Fuel Surcharge Reporting Form

OMB Control No. 2140-0014
Expires _________, 2010

RAILROAD NAME ____________________
MONTHLY REPORT OF
FUEL COST, CONSUMPTION, AND SURCHARGE REVENUE
FOR THE QUARTER ENDING _________, 20__
Instructions: The report shall contain data only for the reported quarter. Cost and
revenue are defined as accrued or earned that quarter. The report shall be filed with the
Surface Transportation Board on or before 30 days after the end of that quarter.

LI N E
NO

Data

Amount

(a)

(in thousands)
(b)

1

Total fuel cost 1

2

Total gallons of fuel consumed1

3

Total increase or decrease in cost of fuel 2

4

Total revenue from fuel surcharges 3

5

Revenue from fuel surcharges on regulated traffic

I, the undersigned, ___________________________, Title: ______________________,
state that this report was prepared by me or under my supervision and that I have
carefully examined it and on the basis of my knowledge, belief, and verification declare it
to be full, true and correct.
______________________________

1

Include fuel for freight, yard and work train locomotives. Include fuel charged
to train and yard service (function 67-Locomotive Fuels). Include all other fuel used for
railroad operations and maintenance, including motor vehicles and power equipment not
charged to function 67- Locomotive Fuels.
2

Show the total increase or decrease in fuel cost over previous quarter.

3

Show Fuel surcharges billed for all traffic (line 4) and regulated traffic (5).

SUPPLEMENTAL INFORMATION ABOUT THE FUEL SURCHARGE
REPORT
The following information is provided in compliance with OMB requirements, pursuant
to the Paperwork Reduction Act of 1995, 44 U.S.C. 3501 et seq.:
Information in this report is intended to permit the Board to monitor the fuel
surcharge practices of Class I carriers.
The estimated annual hourly, per respondent burden for filing this report is 12
hours.
This report is mandatory for Class I carriers.
Information collected through this report is published on the Board’s website and
is maintained by the agency for at least two years.
The display of a currently valid OMB control number for this collection is
required by law. Under 5 CFR 1320.5(b), persons are not required to respond to
this collection of information unless it displays a currently valid OMB control
number.