Information Collection

Third Party Certified Product Information

IC 24770 under ICR 201512-2060-007 · OMB 2060-0528.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2060-0528 can be found here:

Documents and Forms

Document Name Document Type
Form 5900-33 Third Party Certified Product Information Form and Instruction
5900-33 ENERGY STAR Commitment Form Commitment Form.xls www.energystar.gov/ia/downloads/Manufacturer_Commitment_Form_Comm_Refrigeration.pdf Form and Instruction
5900-251 ENERGY STAR Verification Testing Summary Report Verification Testing Summary Report.xls www.energystar.gov/ia/partners/third_party_certification/downloads/Verification_Testing_SummaryReport.xlsx?c1d6-d965&c1d6 Form and Instruction
5900-252 ENERGY STAR Failure Report ENERGY STAR Failure Report.xls www.energystar.gov/ia/partners/third_party_certification/downloads/ENERGY_STAR_Failure_Report.xls?c1d6-d965 Form and Instruction
5900-253 List of Products not eligible for ENERGY STAR ENERGY STAR Ineligible Products Form.xlsx www.energystar.gov/ia/partners/third_party_certification/downloads/ENERGY_STAR_Ineligible_Product_Form.xlsx?c1d6-d965&c1d Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Third Party Certified Product Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5900-33	ENERGY STAR Commitment Form	Commitment Form.xls	http://www.energystar.gov/ia/downloads/Manufacturer_Commitment_Form_Comm_Refrigeration.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-251	ENERGY STAR Verification Testing Summary Report	Verification Testing Summary Report.xls	http://www.energystar.gov/ia/partners/third_party_certification/downloads/Verification_Testing_SummaryReport.xlsx?c1d6-d965&c1d6-d965	Yes	Yes	Fillable Printable
Form and Instruction	5900-252	ENERGY STAR Failure Report	ENERGY STAR Failure Report.xls	http://www.energystar.gov/ia/partners/third_party_certification/downloads/ENERGY_STAR_Failure_Report.xls?c1d6-d965	Yes	Yes	Fillable Fileable
Form and Instruction	5900-253	List of Products not eligible for ENERGY STAR	ENERGY STAR Ineligible Products Form.xlsx	http://www.energystar.gov/ia/partners/third_party_certification/downloads/ENERGY_STAR_Ineligible_Product_Form.xlsx?c1d6-d965&c1d6-d965	Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 220	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	220	200	20
Annual IC Time Burden (Hours)	2,499	679	1,820
Annual IC Cost Burden (Dollars)	163,599	163,599	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.