OMB Control Number 204 0- 0272

Approval Expires 0 6 /3

0

/201 3



# Irrigation Controller Manufacturer Annual Reporting 2013

WaterSense ® Manufacturer Partners: Please complete and submit this form to U.S. Environmental Protection Agency (EPA) contractor Eastern Research

Group, Inc. (ERG) by February 1 5, 201 3.

Note on C onfidentiality of D ata: Sensitive business information may be claimed confidential under 40 CFR Part 2, Subpart B. ERG has an EPA

- approved

security plan in place to protect confidential business information from unauthorized disclosure. All data submitted as confidential will be handled as such. All

data will be presented to EPA in aggregate.



### Please send a completed hard copy of this form to the address below by February 1 5, 201 3

.

Mail: EPA WaterSense Annual Reporting, c/o ERG Phone : Call (866) 987

- 7367 if you have any questions about

2300 Wilson Boulevard, Suite 350 how to complete or submit this form.

Arlington , VA 22201

D o NOT submit this form via email or fax

.

ALL WaterSense manufacturer partners that joined WaterSense before January 1, 2013 should complete and submit

Sections I and II of th is reporting form and any required product

- spec ific sections, regardless of whether your products

have earned the WaterSense label

.

Section I: General Information

Manufacturer Name on Partnership Agreement :

_______________________________________________________________ If you do not yet have a partnership agreement, please contact the WaterSense Helpline at (866) 987

- 7367 to complete one.



### Contact Name (for questions regarding this form) :

______________________________________________________________ Please provide a U.S. contact

, if possible.



### Email:

_______________________________________________________ P hone :

_______________________________

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 n umber found in the top right

corner of this page in any correspondence. Do not send the completed annual reporting form to this add ress.1

2

3

4 Manufacturer Name on Partnership Agreement:

______________________________________________________________________________________ 

### Section II: Irrigation Controllers

A. Product Shipment Data

I nclude data for products shipped to or within the United States for the period between January 1, 2012, and December 31, 2012.

Please report the number of units ( e.g., individual controllers ) shipped rather than the number of models or model lines produced

. For weather

- based irrigation

controllers, please include data on add

- on, plug

- in, and standalone controllers.

Do NOT include replacements for parts damaged during shipping in any row below.

shipment data ; do not round. ) confidential? All Controllers

Total number of clock timer controllers shipped ?

Note: Clock timer controllers are not currently eligible for the WaterSense label.

Total number of soil moisture sensors shipped?

Note: Soil moisture sensors are not currently eligible for the WaterSense label.

Total number of weather

- based controllers shipped ?

Note: Count ALL weather

- based controllers shipped, including both WaterSense labeled and

non

- WaterSense labeled controllers.

Total number of WaterSense labeled weather

- based controllers shipped ? U.S. Total

(Please submit EXACT Claim as

 Yes  No

 Yes  No

 Yes  No

 Yes  No

B. WaterSense Labeled Irrigation Controller Certification Information

Does your company own or plan to own a certification file ?  Yes  No

Is your company included as an additional company on a certification file?  Yes  No

Certifying Body/Bodies Certification File Number(s) Additional Companies /Customers (if applicable)



### Please include any clarifications regarding your data here :

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