Form 4058 Production Allocation Schedule Report (PASR)

U.S. DEPARTMENT OF THE INTERIOR
Office of Natural Resources Revenue

OMB Control Number 1012-0004
OMB Approval Expires 12/31/2015

PRODUCTION ALLOCATION
SCHEDULE REPORT
(PASR)
REPORTER USE

ONRR USE
PRODUCTION MONTH: (6) MMCCYY

REPORT TYPE:

API GRAVITY: (3) 99.9

____ ORIGINAL
____ MODIFY (DELETE/ADD BY LINE)
____ REPLACE (OVERLAY PREVIOUS REPORT)

BTU: (4) 9999

.

ONRR OPERATOR NUMBER: (5) 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

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

PHONE NUMBER: (10)
(
) (

AUTHORIZING SIGNATURE:

TOTAL: (10)
EXTENSION NUMBER: (5)
-

)
DATE: (8) MMDDCCYY

COMMENTS: (60)
FORM ONRR-4058

PAGE

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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
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) and submitted monthly by operators of the facilities and measurement points
where production from an offshore Federal lease or metering point is commingled with production from other sources
before it is measured for royalty determination. 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 1 minute per line for electronic reporting and 3 minutes per line
for 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
the Natural Resources Revenue, Attention: Rules & Regs Team, P.O. Box 25165, Denver, CO 80225-0165.