OMB Control Number 2040-0272 

 Approval Expires 01/31/2010 

Promotional Partner Annual Reporting 

EPA WaterSense® Program Partners: Please complete and submit to WaterSense by March 1, 2010. 

Section I: General Information 

Organization Name: _____________________________________________________________________________ 

Contact Name: ____________________________ Email: ____________________________________________ 

Telephone: _______________________________ If water provider, population served: ______________________

Section II: Promotional Activities 

1. Please indicate what types of WaterSense promotional activities you conducted last year and what you plan to 

 implement in 2010. 

Activities 2009 2010 

Web site promotion with link to WaterSense  

Print advertising  

Television/radio advertising  

Newsletter or trade journal article (Journal: date: )  

Consumer handouts  

Public signage (Type: e.g., billboards, bus stops)  

Exhibit(s) at public fair, conferences, events  

Bill insert  

Workshops for consumers  

Workshops/training for contractors  

Presentation(s) to schools, community groups, etc.  

Promotion of WaterSense irrigation partners  

Recruitment of new WaterSense partners  

Incentive programs (e.g., tax-free holidays, rebates):  

Other (Please describe: )  

2. If you participated in the 2009 Fix a Leak Week (Mar. 16-20), please describe your activities: 

3. To help WaterSense plan for the future, please describe your efforts in other water conservation areas such as 

 commercial programs and plumber outreach: 
Section III: Incentive Programs 

Please provide the following information for each incentive amount and quantity issued between January 1, 2009, and 

December 31, 2009. If you have a tracking sheet, feel free to attach it to this form. 

Type of Product 

Type of Incentive 

(e.g., rebate, giveaway, 

tax-free holiday) 

Number of Incentives Issued 

 WaterSense Non-WaterSense Combination

Toilets* 

Bathroom Sink Faucets 

Bathroom Sink Aerators or other faucet 

accessories 

Other 

 

* Only toilets that are ≤ 1.28 gpf can earn the WaterSense label, though not all ≤ 1.28 gpf (high-efficiency) toilets are 

WaterSense labeled. Please refer to the WaterSense labeled product list at www.epa.gov/watersense. 

Section IV: WaterSense Program Feedback (Optional) 

In the interest of serving you better, EPA would like to learn more about your opinions regarding the WaterSense 

program and information needs. Please complete the following section to provide feedback to EPA. 

1. On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? Value: ____________ 

 How has WaterSense added value? _______________________________________________________________ 

2. On a scale of 1 to 5 (5 = most valuable), how valuable did you find the materials from the promotional tool kit? 

 Value: ______ 

3. Please provide suggestions for improving the WaterSense program (e.g., tools/materials, communications, Helpline, 

Web site, etc): 

Please submit to the WaterSense Helpline by March 1, 2010. 

Fax: (703) 841-1440

Mail: 2300 Wilson Blvd., Ste. 350, Arlington, VA 22201 

Electronically: If you have Adobe Acrobat Standard or Professional, you can complete the form electronically and 

e-mail it to watersense@epa.gov. Acrobat Reader users must print forms after completing and fax or mail them. 

Contact the WaterSense Helpline at (866) 987-7367 if you have any questions about how to complete this form or 

submission instructions. 

EPA Form Number 6100-09 

The public reporting and record keeping burden for this collection of information is estimated to average 18 hours per response. Send comments on the Agency's 

need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use 

of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, 

Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed annual data form to this address.