OMB Control Number 2040-0272Approval Expires 01/31/2010Manufacturer Annual ReportingEPA WaterSense®Program Partners:Please complete and submit to EPA contractor Eastern Research Group, Inc. (ERG) by March 1, 2010.Note on confidentiality of data:Sensitive business information may be claimed confidential under 40 CFR Part 2, Subpart B. ERG has an EPA-approvedsecurity plan in place to protect confidential business information from unauthorized disclosure. All data submitted as confidential will be handled as such.Please submit the form in hard copy byMarch 1, 2010to the address provided below. Please do notsubmit it via e-mail to the Helpline.Mail:EPA WaterSense Annual Reporting, c/o ERG14555 Avion Parkway, Suite 200Chantilly, VA 20151Call:(866) 987-7367 if you have any questions abouthow to complete or submit this form.Section I: General InformationManufacturer Name on Partnership Agreement:________________________________________________________________________________If you do not yet have a Partnership Agreement, pleasecontact 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 InstructionsDid you join the WaterSense programon or before 12/31/2009? Check one.YesNoIf 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 partnerswho joined the WaterSense program on or before 12/31/2009 should complete and submit Section III.Fill outTable 1below to determine if you should complete additional parts inSection 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, the accuracy of the provided burden estimates,and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to theDirector, 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 annual data form to this address.2Manufacturer Name on Partnership Agreement: _________________________________________________________________________________What if I am a private labeler1?WaterSense is only collecting product shipment data frompartners who are original equipment manufacturers (OEMs)2, not private labelers. Privatelabelers should complete and submitTable 1 and Section III.If you have questions about whether you are considered an OEM ora private labeler, please contact the WaterSense Helpline at(866) 987-7367 orwatersense@epa.gov.Table 1. Eligibility Information and InstructionsProduct TypeA. Do you make or shipfor sale these productsto or within the U.S.?B.Please indicate whetheryour company is the OEM ora private labeler.3InstructionsTank-type toiletsYesNoOEMPrivate labelIf you markedYes and OEMin columns A & B, please print andcompleteSection III andSection IVPart A.If you markedYes andprivate labelin columns A & B, pleaseprint and completeSection III ONLY.If you markedNoin column A, completeSection III ONLY.Lavatory faucetsYesNoOEMPrivate labelIf you markedYes and OEMin columns A & B, please print andcompleteSection III andSection IV Part B.If you markedYes andprivate labelin columns A & B, pleaseprint and completeSection III ONLY.If you markedNoin column A, completeSection III ONLY.Lavatory faucetaccessories(e.g., faucet flowrestrictors, flowregulators, aeratordevices, and laminardevices)YesNoOEMPrivate labelIf you markedYes and OEMin columns A & B, please print andcompleteSection III andSection IV Part C.If you markedYes andprivate labelin columns A & B, pleaseprint and completeSection III ONLY.If you markedNoin column A, completeSection III ONLY.1A private labeler is a party whose brand name appears on the endproduct, which is purchased from an original equipment manufacturer (OEM). Private labelers will be listedas an additional company on an OEM’s WaterSense certification file.2For our purposes, the original equipment manufacturer isthe party that holds the WaterSense certification file.3If you are the OEM and the private labeler for the same product type, check both boxes and only report data for those productsfor which you are the original manufacturer.3Manufacturer Name on Partnership Agreement: _________________________________________________________________________________Section III: WaterSense Labeled Product Availability and Program FeedbackInformation on WaterSense's impact on the marketplace is vitalto the continued success of the program. Please provide data onproduct availability andpromotion.1. a. Are you promoting your WaterSense labeledproducts to consumers or other stakeholders?YesNob. If yes, please estimate the number of consumers reached: ______________________________________________________________________c. If yes, please indicate how you are promoting yourWaterSense 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 retailer/distributor company names,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, Web site, etc):4Manufacturer Name on Partnership Agreement: _________________________________________________________________________________Section IV. Product InformationPart A: Tank-Type ToiletsPlease complete this section only if instructedto do so under Section II. Please include data forall tank-type toilets shipped to or within the United Statesonly 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. If you sell toilets in packagesthat include the seat and installation kit (i.e., all-in-one),please count each of these as one toilet unit and include in theU.S. total.Table 2. Tank-Type Toilet Shipment DataAll Tank-Type ToiletsU.S. TotalClaim as confidential?1. Total number of toilets shipped?Note: Count ALL tank-type toilets shipped, includingboth WaterSense labeled and non-WaterSenselabeled toilets.YesNo2. Total number of high-efficiency toilets with aneffective 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 isthe average of one full and two reduced flushes.YesNo3. Total number of WaterSense labeled toiletsshipped?YesNoPlease include any clarifications regarding your data here:5Manufacturer Name on Partnership Agreement: _________________________________________________________________________________Section IV. Product InformationPart B: Lavatory FaucetsPlease complete this section only if instructedto do so under Section II. Please include data forall lavatory faucets shipped to or within the United Statesonly 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 produced. Please only include data onlavatory faucets shipped for private use(e.g., for installation in homes, or hotel or hospital guest rooms). DoNOTinclude faucets sold for commercial (e.g.,public restrooms) or kitchen sink use or data on lavatory faucetaccessories (e.g., faucet flow restrictors, flow regulators, aerator devices, and laminar devices)(see Section IV, Part C).Table 3. Lavatory Faucet Shipment DataAll Lavatory FaucetsU.S. TotalClaim as confidential?1. Total number of lavatory faucets shipped?Note: Count ALL lavatory faucets shipped, includingboth WaterSense labeled and non-WaterSenselabeled lavatory faucets.YesNo2. Total number of lavatory faucets with a certified flowrate that falls between a minimum of 0.8 gpm at 20psi and a maximum of 1.5 gpm at 60 psi shipped?Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucets that meetthese criteria.YesNo3. Total number of WaterSense labeled lavatoryfaucets shipped?YesNoPlease include any clarifications regarding your data here:6Manufacturer Name on Partnership Agreement: _________________________________________________________________________________Section IV. Product InformationPart C: Lavatory Faucet AccessoriesPlease complete this section only if instructedto do so under Section II. Please include data forall lavatory faucets shipped to or within the United Statesonly for the period between January 1, 2009 and December 31, 2009.If possible, please separate out the number of lavatory faucet accessories shipped foruse as a component in lavatory faucets and those shipped directlyfor sale as an aftermarket lavatory faucet flow control device. Please do not include any dataon 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 modellines produced. Please onlyinclude data onlavatory faucets accessories shipped for private use(e.g., for installation in homes, orhotel or hospital guest rooms). DoNOTincludefaucets accessories sold for commercial (e.g., public restrooms) or kitchen sink use.Table 4. Lavatory Faucet Accessories Shipment DataAll Lavatory Faucet AccessoriesShipped as Components forLavatory FaucetsShipped for Direct Sale asAftermarket DevicesClaim as confidential?1. Total number of lavatory faucet accessoriesshipped?Note: Count ALL lavatory faucet accessoriesshipped, including both WaterSense labeledand non-WaterSense labeled lavatory faucetaccessories.YesNo2. Total number of lavatory faucets with a certifiedflow rate that falls between a minimum of 0.8gpm at 20 psi and a maximum of 1.5 gpm at 60psi shipped?Note: Count both WaterSense labeled and nonWaterSense labeled lavatory faucetaccessories that meet these criteria.YesNo3. Total number of WaterSense labeled lavatoryfaucet accessories shipped?YesNoPlease include any clarifications regarding your data here: