DOE F 413.4 Zero Energy Ready Home

DOE HQ F 413.4
(03/2019)

OMB Control #: 1910-5184
Exp. Date: XX/XX/XXXX

Register for the DOE Zero Energy Ready Home
Complete the online registration to become a DOE Zero Energy Ready Home partner.

* Required Fields

Contact Information
* Organization
Name(complete legal name ­
i.e. Acme, LLC):
* Organization Type:

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Parent Organization (if
applicable):
* Street Address (i.e. "123
Main St." ­ NO CITY; NO
STATE):
* City:
* State:

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* Zip:
* Primary Phone
Number(numbers only, no
hyphens or dots):
Website Address (complete
­
"http://www.example.com"):

Primary Contact
* Authorized Signature?
* First Name:
* Last Name:
* Title/Role:
Complete Mailing
Address (if different from
above):

 Yes 

 No

DOE HQ F 413.4
(03/2015)

* Primary Contact's Direct
Phone Number(numbers
only, no hyphens or dots):
* Email Address (i.e.
jdoe@example.com):
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click the following button.)

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DOE HQ F 413.4
(03/2015)

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Please know your account is subject to review. Your account will be approved and listed as soon as all
requirements are met. You will receive a confirmation email once your account is approved.

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time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information
Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910-5184), U.S. Department of Energy,
1000 Independence Ave SW, Washington, DC 20585-1290; and to the Office of Management and Budget (OMB), OIRA,
Paperwork Reduction Project (1910-5184), Washington, DC 20503.