Pop-Up Headers:

Status

Manufacturer

Brand Name(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

Smoke CADR

Dust CADR

PM2.5 CADR

Annual Energy Consumption

Integrated Energy Factor

Room Size

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 3 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. 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 smoke clean air delivery rate (CADR) in cubic feet per minute (cfm) in the cells below. This should be a decimal number greater than zero.

Enter the dust clean air delivery rate (CADR) in cubic feet per minute (cfm) in the cells below. This should be a decimal number greater than zero.

Enter the particulate matter that is 2.5 micrometers or smaller (PM2.5) clean air delivery rate (CADR) in cubic feet per minute (cfm) in the cells below. This should be a decimal number greater than zero.

Enter the Annual Energy Consumption in kWh/year in the cells below. This should be a decimal number greater than zero.

Enter the Integrated Energy Factor in PM2.5 CADR per watt in the cells below. This should be a decimal number greater than zero.

Enter the room size in square feet below. This should be a decimal number 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	10 ≤ PM2.5 Clean Air Delivery Rate < 100
2	100 ≤ PM2.5 Clean Air Delivery Rate < 150
3	PM2.5 Clean Air Delivery Rate ≥ 150