EIA-871D District Heating Usage

District Steam/Hot Water 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-871D 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-871D
OMB Approval Number: 1905-0145
Expires:xx\xx\xx

District Steam/Hot Water Usage
1.

2.

Was district steam or hot water delivered to the building during the
period from December 1, 2006 through January 31, 2008?

Yes → Go to Question 2

"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 → Go to Question 11, Page 4.

Questions 3 through 5 ask for the total deliveries and costs for district steam or hot water 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 5 to report monthly, otherwise,
go to Question 3 to enter total figures.

3.

Enter the total quantity (and indicate units) of district steam or hot
water delivered by your company to the building during the period
from December 1, 2006 through January 31, 2008.
If consumption is metered both at the central plant and at the building,
report the amounts metered at the building.
If you are unable to separate the delivered amounts for this building,
report for the entire system.

Quantity Delivered
Million Btu
Thousand pounds
Pounds
Other, specify
__________________________

4.

Enter the total cost for the district steam or hot water reported in
Question 3.

$
U.S. Dollars

Include State and local taxes.
Exclude all merchandise or repair charges.
5.

Round all amounts to the nearest dollar.

Please enter the starting and ending dates of the reporting period for
the district steam or hot water deliveries reported in Question 3.

Starting Date:

Mo/Day/Year
Ending Date:

Mo/Day/Year

Page 2 of 6

Form EIA-871D (2007)

District Steam/Hot Water Usage
6.

Is the building billed for the district steam or hot water piped into it?

Yes
No

Don't Know
7.

Is the building a heating plant, that is, does it contain equipment used
to heat other buildings?

Yes
No

Don't Know
8.

Does the answer to Question 3 or the Worksheet include consumption
in any building(s) other than the building identified in the label?

Yes → Go to Question 9

Check the "Yes" box if the quantities reported in Question 3 or on the
Worksheet include substantial consumption in buildings other than the
selected building and you are unable to report separately for the selected
building.

No → Go to Question 11, next page
Don't Know → Go to Question 11,
next page

Check the "No" box if the quantities reported in Question 3 or on the
Worksheet include consumption in the selected building only. Also check
the "No" box if the figures include minor out-buildings, such as a shed.
9.

In your estimation, of the total amount reported in Question 3 or on
the Worksheet, what percentage was consumed at the building
identified in the label?

%
Go to Question 11, next page

Don't Know → Go to Question 10

10.

a.

What is the square footage of the building identified in the label? 10a.

Building Sq. ft.
b. What is the square footage of all the buildings on this district
loop, including the building identified in the label?

10b.

Loop Sq. Ft.

Page 3 of 6

Form EIA-871D (2007)

Building District Steam/Hot Water Usage, cont.
11.

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 4 of 6

Form EIA-871D (2007)

Worksheet (Optional)
Note: Use this worksheet only if you have not provided total deliveries in Questions 3 through 5.
In the table below, please report all district steam or hot water delivered 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.
If consumption is metered both at the central plant and at the building, report the amounts metered at the building.
If you are unable to separate the delivered amounts for this building, report for the entire system, and answer questions 9 or 10
to help us make estimates for the building identified in the label.
Time
Period

Beginning Date

Ending Date

(month/day/year)

(month/day/year)

Quantity Delivered*

Total Dollar Amount**

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

*Units used to report quantities:
(check one)
Million Btu
Thousand pounds
Pounds

**Total Dollar Amount should:
include State and local taxes,
and
exclude all merchandise or repair
charges.

Round amounts to the nearest
dollar.

Other, specify
_______________________

Go to Question 6 on Page 3 and complete Questions 6 through 11.

Go to Question 6 on Page 3 and complete Questions 6 through 11.
Page 5 of 6

Form EIA-871D (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 6 of 6

Form EIA-871D (2007)