OMB Control Number 2040-0272 

 Approval Expires xx/xx/xxxx 

Builder Partner Annual Reporting 

EPA WaterSense® Program Partners: Please complete and submit to WaterSense by March 1, 2011. 

Section I: General Information 

Organization Name: ___________________________________________________________________________ 

Contact Name: ___________________________ Email: ___________________________________________ 

Telephone: ______________________________ 

Section II: New Homes Information 

1. Number of homes built to a WaterSense specification and labeled in 2010: ___________________________________ 

2. Markets (county, state) where you build homes: ____________________________________________

Section III: Promotional Activities 

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

 implement in 2011. 

Activities 2010 2011 

Include WaterSense promotional label on company Web site  

Include WaterSense promotional label in company literature (e.g., brochures)  

Print advertising including WaterSense promotional label  

Television/radio advertising including mention of WaterSense  

Public signage including WaterSense (e.g., in front of new/model homes or in 

developments) 

 

Other (Please describe: )  

2. At what point in the sales process do you promote WaterSense? ____________________________________________

_______________________________________________________________________________________________________

Section IV: WaterSense Program Feedback 

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 builder tool kit? 

 Value: ______ 

3. What WaterSense tools did you find most useful? ___________________________________________________ 

 
4. 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, 2011. 

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-XX 

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.