Natural Gas Data Collection Program Package

OMB No. 1905-0175
Expiration Date: 12/31/2011
Version No.: 2009.01

Burden: 0.5 hours
ANNUAL QUANTITY AND VALUE OF NATURAL GAS PRODUCTION REPORT
FORM EIA-895
This report is voluntary under the Federal Energy Administration Act of 1974 (Public Law 93-275). For the provisions concerning the confidentiality of information and sanctions, see the Form EIA-895A instructions.

PART 2. SUBMISSION INFORMATION

PART 1. RESPONDENT IDENTIFICATION DATA
REPORT PERIOD:

Year:

2 0

A completed form should be filed no later than 90
days after the report year.

STATE NAME:

Form may be submitted using one of the following
methods:

If this is a resubmission, enter an "X" in the box:

Mail to:

If any Respondent Identification Data has changed since the last report, enter an "X" in the box:
Contact Name:

-

Phone No.:

-

Ext:

-

Fax No:

ATTN: EIA-895
U. S. Department of Energy
Oil & Gas Survey
Ben Franklin Station
P.O. Box 279
Washington, DC 20044-0279

Address 1:

Email:

[email protected]

Address 2:

Fax:

(202) 586-1076

City:

State:

Zip:

Email address:

-

Secure File Transfer:

Questions? Call: (877) 800-5261

https://signon.eia.doe.gov/upload/noticeoog.jsp

PART 3. ANNUAL SCHEDULE: GROSS WITHDRAWALS AND MARKETED PRODUCTION (to be completed at the end of the calendar year)
Total number of producing gas wells in operation as of December 31 for the reporting year
o

Pressure base at which all volumes are reported (psia at 60 Fahrenheit)
Gross Withdrawals (excluding lease condensate)

Month

Gas and
Condensate
Wells

Oil Wells

Coalbed
Methane Wells

Shale
Gas

Total

(1)

(2)

(3)

(4)

(5)

Used for
Repressuring
or
Reinjection

Natural Gas
Vented
and Flared

Nonhydrocarbon
Gases
Removed

Marketed
Production

Natural Gas
Used as Fuel
on Leases
(Lease Fuel)

(6)

(7)

(8)

(9)

(10)

Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Total

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OMB No. 1905-0175
Expiration Date: 12/31/2011
Version No.: 2009.01
ANNUAL QUANTITY AND VALUE OF NATURAL GAS PRODUCTION REPORT
FORM EIA-895A
REPORT PERIOD: YEAR: 2 0

RESUBMISSION

STATE NAME:
PART 4. ANNUAL SCHEDULE: VALUE AND QUANTITY OF MARKETED PRODUCTION (to be
completed at the end of the calendar year).
Quantity of Marketed Production
Month

Value of Marketed Production

(Value Based)

Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Total
0
0
Comments: Identify any unusual aspects of your reporting period's activity. (To separate one comment from
another, pres ALT + ENTER.)

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