Imaging Equipment Data Collection Form by zhangyun

VIEWS: 7 PAGES: 3

									                                                                                          OMB Control No. 2060-0528
                                                                                          Approval expires 03/31/2011


                                                        United States
                         ENVIRONMENTAL PROTECTION AGENCY
                                                  Washington, D.C. 20460

                                       ENERGY STAR Imaging Equipment Partner
                                           Office of Atmospheric Programs

NAME OF MANUFACTURER:
DATE OF SUBMISSION:
SUBMITTED BY (NAME):
PLEASE LIST ANY UNAFFILIATED
PRIVATE LABELERS THAT
REBRAND YOUR PRODUCTS:

Below, only report shipments to consumers or retailers. Do not include business to
business shipments (shipments to unaffiliated private labelers). If you ONLY ship to
private labelers, indicate zero shipments and list private labelers selling in the U.S.
marketplace on the line above.

Reporting Period: CALENDAR YEAR 2009 (JAN. TO DEC.)




                                                                ENERGY STAR® U.S.
                                                                 Unit Shipments to
                                                                  Consumers or
                                                                      Retailers
 Imaging Equipment Product Type                                    (REQUIRED)
Copiers Total
 Qualified by OM
   Large Format (Color DS, Color TT, DT, Mono DS, Mono
   EP, Mono TT, Color EP, SI)
 Qualified by TEC
   Mono Standard Format Total (Thermal, Dye sub, EP)
        ≤ 15 IPM
        16 - 39 IPM
        40 - 82 IPM
        ≥ 83 IPM
   Color Standard Format Total (Thermal, Dye sub, EP,
   solid ink)
        ≤ 32 IPM
        33 - 58 IPM
        ≥ 59 IPM
Digital Duplicators Total
   Mono Standard Format Total
        ≤ 15 IPM
        16 - 39 IPM
        40 - 82 IPM
        ≥ 83 IPM
   Color Standard Format Total
        ≤ 32 IPM
        33 - 58 IPM
        ≥ 59 IPM



    EPA Form No. 5900-163
                                                                 OMB Control No. 2060-0528
                                                                 Approval expires 03/31/2011


Fax Machines Total
 Qualified by OM
    Ink Jet Standard Format (Color or Mono)
 Qualified by TEC
    Mono Standard Format Total (Thermal, Dye sub, EP)
        ≤ 15 IPM
        16 - 39 IPM
        40 - 82 IPM
        ≥ 83 IPM
    Color Standard Format Total (Thermal, EP, solid ink)
        ≤ 32 IPM
        33 - 58 IPM
        ≥ 59 IPM
Mailing Machines Total
Multifunction Devices (MFDs) Total
 Qualified by OM
    Ink Jet Standard Format (Color or Mono)
    Ink Jet Large Format (Color or Mono)
    Non-Ink-Jet Large Format (Color DS, Color TT, DT,
    Mono DS, Mono EP, Mono TT, Color EP, SI)
 Qualified by TEC
    Mono Standard Format Total (High Performance Ink
    Jet, Thermal, Dye sub, EP)
        ≤ 9 IPM
        10 - 26 IPM
        27 - 68 IPM
        ≥ 69 IPM
    Color Standard Format Total (High Performance Ink Jet,
    Thermal, Dye sub, EP, solid ink)
        ≤ 26 IPM
        27 - 62 IPM
        ≥ 63 IPM
Printers Total
 Qualified by OM
    Impact Standard Format (Color Impact, Mono Impact )
    Ink Jet Standard Format (Color or Mono)
    Ink Jet Large Format (Color or Mono)
    Small Format (Color DS, DT, Color IJ, Color Impact,
    Color TT, Mono DS, Mono EP, Mono IJ, Mono Impact,
    Mono TT, Color EP, SI)
    Non-Ink-Jet Large Format (Color DS, Color Impact,
    Color TT, DT, Mono DS, Mono EP, Mono Impact, Mono
    TT, Color EP, SI)
 Qualified by TEC
    Mono Standard Format Total (High Performance Ink
    Jet, Thermal, Dye sub, EP)
        ≤ 15 IPM
        16 - 39 IPM
        40 - 82 IPM
        ≥ 83 IPM
    Color Standard Format Total (High Performance Ink Jet,
    Thermal, Dye sub, EP, solid ink)
        ≤ 32 IPM
        33 - 58 IPM
        ≥ 59 IPM
Scanners Total
Total                                                        0



   EPA Form No. 5900-163
                                                                                                 OMB Control No. 2060-0528
                                                                                                 Approval expires 03/31/2011



Submission Deadline: February 26, 2010
Deadline to Avoid Partnership Termination: March 31, 2010

*Do not provide duplicate data to both ITI and ICF

ITI has agreed to aggregate data for all Imaging                  Please submit by mail or email to:
Equipment Partners.                                               Joshua Forgotson
Please submit by email or fax to:                                 ICF International
Ken Salaets                                                       1725 Eye Street, NW
ksalaets@itic.org                                                 Suite 1000
Fax: (202) 638-4922                                               Washington, DC 20006
                                                                  unitshipmentdata@icfi.com

EPA plans to use the data only for program evaluations. EPA will release this information only as aggregated data and only to the
extent required by law.


The public reporting and recordkeeping burden for this collection of information is estimated to average 6.69 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 form to this address.




    EPA Form No. 5900-163

								
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