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, 20 11. 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 promotio nal activities you conducted last year and what you plan to implement in 2011.

Activities 2010 2011 Include WaterSense promotional label on company Web sit e   Include WaterSense promotional label in company litera ture (e.g., brochures)   Print advertising including WaterSense promotional la bel   Television/radio advertising including mention of Water Sense   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 Wa terSense?

____________________________________________

___________________________________________________ ___________________________________________________ _ Section IV: WaterSense Program Feedback
In the interest of serving you better, EPA would like to learn more about your opinions regarding the Water Sense program and information needs. Please complete the fo llowing section to provide feedback to EPA.
1. On a scale of 1 to 5 (5 = most valuable), how valua ble do you find the WaterSense program? Value: _____

______ How has WaterSense added value? ___________________

__________________________________________ 2. On a scale of 1 to 5 (5 = most valuable), how valu able did you find the materials from the builder too l kit? Value: ______
3. What WaterSense tools did you find most useful? __

_________________________________________________4. Please provide suggestions for improving the WaterS ense program (e.g., tools/materials, communications, H elpline, 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, yo u 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 aver age 18 hours per response. Send comments on the Ag ency's need for this information, the accuracy of the prov ided burden estimates, and any suggested methods fo r minimizing respondent burden, including through t he 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 nu mber in any correspondence. Do not send the comple ted annual data form to this address.