5900-255 Application for Witnessed or Supervised Testing Lab

Application for Witnessed or Supervised Testing Laboratory (W/SMTL) Version 1.20

Instructions: This Data Entry Sheet shall be used to submit first-party laboratories to EPA for a certification body's Witnessed or Supervised Manufacturer's Testing Laboratory Program (W/SMTL). Lighting categories which require Proficiency Testing (PT) are found on the second tab of this application. Completed forms should be sent to Certification@energystar.gov.

Laboratory Information

Laboratory Name:

Laboratory Address

Address Line 1:

Address Line 2:

City:

State / Province:

Country:

Postal Code:

Laboratory Contact

First Name:

Last Name:

Job Title:

Email Address:

Telephone Number:

Ext:

Laboratory Category (please select one, not both):

Supervised

Witnessed

ENERGY STAR Manufacturing Partner Affiliated with Laboratory (please provide Org ID):

Manufacturer name (if different from ENERGY STAR partner):

Certification Body Supervising or Witnessing Laboratory:

Describe any lab limitations here (be as descriptive as possible):

Product Categories Testing (Select all that apply):

Appliances

Clothes Dryers

Dishwashers

Clothes Washers

Consumer Refrigeration

Residential Electric Cooking Products

Heating and Cooling

Boilers

Geothermal Heat Pumps

Air-Source Heat Pumps

Light Commercial HVAC

Commercial Packaged Boilers

Room Air Cleaners and Purifiers

Commercial Water Heaters

Room Air Conditioners

Connected Thermostats

Residential Water Heaters - Solar

Dehumidifiers

Residential Water Heaters - Non-Solar

Furnaces

Electronics and Office Equipment

Audio/Video

Large Network Equipment

Computers

Telephony

Data Center Storage

Televisions

Displays

Uninterruptible Power Supplies

Computer Servers

Imaging Equipment

Lighting and Fans

Decorative Light Strings

Downlights

Ceiling Fans

Residential Ventilating Fans

Commercial Food Service

Commercial Coffee Brewers

Commercial Combination Ovens

Commercial Dishwashers

Commercial Convection Ovens

Commercial Electric Cooktops

Commercial Rack Ovens

Commercial Fryers

Commercial Refrigerators and Freezers

Commercial Griddles

Commercial Steam Cookers

Commercial Hot Food Holding Cabinets

Commercial Ice Machines

Home Building Materials

Storm Windows

Other

Water Coolers

Pool Pumps

Lab-grade Refrigerators/Freezers

Vending Machines

Smart Home Energy Management Systems (SHEMS)

The public reporting and recordkeeping burden for this collection of information is estimated to average 1.5 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.

Electrical Vehicle Supply Equipment