| The public report burden for this information collection is estimated to average 12 hours. |
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FORM APPROVED OMB NO. 2125-0032 |
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STATE NAME: |
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| STATE MOTOR-FUEL TAX RECEIPTS AND |
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| INITIAL DISTRIBUTION BY COLLECTION AGENCIES |
YEAR ENDING (mm/yy): |
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VOLUME TAXES |
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OTHER |
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GASOLINE |
SPECIAL FUELS |
RECEIPTS |
TOTAL |
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NOTE: This collection of information is required by 23 U.S.C. 104 (b) and 105 (b); and 23 C.F.R. 1.5 and 420.105(b). Public reporting burden is estimated to average12 hours per response. The Guide data is used by FHWA in administering the Federal-Aid Highway Program; in assessing highway policies, programs and performance of the Nation’s highway transportation system; in identifying future highway system investment needs; and in making policy and program recommendations. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 2125-0032, which expires on XX/XX/XXXX. |
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(A) |
(B) |
(C) |
(D) |
| 1. Receipts for Year |
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| a. |
(1) Gross collections by distributor |
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| Volume |
(2) Less: distributor allowance for collection expense |
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| Tax |
(3) Gross receipts by State |
(1) - (2) |
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| Collections |
(4) Less: refunds and credits |
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(5) Net receipts |
(3) - (4) |
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| b. |
(1) Distributor and dealer licenses |
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| All Other |
(2) Motor-fuel inspection fees |
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| Receipts |
(3) Fines, penalties, and interest |
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| Under Motor- |
(4) Motor-carrier fuel tax registration (decals) |
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| Fuel Tax |
(5) Alternative fuel tax decals (inlieu of volume tax) |
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| Laws |
(6) |
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(7) |
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(8) |
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(9) |
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(10) Total |
(1) thru (9) |
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| c. Net Total Receipts |
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a. + b. |
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| 2. Nonhighway |
a. |
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| Dedications of |
b. |
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| Volume Tax |
c. |
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| from Nonhighway |
d. |
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| Gasoline |
e. Total |
a. thru d. |
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| 3. Adjusted Total Receipts |
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1 - 2 |
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| 4. Deductions |
a. Expense of Collecting & Administering Volume Taxes |
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| by State |
b. Expense of Inspecting Motor Fuel |
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| Collecting |
c. |
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| Agency ¹ |
d. Total |
a. + b. +c. |
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| 5. Net Proceeds Available for Distribution |
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3. - 4. |
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| 6. Balance Undistributed at End of Previous Year |
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| 7. Total Funds Available for Distribution |
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5. + 6. |
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| 8. Amounts Distributed (Specify Fund or Purpose) |
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| a. |
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| b. |
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| c. |
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| d. |
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| e. |
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| f. |
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| g. |
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| h. |
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| i. |
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| j. |
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| k. Total |
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a. thru j. |
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| 9. Balance Undistributed at End of Year |
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7. - 8. |
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| ¹ If collecting agency activities are funded by another revenue source, note this fact and provide the actual collection and administrative expenses |
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| in a footnote. |
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| Form FHWA-556 (Rev 07-2000) PREVIOUS EDITIONS OBSOLETE |
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Excel |
(Next page) |
| 1 |
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STATE NAME: |
| STATE MOTOR-FUEL TAX RECEIPTS AND |
0 |
| INITIAL DISTRIBUTION BY COLLECTION AGENCIES |
YEAR ENDING (mm/yy): |
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0 |
| RECONCILIATION BETWEEN FHWA-551M VOLUME AND FHWA-556 COLLECTIONS MAY BE SHOWN HERE, OR IN AN ATTACHMENT. |
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| INTERSTATE MOTOR-CARRIER FUEL TAX (FUEL USE TAX) RECEIPTS: |
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Gasoline |
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Special Fuels |
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| IMC fuel tax receipts |
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| Less: IMC refunds and credits |
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| Net IMC fuel tax receipts |
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| Notes and Comments: |
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| COLLECTING AGENCY: |
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| INFORMATION FROM RECORDS OF: |
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| COMPILED UNDER DIRECTION OF: |
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| Form FHWA-556 (Rev. 12-96) |
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| 2 |