OMB Control No. xxxx-xxxx

During the past three months energy efficiency improvements were
completed on your home by    

    <contractor name>    . To help us evaluate the quality of work
performed by contractors that participate in the Home Performance with
ENERGY STAR program please complete our short (3 questions) customer
satisfaction form.  You can complete this form online at:
http://www.energystar.gov/feedback

CUSTOMER SATISFACTION FORM

Contactor Name: ____________________     

How satisfied were you with the following aspects of the work you had
done.

	Check the appropriate box.

	Very

Satisfied	

Satisfied	

Dissatisfied	Very

Dissatisfied	Unknown or Not Applicable

Information from initial energy audit	G	G	G	G	G

Listened to my concerns and goals	G	G	G	G	G

Explanation of work to be done and why	G	G	G	G	G

Quality of work done	G	G	G	G	G

Speed and timeliness of work	G	G	G	G	G

Clean up after work done	G	G	G	G	G

Overall satisfaction with work done	G	G	G	G	G



How did you hear abut this contractor? 

G	Web site

G	Referral from friend/family 

G	TV ad

G	Radio ad

G	Newspaper ad

G	Yellow pages

G	Other (please describe) ________________________________________

____________________________________________________________

Would you recommend this contractor or Home Performance with ENERGY STAR
to a friend?

G	Yes

G	No

Please share any comments or concerns about your experience.
________________________________________________________________________
____

________________________________________________________________________
____

Home Performance with ENERGY STAR is a program sponsored by the U.S
Environmental Protection Agency and the U.S. Department of Energy.  For
more information visit   HYPERLINK "http://www.energystar.gov" 
www.energystar.gov .

EPA Form 5900-182

The government estimates the average time needed to fill out this form
is 0.05 hours and welcomes suggestions for reducing this effort. Send
comments (referencing OMB Control Number) to the Director, Collection
Strategies Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460.

  PAGE  2 

