EPA ICR No. 2450.01; OMB Control No. 2070-NEW

ATTACHMENT B

Design for the Environment Safer Product Labeling Program 

Partner of the Year Application Form
EPA Form TBD Page 1 of 6

Design for the Environment (DfE)

Safer Product Labeling Program 

Partner of the Year Awards 

Instructions for Application Form

EPA developed The Partner of the Year Awards to recognize DfE stakeholders who have 

furthered the safer chemistry goals of the DfE Safer Product Labeling Program through their 

active and exemplary participation in and promotion of the program. Making DfE’s mission 

known to the widest possible audience, through its safer product label and in other forms of

communication, is critical to fully realizing the program’s goals of protecting human health and 

the environment, promoting a sustainable economy, and creating green jobs, especially in the 

small business sector. DfE anticipates that selecting the Partner of the Year will be a challenging 

task. Applicants with outstanding applications that do not win the Partner award may receive 

an honorable mention. 

The Partner of the Year Awards will be an annual event, with recognition for DfE stakeholder 

organizations from five broad categories: (1) Formulators/Product Manufacturers (of both 

consumer and Institutional/Industrial (I/I) products), (2) Purchasers and Distributors, (3) 

Retailers, (4) Supporters (e.g., non-governmental organizations, including environmental and 

health advocates, trade associations, academia, sports teams, and others), and (5) Innovators

(e.g., chemical manufacturers, technology developers, and others). Within these categories, DfE 

may elect to give an additional award in the subcategories of “small business” and “sustained 

excellence.” Organizations that wish to apply in more than one award category must complete 

individual application packages. 

To be eligible for recognition, candidates 

should complete this application and have 

it signed by an appropriate company or 

organization official (e.g., CEO or vice 

president for government relations ). 

EPA reserves the right to request at any 

time additional documentation to confirm 

that candidates have achieved the criteria 

for recognition. If documentation is 

requested but not received within a 

reasonable time (e.g., X days), EPA may 

deny or withdraw recognition.

Application Process: The application is 

available online and may be filled out and 

submitted in hard copy by mail, faxed, or 

scanned and emailed to 

DfEPartner@epa.gov. All applications 

received will be considered public 

information and no materials submitted will 

be returned. If you choose to send the 

application electronically, the application 

and signed signature page must be scanned 

and sent to DfEPartner@epa.gov.

To be eligible for the awards, which may be 

announced as soon as fall 2012, candidates 

would need to submit their application by 

summer 2012 [date to be determined]. 

Supplemental documents such as photos, 

pamphlets, copies of advertisements, 

videos, audio files, etc. may be sent with 

your application as PDF files (each file must 

be less than 12MB). If necessary, you can 

mail hard copies of supplemental material 

to the following address maintained by our 

contractor (EPA Contract No. 

XXXXXXXXX):

Design for the Environment

Safer Product Labeling Program

Partner of the Year Awards

c/o Abt Associates Inc.

Attn: Aviva Loew

4550 Montgomery Avenue, Suite 800 North
EPA Form TBD Page 2 of 6

Bethesda, MD 20814-5341

P: 301-347-5517

F: 617-386-8090

Confirmation of Receipt: You will receive an 

email within one week confirming any 

materials you submit. It will be sent to the 

Primary Communications contact in the 

award application. If you do not receive 

confirmation within one week, please 

contact the DfE Partner Awards lead, 

Bridget Williams, at 

williams.bridget@epa.gov or 202-564-8558.

Notification: You may be notified as soon as 

early fall 2012 of the status of your 

application. 

Questions: Questions about eligibility, 

nomination procedures, or Design for the 

Environment should be directed to Bridget 

Williams of EPA’s Design for the 

Environment Program at 

williams.bridget@epa.gov or 202-564-8558.

Paperwork Burden Estimate 

The public reporting and recordkeeping 

burden for this collection of information is 

estimated to average 15 hours per 

response, including the time for reviewing 

instructions, gathering information, and 

reviewing and completing the application. 

An agency may not conduct or sponsor, 

and a person is not required to respond to, 

a collection of information unless it displays 

a currently valid OMB control number. The 

OMB control number for this collection is 

2070-xxxx. Approval expires on DATE.

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 application to 

this address.
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EPA Form TBD Page 3 of 6

Design for Environment 

SECTION 1a:

Enter requested 

information for the 

authorized 

representative

Organization Name

Contact Name

Address

City, State, Zip

Phone Fax

Email

Website

SECTION 1b:

Indicate your type of 

organization

Formulators/Product Manufacturers – both Consumer and 

Industrial/Institutional (Complete items 1-5 in Section 2)

Purchasers and Distributors (Complete items 3-5 in Section 2)

Retailers (Complete items 3-5 in Section 2)

Supporters – e.g. non-governmental organizations, including environmental 

and health advocates, trade associations, academia, sports teams, and 

others who promote DfE and the development and use of safer product 

formulations (Complete items 3-5 in Section 2)

Innovators – e.g., chemical manufacturers, technology developers, and 

others who create innovative ways to advance the goals of the DfE Safer 

Product Labeling Program (Complete items 4-5 in Section 2)

SECTION 1c: 

Indicate whether your 

organization is a 

small business. To 

qualify as a small 

business, your 

business must meet 

the criteria in the 

Regulatory Flexibility 

Act / Small Business 

Regulatory 

Enforcement Fairness 

Act (RFA/SBREFA)1

Yes

No

1For more information, please visit the RFA/SBREFA website at http://www.epa.gov/sbrefa/
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EPA Form TBD Page 4 of 6

SECTION 2:

As part of its environmental mission, the DfE Safer Product Labeling Program partners with 

businesses and others to reduce health and environmental risks by advancing the 

manufacture and use of safer products and technologies. Toward this end, DfE increases 

awareness of the toxicological properties of chemicals through the replacement of chemicals of 

potential concern with safer alternatives. DfE allows the use of its logo on products that 

perform well and contain the safest possible ingredients, as determined by expert evaluation of 

the best available science. DfE recognition represents the highest level of achievement in 

formulating products that are safer for families and the environment. 

Making DfE’s mission known to the widest possible audience is key to fully realizing the 

program’s goals and potential. The purpose of the Partner of the Year award is to recognize 

stakeholders who have made exceptional contributions to advancing DfE’s mission.

Evaluation criteria:

Criteria for evaluating applications for this award are listed below. In addition, each applicant 

will be screened to determine their history of civil or criminal EPA enforcement actions. 

Results of this screening will be factored into the winner selection process.

Please describe your company’s or organization’s activities and accomplishments in furthering 

DfE’s mission. Your narrative should:

 Be no more than three pages, but may be accompanied by samples of specific 

promotions, advertisements, or other activities your organization. 

 Describe your company’s or organization’s recent activities and accomplishments in 

as much detail as possible.

 Cumulative accomplishment statements may be included in the Accomplishments 

Narrative, but data specific to the past year’s activities must be highlighted. When 

discussing cumulative accomplishments, ensure that you include a time frame (e.g., 

reduced the use of chemicals of concern by 100,000 pounds in 2011, and more than 

3,000,000 pounds since 2003). 

 Use the information elements in the listed in the table below to guide development of 

your narrative. 

Tips for Success:

There are a few steps you can take to ensure a successful application. 

 Partner of the Year Awards are based on activities that increase awareness of the DfE 

Safer Product Labeling Program, DfE-labeled products, and the program’s mission to 

help safeguard human and environment health through safer chemistry. While general 

education on the importance of safer chemicals is valued, your application should focus 

on your specific activities and accomplishments to promote the use of DfE-labeled 

products and your actions to advance the program. 

 Be sure to provide measurable results in your written statement—e.g., number of DfE -

labeled products sold, people reached, advertisements run, signs posted, newsletters 

distributed, etc.
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EPA Form TBD Page 5 of 6

In your Accomplishments Narrative, address the questions appropriate to your organization 

type:

Formulators/Product 

Manufacturers1

Complete items 1-5

1. Participation in the DfE Safer Product Labeling Program (Applicants 

must address each of the following items.)

 Number of DfE-labeled products and percentage change over 

previous year. 

 Percentage of product line that is DfE-labeled and percentage 

change over previous year.

 Percentage of total sales that were DfE-labeled and percentage 

change over previous year.

 Information on leadership in DfE-labeled products, including a 

brief description of any safer chemistry innovations in the 

product design (e.g., use of a green-chemistry-award-winning 

ingredient or chemistry that furthers other environmental goals 

like energy efficiency). 

2. Use of the DfE Label

 Confirm that the DfE logo is used appropriately on products, 

packaging, website and other materials (N.B., the logo must appear 

with the DfE tag line and web address. Consult the DfE Welcome 

Handbook for guidance on proper logo use.)

 Indicate the percentage of DfE - recognized products that carry the 

DfE logo and the location of the logo on containers (front, back or 

cap).

 Provide information on labeling that goes beyond the basic 

requirements, for example, unique or prominent use of the DfE 

logo on products or packaging.

 Provide examples or pictures to illustrate DfE logo use.

3. Promotion and Use of DfE-labeled Products 

 Describe your efforts to promote or use DfE-labeled products; 

examples include: featuring DfE in exhibits at industry tradeshows, 

presentations and other communications; using DfE-labeled 

products to clean homes, stores and facilities; and, advocating for 

use of labeled products. 

 Indicate if you have led or participated in cooperative promotions of 

the DfE label, such as in-store or web-based notices or advertising.

 For each significant promotion or use, include information on the 

role of participants and the duration, reach, and outcomes.

 Submit examples of print, radio, television, or direct-mail 

advertising, as appropriate.

4. Communications on DfE to Consumers and End-Users 

 Describe your DfE-themed outreach or advocacy activities and 

messaging; for example, public relations efforts, special events, 

press releases, etc.

 Submit good examples of outreach and advocacy efforts; for 

Purchasers and 

Distributors; Retailers

Complete items 3-5

Supporters; 

Innovators

Complete items 4-5

 

1

All current DfE Partners may apply. Please note that to be eligible for the Partner of the Year award, 

partners must be in compliance with all applicable requirements in the DfE Partnership Agreement.
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example, brochures with DfE messages and logo; incorporation of 

DfE logo and messaging on company website; development of 

technology or computer application that educates the public on 

and promotes the use of safer products or environmental 

messaging in general.

 Include information on audience, frequency, and reach, and 

pictorial examples like Web shots or ads.

5. Innovations in Safer Chemistry and Other Efforts to Advance DfE 

and Environmental Protection 

 Describe your efforts/successes in developing safer chemicals for 

use in DfE-labeled products (include number of chemicals in 

Cleangredients database or used in DfE - labeled products).

 Discuss your leadership of or participation in activities related to 

new or existing DfE projects (beyond safer product labeling).

 Provide examples of your organization’s commitment to chemicalrisk-reduction activities or other environmental and health 

protection/stewardship initiatives.

SECTION 3:

Certification of 

Application

Please have the appropriate company or organization official (e.g., CEO, vice 

president for government affairs, division head, or other authorized signatory) sign 

here to verify the accuracy of the application.

Signature of Authorizing Entity Date

Printed Name and Title Date

I hereby affirm that the contents of this application are true and accurate to the best of my 

knowledge, and that I am a representative of the company or organization named above and 

am duly authorized to sign on its behalf.