Form DOE HQ F 413.4 DOE HQ F 413.4 Zero Energy Ready Home Registration

OMB Control #: 1910-NEW

DOE HQ F 413.4
(03/2015)

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:

Select

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

Select

* 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

* Primary Contact's Direct
Phone Number(numbers
only, no hyphens or dots):
* Email Address (i.e.
jdoe@example.com):
GovDelivery Subscription:
(To subscribe to the DOE
Zero Energy Ready Home e­
newsletter, please enter your
email address above, and
click the following button.)

Subscribe to DOE Zero Energy Ready Home Newsletter (opens new window)

Upload your organization's logo
Choose File No file chosen

The format of this logo must be in the following formats: JPEG, JPG, PNG

All places your organization conducts business

Select/Deselect
All
 Alabama
 Alaska
 Arizona
 Arkansas
 California
 Colorado
Connecticut
 Delaware

District of
Columbia

 Kentucky

Montana

 Ohio

 Utah

 Louisiana

Nebraska

Oklahoma

Vermont

 Maine

Nevada

 Oregon

 Virginia

Florida
Georgia
 Maryland
Hawaii
 Idaho
Illinois

Massachusetts

 New
Hampshire

Pennsylvania Washington

 New
Jersey

 Rhode
Island

 West
Virginia

 New
Mexico

 South
Carolina

Wisconsin

 Michigan

Indiana

 Minnesota

 Iowa

Mississippi

Kansas

 Missouri

 New York
 North
Carolina

 South
Dakota
Tennessee

Wyoming

 North
Dakota

 Texas

Register Account

  Reset Form

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.

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the 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-XXXX), 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-XXXX), Washington, DC

20503.