Compliance Statement Energy/Water Conservation Standards for Appliances

---

Overview

Input
Lamp Type Description
Production Date Code Legend
Instructions

---

Sheet 1: Input

	Product Type:		General Service Fluorescent Lamps						Version 3.0		Overall Status	No Data
�
	Manufacturer:
			Type manufacturer name in the box above
�	If Applicable: Third Party Representative
						If applicable, enter the name of the third party representative in the box above
	Compliance Statement - (Appendix A to Subpart F of 10 CFR Part 430)
	This compliance statement and all certification reports submitted are in accordance with 10 CFR Part 430 (Energy or Water Conservation Program for Consumer Products) and the Energy Policy and Conservation Act, as amended. The compliance statement is signed by a responsible official of the above named company. The basic model(s) listed in certification reports comply with the applicable energy conservation standard or water (in the case of faucets, showerheads, water closets, and urinals) conservation standard. All testing on which the certification reports are based was conducted in conformance with applicable test requirements prescribed in 10 CFR Part 430 subpart B. All information reported in the certification report(s) is true, accurate, and complete. The company is aware of the penalties associated with violations of the Act, the regulations thereunder, and is also aware of the provisions contained in 18 U.S.C. 1001, which prohibits knowingly making false statements to the Federal Government.
									�Type your full name in the box to signify compliance
										Must enter name
	� Enter your email address							Must enter email address
		�Certification Report
	· Please enter your data in the columns shaded in gray below, using a separate line for each model. · Click on the column heading or any cell for instructions on how to complete that cell. · Cells highlighted in yellow indicate an "Error." "Error" means that information is missing or there is an issue with the entry. · If the "Status" for a row is "Error," you can see an explanation in the columns to the right of the Status column. · Reports submitted with errors cannot be processed and will be returned for resubmission.															The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".		The cells below provide an explanation for "Errors".			The cells below provide an explanation for "Errors".
	· To review the effective dates of current standards for consumer products and certain commercial and industrial equipment													click here
	Line No.	Manufacturer	Brand	Model	Action	Covered Lamp Type	Explanation of 'Other' Covered Lamp Type	Lamp Wattage	12 Month Average Color Rendering Index (CRI)	12 Month Average Lamp Efficacy (LPW)	NVLAP ID No.	Manu-facturer's Production Date Code	Status		Manu-facturer Status	Brand Status	Model Status	Action Status	Covered Lamp Type Status	Explanation of 'Other' Covered Lamp Type Status	Lamp Wattage Status	12 Month Average Color Rendering Index (CRI) Status	12 Month Average Lamp Efficacy (LPW) Status	NVLAP ID No. Status	Manufacturer's Production Date Code Status
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
	17
	18
	19
	20
	21
	22
	23
	24
	25
	26
	27
	28
	29
	30
	31
	32
	33
	34
	35
	36
	37
	38
	39
	40
	41
	42
	43
	44
	45
	46
	47
	48
	49
	50
	51
	52
	53
	54
	55
	56
	57
	58
	59
	60
	61
	62
	63
	64
	65
	66
	67
	68
	69
	70
	71
	72
	73
	74
	75
	76
	77
	78
	79
	80
	81
	82
	83
	84
	85
	86
	87
	88
	89
	90
	91
	92
	93
	94
	95
	96
	97
	98
	99
	100
	101
	102
	103
	104
	105
	106
	107
	108
	109
	110
	111
	112
	113
	114
	115
	116
	117
	118
	119
	120
	121
	122
	123
	124
	125
	126
	127
	128
	129
	130
	131
	132
	133
	134
	135
	136
	137
	138
	139
	140
	141
	142
	143
	144
	145
	146
	147
	148
	149
	150

---

Sheet 2: Lamp Type Description

The following is a description of each lamp type:
Lamp Type	Lamp Type Description
1	4-foot medium bi-pin
2	2-foot U-shaped
3	8-foot slimline
4	8-foot high output
Other	Other general service fluorescent lamps not listed above (if you enter "Other", you must provide a rationale in the 'Explanation of "Other" Lamp Type' column on the "Input" sheet).

---

Sheet 3: Production Date Code Legend

PLEASE ENTER THE CODING SCHEME FOR THE MANUFACTURER'S

PRODUCTION DATE CODE IN THIS WORKSHEET

THIS CODING SCHEME MAY BE ENTERED IN ANY FORMAT OR

COPIED IN FROM AN OUTSIDE SOURCE

---

Sheet 4: Instructions

Instructions for CCMS Reporting Templates

Use your mouse, the "Tab" key and arrows on your keyboard to navigate through the fillable fields in the template. If all fields have been completed correctly the "Overall Status" indicator on the top right corner of the template will show "ok." If this indicator reads "Error," look for incomplete/incorrect field entry explanations by comparing the mirrored cells on the right of your template screen with your report entries. Call 505-663-1302 ext 101 for additional assistance.

Step 1

Enter the manufacturer's name

�

Type manufacturer name in the box above

Step 2

Enter the full name of the third party representative if "applicable" in the cell above "If applicable, enter the name of the third party representative in the box above"

If Applicable: Third Party Representative

�

If applicable, enter the name of the third party representative in the box above

Step 3

Enter your full name in the cell above "Must enter name." Be certain that your are aware of the provisions contained in 18 U.S.C. 1001 before entering your name.

�

Type your full name in the box to signify compliance

Must enter name

Awareness Statement

Step 4

Enter your contact email address to the left of "Must enter email address."

�

Enter your email address

Must enter email address

Step 5

Starting on line No. 1, begin entering applicable data in each field. When you have chosen a field, an instruction box will display. Each template has different product type standards. Although all product template instructions are similar, your product template may display different data entry fields from the examples below. If the status at the end of the line reads "Error," review your data to verify entries and check the explanation table to the right of the data entry table for an error description. Lines with an "ok" status have been completed correctly.

�

Step 6

Save the template to a local drive for safekeeping. You will upload this template later to DOE via the CCMS application.

z