Report of Fuel Cost, Consumption, and Surcharge Revenue

STB Ex Parte No. 661 (Sub-No. 1)
APPENDIX B
OMB Control No. 2140-0014
Expires October 31 , 2010
RAILROAD NAME ____________________
QUARTERLY 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

Data

Amount

(a)

(in thousands)
(b)

NO

1

Total fuel cost1

2

Total gallons of fuel consumed1

3

Total increase or decrease in cost of fuel2

4

Total revenue from fuel surcharges3

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 for only regulated traffic (line 5).