EPA Form Number 6100-11 

The public reporting and record keeping burden for this collection of information is estimated to average 8 hours per response. Send comments on the Agency's of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspcompleted New Certified Product Notification form to this address. 

New Certified Produ

Tank-Type High-Efficiency Toilet 

EPA WaterSense® Program Partners: Please complete and submit within two weeks of notification from a certifying body that y

has received the WaterSense label. By submitting this form, the manufacturer partner agrees to continue to uphold the requireme

partnership agreement. Section I: General Information Manufacturer Name1: __________________________________________________________________ 

Contact Name (for questions from the EPA WaterSense Team regarding this form) 

Name: ________________________________ Telephone: ______________________________ Fax: ________________________________ E-mail: ______________________________ Section II: Product Information 

Product 

Brand Name Model Name Model Number Rated Flush Volum

HET2 Bowl Tank 

Flush Type 

(single, dual, other) Single or 

Average 

Min 

For EPA Records Only (This information will not be posted on Web site)Name of Certifying Body Certification File Number Certification Date 

(mm/dd/yy)

P

Submit this form (rewriteable PDF) to WaterSense via: Fax: (703) 841-1440Mail: WaterSense, c/o ERG, 2300 Wilson Blvd, Suite 350, Arlington, VA 22201 Electronically: If you have Adobe Acrobat Standard or Professional, you can fill out the form electronically and e-mail it to: water

Reader users must print forms after completing and fax or mail them. Contact the WaterSense Helpline at 866 987-7367 if you ha

1 Please use the same name used on your partnership agreement. If you do not yet have a partnership agreement, please contact the WaterSense program to co2 Please use this column if you have either a single model number or a combination model number (for both the bowl and tank). 
Product 

Brand Name Model Name Model Number Rated Flush Volum

HET2 Bowl Tank 

Flush Type 

(single, dual, other) Single or 

Average 

Min 

For EPA Records Only (This information will not be posted on Web site)Name of Certifying Body Certification File Number Certification Date 

(mm/dd/yy)

P

Product 

Brand Name Model Name Model Number Rated Flush Volum

HET2 Bowl Tank 

Flush Type 

(single, dual, other) Single or 

Average 

Min 

For EPA Records Only (This information will not be posted on Web site)Name of Certifying Body Certification File Number Certification Date 

(mm/dd/yy)

P

Product 

Brand Name Model Name Model Number Rated Flush Volum

HET2 Bowl Tank 

Flush Type 

(single, dual, other) Single or 

Average 

Min 

For EPA Records Only (This information will not be posted on Web site)Name of Certifying Body Certification File Number Certification Date 

(mm/dd/yy)

P

Product 

Brand Name Model Name Model Number Rated Flush Volum

HET Bowl Tank 

Flush Type 

(single, dual, other) Single or 

Average 

Min 

For EPA Records Only (This information will not be posted on Web site)Name of Certifying Body Certification File Number Certification Date 

(mm/dd/yy)

P

Please copy this side and submit additional sheets as needed.