HOME MANUFACTURER 	                                                     
                                                                        
                   OMB Control No. xxxx-xxxx

	

Company																												Contact																				Home
serial number

	

Address																												City										State			Zip 					
Telephone	

Instructions for manufacturer's field representative:

1. Fill in retailer and homeowner contact information.

2. Verify that all ENERGY STAR CONSTRUCTION REQUIREMENTS listed below
have been successfully completed.

3. Confirm that the blue EPA ENERGY STAR label and gray quality
assurance (QA) label are affixed to the home (near the HUD data plate or
the main electrical panel).

4. When all ENERGY STAR construction requirements have been successfully
completed:

• Sign and date this form.

• Sign and date the QA label.

• Promptly return this completed form to the manufacturer.	

If there are any discrepancies, contact the manufacturer immediately.

RETAILER*

	

Company																												Contact																				Email
address

	

Address																												City										State			Zip					
Telephone	

HOMEOWNER*

	

Name																																																					Telephone

	

Address																												City										State			Zip 					
County	

	

ENERGY STAR CONSTRUCTION REQUIREMENTS

A. Marriage Line Seal

The marriage line areas must be filled with a continuous non-porous
insulating gasket creating a permanent air barrier at joints in the
ceiling, walls and floor. Acceptable gaskets can be one or two-part
systems, including proprietary gaskets, foams, insulation wrapped in
poly, and insulation covered by butyl or other long-life tape on one
side. In addition, there must be no visible signs of gaps or tears.

B. Tears in Bottom Board Material Repaired

All tears in the bottom board material must be covered and sealed with a
durable, permanent patch to prevent air leakage. (Foam sealant can be
used on lag bolt and other small holes.)

C. Exterior (Including Crossover) Duct Installation

For multi-section homes, the exterior ducts must be sealed with a
permanent connection per the Manufacturer's Installation Manual.
Identify that the following items are completed:

All exterior ducts have been installed and wrapped with insulation.

Crossover collar is secured to the trunk with at least three screws and
cannot rotate or move.

All exterior duct insulation is a minimum of R-_______.

Nylon or metal straps and saddles are used to support the exterior duct;
duct does not touch the ground.

Three or more screws are placed below the straps through the flexible
duct and into the crossover collar.

Exterior duct insulation is pushed into the floor cavity and sealed with
tape or foam sealant at all bottom board penetrations.

D. Field Installed Heat Pump

Heating equipment efficiency meets or exceeds the following
specification: HSPF-_______.

E. For Homes Installed Over Basements (One of the following must be
checked)

This home has an UNHEATED BASEMENT. All interior stairwells from the
heated space into the basement are constructed in the same manner as an
exterior wall with full insulation and a weather-stripped, insulated
exterior door.

This home has a HEATED BASEMENT. The basement wall insulation level is a
minimum of: R-_______.

		

Signature (Manufacturer's Representative) 											Print Name 								
									Date

Fax this completed form to 				 or mail to the home manufacturer at the
address above.

Fax Number

* The retailer and/or homeowner may be contacted as part of the ENERGY
STAR for Homes quality assurance program.

EPA Form 5900-172

The government estimates the average time needed to fill out this form
is 0.25 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.

Site Installation Checklist 

for ENERGY STAR® Qualified Manufactured Homes

