EIA-871F Fuel Oil Usage

Fuel Oil 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-871F 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-871F
OMB Approval Number: 1905-0145
Expires:xx\xx\

Building Fuel Oil Usage
1.

Questions 2 through 6 ask for the total deliveries and costs for fuel oil delivered to the building identified on the
mailing label on the front page of this questionnaire, as well as the reporting period for the information.
If it is easier for you to report separate deliveries, you may use the Worksheet on page 4 to list all deliveries,
otherwise go to Question 2 to enter total figures.

2.

Enter the total amount of fuel oil 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.
Gallons

The total to be reported is the sum of the individual deliveries of fuel oil 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.
3.

Enter the type of fuel delivered to this building. (Check one)
Fuel Oil (includes distillate and
residual)

If more than one type of fuel was delivered, indicate the type of fuel delivered
to most of the customers in the building most of the time.

Kerosene

Fuel oil includes distillate (#1, #2, and #4 fuel oil) and residual (#5 and #6 fuel
oil).
Diesel includes #1 and #2 diesel oils.

Diesel
Don't Know

4.

Enter the total costs for the total fuel oil deliveries reported in Question 2.
$

Include State and local taxes.
Exclude merchandise, repair or service charges.

U.S. Dollars
.

Round amounts to the nearest dollar.
5.

Please enter the starting and ending dates of the reporting period for the
fuel oil deliveries reported in Question 2.

Starting Date:

Mo/Day/Year
Ending Date:

Mo/Day/Year
6.

Enter the date of the last delivery to this building prior to the starting date
reported in Question 5.

Mo/Day/Year

Page 2 of 4

Form EIA-871F (2007)

Building Fuel Oil Usage
7.

Do the responses to Question 2 or on the Worksheet include all accounts or
customers active in this building as of January 31, 2008?
The term "customer" refers to a company, office, person, agency, etc., that is sent a
bill for deliveries of fuel oil to the building. "Customer" means 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. The term also includes any separate bill
sent to the building management or owners for the costs of deliveries of fuel oil for
the building as a whole (hallways, lobbies, areas used for storage or maintenance
operations, etc.).

8.

Does the information in Question 2 or on the Worksheet include deliveries to any
building(s) other than the building shown in the label on the front page of this
questionnaire?
Check the YES box if the bills that furnished the information for Question 2 or the
Worksheet include substantial deliveries to buildings other than the selected one, and
you are unable to report separately for the selected building.
Check the NO box if the bills include deliveries for the selected building only. Also
check the NO box if the figures include only minor out-buildings, such as a shed.

9.

Yes

No

Don't Know

Yes

No

Don't Know

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

-

Fax Number:

-

E-mail address:

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 3 of 4

Form EIA-871F (2007)

Worksheet (Optional)
Note: Use this worksheet only if you have not provided total amounts in Questions 2 through 6 on
page 2.
In the table below, please report the date, quantity delivered, and dollar amount for all deliveries of fuel oil to the building
identified in the label on the front page of this questionnaire from December 1, 2006 through January 31, 2008, beginning at
Time Period 1.
For Time Period 0, indicate the date of the last delivery prior to those for which quantities are reported.

Time
Period

Delivery Date
(month/day/year)

Fuel Oil Delivered
(gallons)

Total Costs1
(U.S. Dollars)

0
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Note 1:

Total costs should include State and local taxes, and exclude merchandise, repair or service charges.
Round all amounts to the nearest dollar.

Go to Question 7, page 3 and complete the questionnaire.

Page 4 of 4

Form EIA-871F (2007)