EIA-856 Monthly Foreign Crude Oil Acquisition Report

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

FORM EIA-856
MONTHLY FOREIGN CRUDE OIL ACQUISITION 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
If any Respondent Identification information has changed
since the last report, enter an "X" in the block:
Mo
Year
Report Period:
EIA ID NUMBER:
Company Name:

Due Date: A completed form must be filed by
the 30th calendar day following the end of the
report month.
How to Submit Forms:
Instructions:
http://www.eia.gov/survey/form/eia_856/instructions.pdf

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

Appendix A:
http://www.eia.gov/survey/form/eia_856/eia856appa.pdf

Appendix B:
http://www.eia.gov/survey/form/eia_856/eia856appb.pdf

State:
Contact Name:

Zip Code

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

Phone No.:
Fax No.:

-

Ext:

-

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

Mo

Day

Year

Mo

Day

Year

Email form to: [email protected]
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
Questions? Call toll free: 1-800-638-8812

1. Total Acquisitions
(Enter the total volume of foreign crude oil acquired during the report
month for importation into the United States. This is the sum of
column (l), Part III, excluding resubmission.)

Barrels

2. Offshore Inventories
(Enter the total volume of foreign oil owned by the firm, for eventual
importation into the United States which is held in storage outside
the United States and/or is enroute to the United States as of the
end of the report month.)

Barrels

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

FORM EIA-856
MONTHLY FOREIGN CRUDE OIL ACQUISITION REPORT
Page

of

PART 3. TRANSACTIONS
EIA ID NUMBER:

(a)
(b)
(c)
Transaction Type of Country/
Num- Trans- Crude Code
ber action

(d)

(e)

(f)

(g)

Crude Type

Gravity

Date of
Loading
(YYMMDD)

Port
of
Loading

(h)
(I)
Port Date of
of
Landing
Desti- (YYMM)
nation

Comments: (Report any occurences that could explain variation in the data reported)

(j)
Vessel

(k)
Contract/Point
Code

(l)
Volume
Acquired
(BBLs)

Report Period:
Date submitted:
(m)
(n)
(o)
(p)
Acquisi- Other Landed
tion Price Cost
Cost
Days
($/BBLs) ($/BBL) ($/BBL) Credit

(q)
Name of Vendor