NWPA-830G Annex A to Appendix G

U.S. Department of Energy Energy Information Administration Form NWPA-830G (Revised 03/12)

ANNEX A TO APPENDIX G Standard Remittance Advice For Payment of Fees

OMB No: 1901-0260 (Expires: xx/xx/xxxx ) Burden: 5 Hours

Section 1. Identification Information: Please first read the instructions on the back.

Section 2. Net Electricity Generated Calculation

1.1

Purchaser Information:

Item

Unit 1

Unit 2

Unit 3

Station Total 1

1.11 Name:____________________________________________

2.1 Unit ID Code:

1.12 Address:__________________________________________

2.2 Gross Thermal Energy Generated (MWh):

1.13 Attention: _________________________________________

2.3 Gross Electricity Generated (MWh):

1.14 City: _________________________ 1.15 State: ________________________

1.16 Zip: ___________

2.4a Nuclear Station Use While At Least One Nuclear Unit Is In Service 2 (MWh):

1.17 Utility ID Number: ____ ____

2.4b Pumped-Storage Hydro Offset 3 (MWh):

1.2

Contact Person: 1.21 Name: ___________________________________________

2.5 Nuclear Station Use While All Nuclear Units Are Out Of Service 2 (MWh):

1.22 Title: __________________________ 1.23 Phone No.: ( )( - )

__________________ Ext:_______________

2.6 Net Electricity Generated (MWh) (Item 2.3 minus (Item 2.4a plus Item 2.4b))

1.3

Station Name: ________________________________________ ________________________________________

2.7 Footnote (if any):

1.4 1.5

Standard Contract Identification No: _____________________ Period Covered (MM/DD/YY): 1.51 From: ______ / ______ / ______ To: _____ / _____/ _____ 1.52 Date of This Submission: ________ /________ / ________ 1.53 Revision Number: ____ ____

1 For a nuclear station with more than one reactor and different ownerships for each reactor, a separate Annex A is required. 2 Utilities unable to meter individual unit use shall report estimated unit use and shall explain in a footnote how the unit data were estimated. 3 Complete this item only if DOE has approved a methodology for calculating such offsets.

Section 3. Total Energy Adjustment Factor

3.1

Data Sources: 1. EIA-861;

2. FERC Form No. 1; 3. Other (Specify in attachment)

3.2

Owner's Share Method:

 Contractual Share;  Prorata Share of Electricity;  Fixed Entitlement Share

3.3

Weighted Energy Adjustment Factor Calculation

Adjustment for Sales to ultimate Consumer (ASC)

Adjustment for Sales for Resale (ASR)

Weighted Energy Adj. Factor (WEAF)

Name of Nuclear Station Owner(s)

Data Source

Fraction of Sales to ultimate Consumer (FSC)

Sales to ultimate Consumer Adj. Factor (SCAF)

Fraction of Sales for Resale (FSR)

National average Adjustment Factor (NAF)

Owner's Energy Adjustment Factor (OEAF)

Owner's Share (OS)

<<-----------------------------------------------------------Round Data to 5 Decimal Places ---------------------------------------------------------------------->>

1.

( . x . ) + ( . x . ) = . x . = .

2.

( . x . ) + ( . x . ) = . x . = .

3.

( . x . ) + ( . x . ) = . x . = .

4.

( . x . ) + ( . x . ) = . x . = .

5.

( . x . ) + ( . x . ) = . x . = .

6.

( . x . ) + ( . x . ) = . x . = .

7.

( . x . ) + ( . x . ) = . x . = .

8.

( . x . ) + ( . x . ) = . x . = .

9.

( . x . ) + ( . x . ) = . x . = .

10.

( . x . ) + ( . x . ) = . x . = .

11.

( . x . ) + ( . x . ) = . x . = .

12.

( . x . ) + ( . x . ) = . x . = .

3.4

Total Energy Adjustment Factor (TEAF =  WEAF) Round to 4 Decimal Places ------>

.

Section 4. Fee Calculation for Electricity Generated and Sold (Complete Items After 4.2 Only When Fee Rate Is Greater Than Zero)

Item

Unit 1

Unit 2

Unit 3

Station Total 1

4.1

Total Energy Adjustment Factor (Enter value from Item 3.4 above):

4.2

Electricity Generated and Sold (Items in 4.1 times Items in 2.6):

----

Current Fee Rate (enter current rate in dollars per magawatt-hour):

4.3

Current Fee Due (Whole Dollars): (Transfer Station Total to line 3.4 of Appendix G)