Document ID: EPA-HQ-OW-2006-0408-0010
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2006-12-07T05:00Z

ANNUAL UPDATE

General Information (all partners)

Organization Name:
______________________________________________________________________

Contact Information (for questions from the EPA WaterSense Team
regarding this plan)

Name:	________________________________Telephone:_______________________

Fax:	________________________________Email:___________________________

Number of residential customers in service area:
________________________________

A. Retailers and Distributors

I. Promotional Activities

Have you implemented a WaterSense education campaign? ( Yes ( No

If yes, please estimate the number of households
reached:___________________________

Campaign activities conducted, please indicate number of times for each
campaign activity:

___   Print advertising

___   Exhibit(s) at public fair, meetings, etc.

___   Bill insert

___   Program/workshop for consumers

___   Presentation(s) to schools, groups, etc.

___  Web site promotion

___  Partnership with other organization (e.g., a retailer or utility
(name of partner:___________) 

	____ Other, please describe: _______________________________________

Activities conducted: 	(  Print advertising

In-store promotions

Television/radio advertising

Billboard advertising

Web site promotion

Program/workshop for consumers

Partnership with government or utility (name:___________)

Newsletter or trade journal article placed (name of journal: ________,
date)

(  Other, please describe: 

II. Sales Data

For each WaterSense product sold:

Product Name (Make and Model):
_________________________________________________ 

Estimated marketshare of WaterSense product compared with conventional
product: _________

Units sold: ____________ 

Geographic area in which sales occurred (if available)
:________________________________________

B. Product Manufacturers

I. Product Information

For each WaterSense certified product:

Product Name (Make and Model):
__________________________________________

Date of market launch: _____________________________

Total WaterSense labeled units shipped: _______________________

Total units shipped for each model in product line: __________

Percent of total units in product line that are WaterSense
labeled_________

C. Certifying Organizations

Name/Number of professionals certified in delivery of water-efficient
services

D. Promotional Partners

I. Promotional Activities (All promotional partners)

Have you implemented a WaterSense education campaign? ( Yes ( No

If yes, please estimate the number of households
reached:___________________________

Campaign activities conducted, please indicate number of times for each
campaign activity:

___   Print advertising

___   Exhibit(s) at public fair, meetings, etc.

___   Bill insert

___   Program/workshop for consumers

___   Presentation(s) to schools, groups, etc.

___  Web site promotion

___  Partnership with other organization (e.g., a retailer or utility
(name of partner:___________) 

	____ Other, please describe: _______________________________________

II. Rebates (Utility partners only)

Residential population served (e.g., number of residential
hook-ups):______________________

Did you offer rebates on any WaterSense products? □ Yes   □  No

For each product, please indicate the rebate amount and number of
rebates issued:

Name of Product	Amount of Rebate		Number of Rebates Issued

III. Water Distribution Information (Utility partners only)

Gallons of water sold: ______________________(please specify time
period; e.g., average annual residential use per hookup)

Price per gallon of water: __________________________

IV. Wastewater Treatment Information (Utility partners only)

Gallons of waste water treated: ______________________(please specify
time period; e.g., annually, daily)

 Please use the same name used on your partnership agreement. If you do
not yet have a partnership agreement, please contact us to complete one.

 For utilities only

OMB Control Number 2040-XXXX

Approval Expires XX/XX/XXXX

EPA Form Number 6100-09

The public reporting and recordkeeping 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 number in any correspondence. Do not send
the completed promotional annual update to this address.