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Technology Submission Application

* Submissions must be made by Grantees of the Department of Energy Weatherization Assistance Program and state the Grantee’s desire to use the material or technique in the program.

* Submissions must include all third party testing documents and results to support the manufacturer’s claim of efficiency and effectiveness.

* DOE’s task is not to conduct any independent testing, but only to review and confirm the validity and independence of test and field data submitted.

First Name: *
Last Name: *
Title: *
Organization: *
Street Address: *
City: *
State: *
Zip: *
Phone: *
Fax: *
E-mail: *

Describe the nature of the material (or product) and how it works. On what principles or laws of science and engineering does it function? *
Are there alternative materials that perform the same function? *
What are the durability, reliability, maintainability, and serviceability of this product? *
What is the useful life of this product? If this is an estimate, what assumptions are the basis for the estimate? *
How long has this material been available? What is the track record? *
What are the known or potential effects on health, indoor air quality, life and fire safety, and structure or cosmetic deterioration of the dwelling unit? Please provide any Materials Safety Data Sheets (MSDS). *
DOE’s task is not to conduct any independent testing, but only to review and confirm the validity and independence of test and field data submitted. Materials must have been tested by a recognized independent testing laboratory in accordance with the approved standard test method or certification procedure. Please provide a copy of the independent testing document. *
Has the material been reviewed by government agencies, trade associations, national laboratories, or other organizations? If so, please provide this information.*
Describe potential energy conservation (and/or health and safety) improvements to the Weatherization Program produced by the submission (e.g. energy and/or cost savings, emissions reductions, etc.). *
Describe the potential impact of the submission on existing measures/protocols.*
Describe any non-energy benefits that should be considered.*
Provide any information on the demonstrated/ projected cost-effectiveness of the submission (energy, time, money valuation).*
Provide projected cost to Weatherization agency associated with integrating submission into normal practices (including initial investment in capital equipment, materials cost, maintenance, etc.).*
Do you know whether the energy audit or reporting forms will need to be amended to account for this new technology/technique? *
File upload/attach PDF or Word files - max size 4,096 KB). File extentions accepted: pdf, doc, docx, xls, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif.*

* Required Information