EIA-871C Natural Gas Usage

Natural Gas Usage Form
2007 Commercial Buildings Energy Consumption Survey (CBECS)

Timely submission of this report is mandatory under Public Law 93-275, as amended.

2.

This completed questionnaire is due by

3.

Data reported on this questionnaire are for the
entire building identified in the label to the right.

4.

Data may be submitted directly on this
questionnaire or in any other format, such as a
computer-generated listing, which provides the
same information and is convenient for your
company.

l
e
b
a
L

1.

a. You may submit a single report for the entire
building, or if it is easier, a separate report for
each of several accounts in the building. These will
then be aggregated by the survey contractor.
b. If you are concerned about your individual
account information, you may choose to mark out
account numbers on any computer-generated listing that you send us; however, write the CBECS building identification
number (indicated in the label above) on your listing.
c. Whatever format is used to report, ensure that answers are submitted for all pertinent questions.
5.

If you have any specific questions concerning this questionnaire, please contact the CBECS Supplier Survey Specialist
(toll free) at 1-888-xxx-xxxx. For general information about the survey, visit our Web site at
www.eia.doe.gov/emeu/cbecs.

6.

Please use the enclosed self-addressed, postage-paid envelope to return the completed questionnaire or mail it to:
Commercial Buildings Energy Consumption Survey
or FAX to: 1-888-xxx-xxxx
c/o [CONTRACTOR]
STREET.
CITY, ST ZIPCD-PLUS

This report is mandatory under Public Law 93-275, as amended. The timely submission of Form EIA-871C by those required to report is
mandatory under Section 13(b) of the Federal Energy Administration Act of 1974 (Public Law 93-275), as amended. Failure to respond may result in
criminal fines, civil penalties, and other sanctions as provided by law. Per the Paperwork Reduction Act of 1995, you are not required to respond to any
Federally-sponsored collection of information unless it displays a valid OMB Approval Number. The valid OMB Approval Number for this information
collection (1905-0145) is displayed at the lower left hand corner of this page. Title 18 U.S.C. 1001 makes it a criminal offense for any person knowingly and
willingly to make to any Agency or Department of the United States any false, fictitious, or fraudulent statements as to any matter within its jurisdiction.

Confidentiality: Under the Confidential Information Protection and Statistical Efficiency Act of 2002 (P.L. 107-347) any information collected that will
permit identification of respondents or their buildings will be confidential and used only for statistical purposes. Data that can be identified with individual
respondents will not be publicly disclosed or released.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time of reviewing instructions,
searching existing data records, 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 the Energy
Information Administration, Statistics and Methods Group, EI-70, Washington, DC 20585-0670, and to the Office of Information and Regulatory Affairs,
Office of Management and Budget, Washington, DC 20503.

Form EIA-871C
OMB Approval Number: 1905-0145
Expires:xx\xx\xx

General Instructions
7.

The sections of the questionnaire you must complete depend on your answer to Question #1, as to whether you deliver and/or
sell natural gas to the building identified in the label on the front page of this questionnaire:

If you only deliver natural gas to the building →

Complete Section A, Questions 2 through 5 and Section C,
Questions 17 through 20.

If you both deliver and sell natural gas to the building →

Complete Section A, Questions 2 through 11 and Section C,
Questions 17 through 20.

If you only sell (but not deliver) natural gas to the building →

Complete Section B, Questions 12 through 16, and Section C,
Questions 17 through 20.

8.

All information reported on this questionnaire should be for the entire building as identified in the label on the front page of this
questionnaire.

9.

Round all dollar amounts to the nearest dollar.

10.

We are requesting figures (for December 1, 2006 through January 31, 2008) throughout the questionnaire. However, if it is
easier for you to report monthly figures, you may use the optional Worksheets at the end of the questionnaire.

Page 2 of 12

Form EIA-871C (2007)

Building Natural Gas Usage
1.

During 2007, did your company deliver natural gas to the building
during the period from December 1, 2006 through January 31, 2008?

Yes, delivered natural gas to the
building → Go to Question 2, Section
A, this page

"The building" referred to in this question and following questions, is the
building identified in the label on the front page of this questionnaire.

No, only sold natural gas to the
building → Go to Question 12,
Section B, Page 6.

Section A: Natural Gas Deliveries
2.

Questions 3 through 5 ask for the total deliveries and costs for natural gas delivered to the building identified in the
label on the front page of this questionnaire, as well as the reporting period for the information.
If it is easier for you to list deliveries by month, you may use Worksheet #1 on Page 10 to report monthly, otherwise,
go to Question 3 to enter total figures.

3.

Enter the total quantity (and indicate units) of natural gas delivered
by your company to the building during the period from December 1,
2006 through January 31, 2008.
Include all natural gas delivered to the building, whether bought from you
or someone else.
The total to be reported is the sum of all the natural gas delivered to all
separately billed customers in the building during the period from
December 1, 2006, through January 31, 2008.
The total should include:
--former customers who were in the building during the reporting period,
and
--all customers or accounts in the building, whether commercial or
noncommercial.

Total Deliveries
(volume)
Therms
Cubic feet (cf)
100 cubic ft (Ccf)
1,000 cubic ft (Mcf)
Dekatherms
Other, specify
__________________________

4.

Please enter the starting and ending dates of the reporting period for
the natural gas deliveries reported in Question 3.

Starting Date:

Mo/Day/Year
Ending Date:

Mo/Day/Year

Page 3 of 12

Form EIA-871C (2007)

Building Natural Gas Usage
Section A: Natural Gas Deliveries, cont.
5.

Enter the total cost for the natural gas deliveries reported in
Question 3.

$

Include State and local taxes and fuel adjustment charges, system charges
(minimum bill or base charge), delivery charges, management fees,
transportation fees, and storage fees.

U.S. Dollars
Round amounts to the nearest dollar.

Exclude merchandise, repair or service (hookup or disconnect fees, late
payment fees, etc.) and any other charges not specifically mentioned in the
"include" list.
6.

Was all of the natural gas delivered to the building during the period
from December 1, 2006 through January 31, 2008, sold by your
company?

Yes → Go to Question 17, Section
C, Page 8.
No, some or all natural gas was sold
by another company → Go to
Question 7

7.

Questions 8 through 11 ask for the total sales and costs for natural gas sold to the building identified in the label on
the front page of this questionnaire, as well as the reporting period for the information.
If it is easier for you to list sales by month, you may use Worksheet #2 on Page 11 to report monthly, otherwise go to
Question 8 to report total figures.

8.

Enter the total quantity of natural gas sold by another company (but
delivered by your company) to the building during the period from
December 1, 2006 through January 31, 2008.
Note: The total natural gas deliveries reported in Question 3 should
include this amount.

Total Deliveries
(volume)
Therms
Cubic feet (cf)
100 cubic ft (Ccf)
1,000 cubic ft (Mcf)
Dekatherms
Other, specify
__________________________

Page 4 of 12

Form EIA-871C (2007)

Building Natural Gas Usage
Section A: Natural Gas Deliveries, cont.
9.

Please enter the starting and ending dates of the reporting period for
the natural gas sales reported in Question 8.

Starting Date:

Mo/Day/Year
Ending Date:

Mo/Day/Year
10.

Enter the total cost for the natural gas sales reported in Question 8.
Include State and local taxes and fuel adjustment charges, system charges
(minimum bill or base charge), delivery charges, management fees,
transportation fees, and storage fees.

$
U.S. Dollars

Exclude merchandise, repair or service (hookup or disconnect fees, late
payment fees, etc.) and any other charges not specifically mentioned in the
"include" list.

Round amounts to the nearest dollar.

Note: The total deliveries costs reported in Question 5 should include
these costs.
11.

What charges are included in the cost reported in Question 10?

Commodity costs

(Check all that apply)
Delivery charges

Management, Processing, Handling
or Broker fees
Taxes

Storage fees

Other, specify
__________________________

Go to Question 17, Section C, Page 8.
[Do not complete Section B.]

Page 5 of 12

Form EIA-871C (2007)

Building Natural Gas Usage
Section B: Natural Gas Sales
12.

Questions 13 through 16 ask for the total sales and costs for natural gas sold to the building identified in the label on
the front page of this questionnaire, as well as the reporting period for the information.
If it is easier for you to list sales by month, you may use Worksheet #2 on Page 11 to report monthly, otherwise go to
Question 13 to report total figures.

13.

Enter the total quantity of natural gas sold by your company to the
building identified in the label on the front page of this questionnaire
during the period from December 1, 2006 through January 31, 2008.
Total Deliveries
(volume)
Therms
Cubic feet (cf)
100 cubic ft (Ccf)
1,000 cubic ft (Mcf)
Dekatherms
Other, specify
__________________________

14.

Please enter the starting and ending dates of the reporting period for
the natural gas sales reported in Question 13.

Starting Date:

Mo/Day/Year
Ending Date:

Mo/Day/Year
15.

Enter the total cost for the natural gas sales reported in Question 13.
Include State and local taxes and fuel adjustment charges, system charges
(minimum bill or base charge), delivery charges, management fees,
transportation fees, and storage fees.
Exclude merchandise, repair or service (hookup or disconnect fees, late
payment fees, etc.) and any other charges not specifically mentioned in the
"Include" list.
Page 6 of 12

$
U.S> Dollars
Round amounts to the nearest dollar..

Form EIA-871C (2007)

Building Natural Gas Usage
Section B: Natural Gas Sales, cont.
16.

What fees or charges are included in the cost reported in
Question 15?

Commodity costs

(Check all that apply)
Delivery charges

Management, Processing, Handling
or Broker fees
Taxes

Storage fees

Other, specify
__________________________

Go to Question 17, Section C, next page.

Page 7 of 12

Form EIA-871C (2007)

Building Natural Gas Usage
Section C: Account and Contact Information
17.

Do the responses reported in the questions in Sections A, B or the
Worksheets include all accounts or customers active in this building
as of January 31, 2008?

Yes

The term "account" is a billing unit. It can be linked to a company,
office, person, agency, etc., that is sent a bill for usage of natural gas in
the building.

No

Your response should include all accounts for the building, including all
separately billed tenants or occupants of the building, regardless of
whether the bills are sent to the building address or to some other
address.

Don't Know

The term also includes any separate bill sent to the building
management or owners for the costs of natural gas supplied to the
building as a whole (hallways, lobbies, areas used for storage or
maintenance operations, etc.).
18.

Does the information reported in Question 3, Question 8, Question
13 or the Worksheets include deliveries or sales to any other
building(s)?
Check the YES box if the bills that furnished the information for
Questions 3, 8, 13 or the Worksheets include substantial deliveries or
sales to buildings other than the selected one, and you are unable to
report separately for the selected building.

Yes

No

Don't Know
Check the NO box if the figures reported include deliveries or sales for
the selected building only. Also check the NO box if the figures include
only minor out-buildings, such as a shed.
19.

How do you classify this building/account in your records?
(CHECK ONE)
NOTE: Please provide the reported information for this building even if
this is not a commercial building according to your definition or
records.

Residential

Commercial

Industrial

Commercial/Industrial
Other, specify
__________________________

Page 8 of 12

Form EIA-871C (2007)

Building Natural Gas Usage
Section C: Account and Contact Information, cont.
20.

Contact Information (please print)
Name of person who completed
this questionnaire:
Date:
Title:
Telephone Number:

-

Fax Number:

-

E-mail address:
Any additional information or comments you have concerning the data reported on this questionnaire:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Thank you for completing this questionnaire!
Please return your completed questionnaire to:
Commercial Buildings Energy Consumption Survey
c/o [CONTRACTOR]
STREET
CITY, ST ZIPCD-PLUS

Page 9 of 12

Form EIA-871C (2007)

Worksheet #1: Monthly Natural Gas Deliveries (Optional)
Note: Use this worksheet only if you have not provided total deliveries in Questions 3 through 5.
In the table below, please report total natural gas deliveries to the building identified in the label on the front page of this
questionnaire during the period from December 1, 2006 through January 31, 2008.

Reporting Period
Time
Period

Deliveries

Beginning Date

Ending Date

(month/day/year)

(month/day/year)

Costs1
(U.S. Dollars)

Quantity
(volume)

1
2
3
4
5
6
7
8
9
10
11
12
13
14

Note 1:

Indicate the unit of measure for the reported quantities:
(check one)
[ ] Therms
[ ] 1,000 Cubic Feet (Mcf)
[ ] Cubic Feet (cf)
[ ] Dekatherms
[ ] 100 Cubic Feet (Ccf)
[ ] Other units, specify_______________________

Note 2:

Costs should include:
-State and local taxes
-Fuel adjustment charges
-System charges (minimum bill or base
charge)
-Delivery charges
-Management fees
-Transportation fees
-Storage fees

Costs should exclude:
-Merchandise
-Repair
-Service (hookup or disconnect fees, late payment fees, etc.)
-Any other charges not specifically mentioned in the
"include" list

Round amounts to the nearest dollar.

Go to Question 6, Page 4.

Go to Question 6, Page 4.
Page 10 of 12

Form EIA-871C (2007)

Worksheet # 2: Monthly Natural Gas Sales (Optional)
Note: Use this worksheet only if you have not provided total sales amounts in Questions 8 through
11 or Questions 13 through 16.
In the table below, please report total natural gas sales to the building identified in the label on the front page of this
questionnaire during the period from December 1, 2006 through January 31, 2008.

Reporting Period
Time
Period

Sales

Beginning Date

Ending Date

(month/day/year)

(month/day/year)

Costs1
(U.S. Dollars)

Quantity
(volume)

1
2
3
4
5
6
7
8
9
10
11
12
13
14

Note 1:

Indicate the unit of measure for the reported quantities:
(check one)
[ ] Therms
[ ] 1,000 Cubic Feet (Mcf)
[ ] Cubic Feet (cf)
[ ] Dekatherms
[ ] 100 Cubic Feet (Ccf)
[ ] Other units, specify_______________________

Note 2:

Costs should include:
-State and local taxes
-Fuel adjustment charges
-System charges (minimum bill or base
charge)
-Delivery charges
-Management fees
-Transportation fees
-Storage fees

Costs should exclude:
-Merchandise
-Repair
-Service (hookup or disconnect fees, late payment fees, etc.)
-Any other charges not specifically mentioned in the "include"
list

Round amounts to the nearest dollar.

Go to Question 17, Section C, Page 8, and complete the questionnaire.

Go to Question 17, Section C, Page 8, and complete the questionnaire.

Page 11 of 12

Form EIA-871C (2007)

Thank you for completing this questionnaire!

Please return your completed questionnaire to:
Commercial Buildings Energy Consumption Survey
c/o [CONTRACTOR]
STREET
CITY, ST ZIPCD-PLUS

Page 12 of 12

Form EIA-871C (2007)