Form EIA-14 Refiners' Monthly Cost Report

OMB No. XXXX-XXXX
Expiration Date: XX/XX/XX
Version No: 2013.01

FORM EIA-14
REFINERS' MONTHLY COST REPORT
This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93-275). Failure to comply may result in criminal fines, civil penalties and
other sanctions as provided by law. Title 18 USC 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. See Instructions for further details on the
sanctions and the provisions concerning the confidentiality of information submitted on this form.

PART 1. RESPONDENT IDENTIFICATION

PART 2. SUBMISSION INFORMATION

If any Respondent Identification information has changed
since the last report, enter an "X" in the block:
Mo
Year
Report Period:
EIA ID NUMBER:

Due Date: A completed form must be filed by the
30th calendar day following the end of the report
month.
How to Submit Forms:

Company Name:
Instructions:
Physical Address:
(e.g., Street Address, Bldg, Floor, Suite)
Mailing Address:
(e.g., PO Box, RR)
City:
State:

http://www.eia.gov/survey/form/eia_14/instructions.pdf

Secure File Transfer option available at:
https://signon.eia.doe.gov/upload/noticeoog.jsp

Zip Code

Electronic Transmission: The PC Electronic
Data Reporting Option (PEDRO) is available.
If interested in software, call (202) 586-9659.

-

Contact Name:
Email form to: [email protected]
Phone No.:
Fax No.:

-

-

Ext:
Fax form to: (202) 586-9772
Mail form to: Oil & Gas Survey
U.S. Department of Energy
Ben Franklin Station
PO Box 279
Washington, DC 20044-0279

Email address:
Date of this Report:
Type of Report (Check One ):
(1)
Original
(2)
Resubmission
Revision to Report:

Mo

Day

Year

Mo

Day

Year

Questions? Call toll free: 1-800-638-8812

PART 3. SUMMARY OF CRUDE OIL COSTS AND VOLUMES
MONTHLY ACQUISITIONS
Domestic Crude Oil
Imported Crude Oil
Category Description
Total Cost
Total Volume
Total Cost
Total Volume
PAD DISTRICT
PADD 1
PADD 2
PADD 3
PADD 4
PADD 5
Other
Total U.S.

(Thousands of dollars)

(Thousands of barrels)

(Thousands of dollars)

(Thousands of barrels)

(a)

(b)

(a)

(b)

Comments: (Unusual occurrences which may explain variations in the data and/or explanation of "Other".)