Manufacturer Annual Reporting 

EPA WaterSense® Program Partners: Please complete and submit to EPA contractor Eastern Research Group, Inc. (ERG) by M

Note on confidentiality of data: Sensitive business information may be claimed confidential under 40 CFR Part 2, Subpart B. E

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

Please submit the form in hard copy by March 1, 2010 to the address provided below. Please do not submit it via e-mail to the He

Mail: EPA WaterSense Annual Reporting, c/o ERG 

14555 Avion Parkway, Suite 200 Chantilly, VA 20151 

Call: (866) 987-7367 if you have any questions about how to complete or submit this form. 

Section I: General Information 

Manufacturer Name on Partnership Agreement: ____________________________________________________________If you do not yet have a Partnership Agreement, please contact the WaterSense program to complete one. Contact Name (for questions regarding this form):__________________________________________________________Please provide a U.S. contact if possible.E-mail: _______________________________________________________________________ Phone: __________________Contact Name (optional additional contact): ____________________________________________________________Please provide a U.S. contact if possible.E-mail: _______________________________________________________________________Phone:___________________Section II: Form Instructions Did you join the WaterSense program on or before 12/31/2009? Check one.  Yes  No 

If you answered “No”, you will be eligible to report in 2011 and you do not need to complete this form at this time. 

Which section(s) below should I complete? 

 All manufacturer partners who joined the WaterSense program on or before 12/31/2009 should complete and submit S

 Fill out Table 1 below to determine if you should complete additional parts in Section IV. 

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

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 (282D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed annual data form to this address. 
Manufacturer Name on Partnership Agreement: _____________________________________________________________What if I am a private labeler1? 

 WaterSense is only collecting product shipment data from partners who are original equipment manufacturers (OEMs)2, n

labelers should complete and submit Table 1 and Section III. 

 If you have questions about whether you are considered an OEM or a private labeler, please contact the WaterSense He

watersense@epa.gov. 

Table 1. Eligibility Information and Instructions 

Product Type 

A. Do you make or ship for sale these products to or within the U.S.? 

B. Please indicate whether your company is the OEM or a private labeler.3

Instructions 

Tank-type toilets 

 Yes 

 No 

 OEM  Private label 

 If you marked Yes and OEM in column

complete Section III and Section IV P

 If you marked Yes and private label in 

print and complete Section III ONLY. 

 If you marked No in column A, complet

Lavatory faucets 

 Yes 

 No 

 OEM  Private label 

 If you marked Yes and OEM in column

complete Section III and Section IV P

 If you marked Yes and private label in 

print and complete Section III ONLY. 

 If you marked No in column A, complet

Lavatory faucet accessories (e.g., faucet flow restrictors, flow regulators, aerator devices, and laminar devices)

 Yes 

 No 

 OEM  Private label 

 If you marked Yes and OEM in column

complete Section III and Section IV P

 If you marked Yes and private label in 

print and complete Section III ONLY. 

 If you marked No in column A, complet

1 A private labeler is a party whose brand name appears on the end product, which is purchased from an original equipment manufacturer (OEM

as an additional company on an OEM’s WaterSense certification file. 

2 For our purposes, the original equipment manufacturer is the party that holds the WaterSense certification file. 3 If you are the OEM and the private labeler for the same product type, check both boxes and only report data for those products for which you a
Manufacturer Name on Partnership Agreement: _____________________________________________________________Section III: WaterSense Labeled Product Availability and Program Feedback Information on WaterSense's impact on the marketplace is vital to the continued success of the program. Please provide data on 

promotion. 1. a. Are you promoting your WaterSense labeled products to consumers or other stakeholders? 

 Yes 

 No 

 b. If yes, please estimate the number of consumers reached: __________________________________________________

 c. If yes, please indicate how you are promoting your WaterSense labeled products (please provide samples): 

 On product packaging  On product itself  Brochures, other marketing materials  Product guides  Web site  Other: ________________________________________________________________________________________

 d. If yes, are you working with retailers and/or distributors to promote your WaterSense labeled products? 

 _________________________________________________________________________________________________2. Where can consumers find your WaterSense labeled products? Please list markets (e.g., Los Angeles, Denver) and retaile

if possible. ________________________________________________________________________________________ 

3. On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense label? Value: ____________________

 How has the WaterSense label added value? ____________________________________________________________4. Please provide suggestions for improving the WaterSense program (e.g., general tools/materials, communications, Helpline
 Manufacturer Name on Partnership Agreement: _____________________________________________________________Section IV. Product Information Part A: Tank-Type Toilets Please complete this section only if instructed to do so under Section II. Please include data for all tank-type toilets shipped to 

only for the period between January 1, 2009 and December 31, 2009. Please report the number of units (individual toilets) shipped rather than the number of individual models or model lines produced

that include the seat and installation kit (i.e., all-in-one), please count each of these as one toilet unit and include in the U.S. total. 

Table 2. Tank-Type Toilet Shipment Data 

All Tank-Type Toilets U.S. Total 

1. Total number of toilets shipped? 

Note: Count ALL tank-type toilets shipped, including both WaterSense labeled and non-WaterSense labeled toilets. 

2. Total number of high-efficiency toilets with an 

effective flush volume of 1.28 gpf or less shipped? Notes: Count both WaterSense labeled and nonWaterSense labeled toilets that meet this criterion. The effective flush volume for dual flush toilets is the average of one full and two reduced flushes. 

3. Total number of WaterSense labeled toilets 

shipped? 

Please include any clarifications regarding your data here: 
Manufacturer Name on Partnership Agreement: _____________________________________________________________Section IV. Product Information Part B: Lavatory Faucets Please complete this section only if instructed to do so under Section II. Please include data for all lavatory faucets shipped to 

only for the period between January 1, 2009 and December 31, 2009. Please report the number of units (individual faucets) shipped rather than the number of individual models or model lines produce

lavatory faucets shipped for private use (e.g., for installation in homes, or hotel or hospital guest rooms). Do NOT include faucpublic restrooms) or kitchen sink use or data on lavatory faucet accessories (e.g., faucet flow restrictors, flow regulators, aerator d

(see Section IV, Part C). Table 3. Lavatory Faucet Shipment Data 

All Lavatory Faucets U.S. Total 

1. Total number of lavatory faucets shipped? 

Note: Count ALL lavatory faucets shipped, including both WaterSense labeled and non-WaterSense labeled lavatory faucets.

2. Total number of lavatory faucets with a certified flow 

rate that falls between a minimum of 0.8 gpm at 20 psi and a maximum of 1.5 gpm at 60 psi shipped? Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucets that meet these criteria.

3. Total number of WaterSense labeled lavatory 

faucets shipped? 

Please include any clarifications regarding your data here: 
Manufacturer Name on Partnership Agreement: _____________________________________________________________Section IV. Product Information Part C: Lavatory Faucet Accessories Please complete this section only if instructed to do so under Section II. Please include data for all lavatory faucets shipped to 

only for the period between January 1, 2009 and December 31, 2009. If possible, please separate out the number of lavatory faucuse as a component in lavatory faucets and those shipped directly for sale as an aftermarket lavatory faucet flow control device. P

on lavatory faucets here (see Section IV, Part B). Please report the number of units (individual faucet accessories) shipped rather than the number of individual models or model lin

include data on lavatory faucets accessories shipped for private use (e.g., for installation in homes, or hotel or hospital guest faucets accessories sold for commercial (e.g., public restrooms) or kitchen sink use. Table 4. Lavatory Faucet Accessories Shipment Data 

All Lavatory Faucet Accessories Shipped as Components for Lavatory Faucets Shipped for Direct Sale as Aftermarket Devices 

1. Total number of lavatory faucet accessories 

shipped? Note: Count ALL lavatory faucet accessories shipped, including both WaterSense labeled and non-WaterSense labeled lavatory faucet accessories.

2. Total number of lavatory faucets with a certified 

flow rate that falls between a minimum of 0.8 gpm at 20 psi and a maximum of 1.5 gpm at 60 psi shipped? Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucet accessories that meet these criteria. 

3. Total number of WaterSense labeled lavatory 

faucet accessories shipped? 

Please include any clarifications regarding your data here: