Document ID: EPA-HQ-OAR-2004-0500-0038
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2009-10-26T04:00Z

Modular Rater Application

I, (Name of Rater) 	, hereby assert that I meet or exceed all required
capabilities and qualifications to provide inspection and testing
services as a Rater under the ENERGY STAR Modular Home Program as
indicated by completing the information on this form. Also, I hereby
state that I do not have financial interests in or maintain any
affiliation with the construction, sale or completion of a home, nor do
I provide services that might affect my capacity to evaluate compliance
with the ENERGY STAR program and render reports of findings objectively
and without bias. Other persons performing ENERGY STAR services under my
authority also meet these requirements.

Authorized company

representative: 	 Company: 	

Signature: 	 Date: 	

Address: 	

City/State/Zip: 	

Telephone:______________________  Fax:_____________________ E-Mail: 	

Rater must complete the following:

Modular housing design, construction and installation methods

(Must check all boxes below)

(	Working knowledge of the residential building codes

(	Knowledge of modular home design, construction, installation, material
use, and fabrication

Building science and energy efficiency experience

(Must check at least one box below)

(	Certified Home Energy Rating System (HERS) rater

Submit this form to SBRA:

	  Fax number: 212-496-5389, or 

	  Mailing address: 2109 Broadway, Suite 200, New York, NY 10023, or

  E-Mail: info@research-alliance.org

If approved, SBRA will return a countersigned copy of this application
to the rater. The rater shall provide a copy of the approved application
to the builder. 

Do not write in this space.

SBRA Approval:	 Date: 	

OMB Control No. xxxx-xxxx

Energy Star Modular Homes	Rev.   DATE \@ "M/d/yyyy"  9/17/2009 

EPA Form 5900-191

 

 

 

.

0

6

F

G

M

P

Q

X

Z

[

`

|

}

~

»

¼

Ù

 Ù

Ú

Û

ï

ð

ô

옍

옍

옍

 hours and welcomes suggestions for reducing this effort. Send comments
(referencing OMB Control Number) to the Director, Collection Strategies
Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C.
20460.