OMB Control Number 2040-0272 Approval Expires XXXX 

# Professional Certifying Organization 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: _______________________________ Fax: ______________________________________________

Name of program(s) with the WaterSense label: _______________________________________________________

Approximate number of professionals currently certified under WaterSense labeled program(s): __________________

Section II: Promotional and Recruitment Activities 1. Please indicate what types of WaterSense promotional acti vities you conducted last year and what you plan to implement in 2011.

Activities 2010 2011

Let the public know that they can save water—and money on their utility bills—by hiring WaterSense irrigation partners who have completed your labeled program. Publicize your program in newsletters, local newspapers, Web sites, public service announcements, and at conferences.  

Use the WaterSense label in conjunction with information about your certification program.  

Include a link to the WaterSense Web site on your Web site, along with a description of the WaterSense program and information on the role of certified professionals.  

Educate irrigation professionals on the WaterSense program during instruction provided to prepare for the certification exam.  

Include information about WaterSense in a brochure or fact sheet about your certification program.  

At the location of the certification exam, provide exam takers with a copy of the WaterSense Smart Way to Water Efficient Landscapes brochure.  

Other:  

Section III: 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 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, 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 me thods for minimizing respondent b urden, including through the use of automated collection techniques to the Director, Collection Stra tegies Division, U.S. Environm ental Protection Agency (2822T ), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any co rrespondence. Do not send the completed annual data form to t his address.