Form 4058 Production Allocation Schedule Report (PASR)

OMB Control Number 1012-0004
OMB Approval Expires 12/31/2012
U.S. DEPARTMENT OF THE INTERIOR
Office of Natural Resources Revenue

PRODUCTION ALLOCATION
SCHEDULE REPORT
(PASR)
REPORTER USE

MMS USE
PRODUCTION MONTH: (6) MMCCYY

REPORT TYPE:

API GRAVITY: (3) 99.9

____ ORIGINAL
____ MODIFY (DELETE/ADD BY LINE)
____ REPLACE (OVERLAY PREVIOUS REPORT)
MMS OPERATOR NUMBER: (5)

BTU: (4) 9999

.

OPERATOR NAME: (30)

OPERATOR FACILITY NAME/LOCATION: (30)

OPERATOR/AREA/BLOCK
(30)

INJECTOR (O/G/B)

ACTION CODE (1)

LINE NUMBER

FACILITY/MEASUREMENT POINT NUMBER: (11) OUTPUT FACILITY/MEASUREMENT POINT NUM: (11) SALES FACILITY/MEASUREMENT POINT NUMBER: (11)

VOLUMES
ONRR LEASE/
AGREEMENT
NUMBER
(11)

METERING POINT
NUMBER
(11)

SALES/TRANSFERS
(9)

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23

OTHER SOURCES

24

OTHER SOURCES
TOTAL: (10)

CONTACT NAME: (First, M.I. , Last) (30)
AUTHORIZING SIGNATURE:

PHONE NUMBER: (10)
(
) (

EXTENSION NUMBER: (5)
-

)
DATE: (8) MMDDCCYY

COMMENTS: (60)
FORM MMS-4058

PAGE

OF

INSTRUCTIONS
PRODUCTION ALLOCATION SCHEDULE REPORT
(PASR)
WHO MUST FILE
A separate report must be filed monthly by each designated operator of a facility/
measurement point handling production from a Federal lease/agreement
which is commingled with production from other sources prior to measurement for
royalty determination.
WHEN TO FILE
Reports must be received by the 15th of the second month following the production
month (e.g., the report for June is due on August 15).
You are required to report electronically under 30 CFR 1210 (2010)
(formally 30 CFR 210) unless ONRR approved you to report on paper.
WHERE TO FILE
Reports must be filed with:
Office of Natural Resources Revenue
P.O. Box 25627
Denver, Colorado 80225-0627
REFER TO THE PRODUCTION REPORTER HANDBOOK PRIOR TO
COMPLETING THIS FORM.

The Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that
we collect this information to corroborate oil and gas production and disposition data with sales and royalty data.
Responses are mandatory (43 U.S.C. 1334). Proprietary information is protected in accordance with the standards
established by the Federal Oil and Gas Royalty Management Act of 1982 (30 U.S.C. 1733), the Freedom of Information
Act [5 U.S.C.552(b)(4)], and the Department regulations (43 CFR 2). 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. Public
reporting burden for this form is estimated at an average of 5 minutes/hour per report for electronic and manual reporting,
including the time for reviewing instructions; gathering and maintaining data; and completing and reviewing the
form. Direct your comments regarding the burden estimate or any other aspect of this form to the Office of Natural
Resources Revenue, Attention: Rules & Regs Team, P.O. Box 25165, Denver, CO 80225-0165.