OMB Control Number 2040-0272Approval Expires 01/31/2010New Certified Product Notification FormHigh-Efficiency Lavatory (Bathroom Sink) FaucetEPA WaterSense®Program Partners:Please complete and submit within two weeks of notification from a licensed certifyingbody that your product orproduct model has received the WaterSense label. By submitting this form, the manufacturer partner agrees to continue to upholdthe requirements of itsmanufacturer partnership agreement.Manufacturer Name1: __________________________________________________________________Section I: General InformationName: ________________________________ Telephone: ____________________________________________________________________________________________Fax:E-mail:Contact Name (for questions from the EPA WaterSense Team regarding this form)Section II: Product InformationProduct 1 — Faucet or Faucet Accessory2Brand NameModel NameModel NumberType(faucet or faucetaccessory)Flow type/Spray Pattern(aerated, laminar, spray,other)Certified Flow RateMaximum @ 60 psiMinimum @ 20 psiFor EPA Records Only (This information will not be posted on Web site)Name of Licensed Certifying BodyCertification File NumberCertification Date(mm/dd/yy)Submit this form (rewriteablePDF) to WaterSense via:Fax:(703) 841-1440Mail:WaterSense, c/o ERG, 2300 Wilson Blvd, Suite 350, Arlington, VA 22201Electronically: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 themand fax or mail them. Contact the WaterSense Helpline at 866 WTR-SENS (987-7367)if you have any questions.1Please use the same name used on your partnership agreement. If you do not yet have a partnership agreement, please contact the WaterSense Helpline at (866) WTR-SENS (987-7367) tocomplete one.2Product certification can apply to either afaucet or a faucet accessory. A faucet accessory is sold independently of the faucet and is defined in the specificationas “a component that can, at thediscretion of the user, be readily added, removed, or replaced, and that, when removed, will not prevent the fitting from fulfilling its primary function. An accessory can include, but is not limited to:lavatory faucet flow restrictors, flow regulators, aerator devices, or laminar devices.” Please list the certified product andindicate the type.EPA Form Number 6100-15Product 2— Faucet or Faucet AccessoryBrand NameModel NameModel NumberType(faucet or faucetaccessory)Flow type/Spray Pattern(aerated, laminar, spray,other)Certified Flow RateMaximum @ 60 psiMinimum @ 20 psiFor EPA Records Only (This information will not be posted on Web site)Name of Licensed Certifying BodyCertification File NumberCertification Date(mm/dd/yy)Product 3 — Faucet or Faucet AccessoryBrand NameModel NameModel NumberType(faucet or faucetaccessory)Flow type/Spray Pattern(aerated, laminar, spray,other)Certified Flow RateMaximum @ 60 psiMinimum @ 20 psiFor EPA Records Only (This information will not be posted on Web site)Name of Licensed Certifying BodyCertification File NumberCertification Date(mm/dd/yy)Product 4 — Faucet or Faucet AccessoryBrand NameModel NameModel NumberType(faucet or faucetaccessory)Flow type/Spray Pattern(aerated, laminar, spray,other)Certified Flow RateMaximum @ 60 psiMinimum @ 20 psiFor EPA Records Only (This information will not be posted on Web site)Name of Licensed Certifying BodyCertification File NumberCertification Date(mm/dd/yy)The public reporting and record keeping burden for this collectionof information is estimatedto average 8 hours per response.Send comments on the Agency's need for this information, the accuracyof the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to theDirector, Collection StrategiesDivision, U.S. Environmental ProtectionAgency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send thecompleted New Certified Product Notification form to this address.Please copy this side and submit additional sheets as needed.