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OMB Control No. 2140-0014 |
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Expires 03-31-2017 |
| RAILROAD NAME |
| QUARTERLY REPORT OF |
| FUEL COST, CONSUMPTION, AND SURCHARGE REVENUE |
| FOR THE QUARTER ENDING , 20_ |
| Instructions: The report shall contain d ata only for the reported quarter. Cost and revenue are defined as accrued or earned that quarter. The report shall be filed with the Surface Transportation Board on or before 30 days after the end of that quarter. |
| LINE NO. |
Data (a) |
Amount
(in thousands) (b) |
| 1 |
Total fuel cost 1 |
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| 2 |
Total gallons of fuel consumed 1 |
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| 3 |
Total increase or decrease in cost of fuel2 |
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| 4 |
Total revenue from fuel surcharges3 |
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| 5 |
Revenue from fuel surcharges on regulated traffic |
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| I, the undersigned, , Title: , state that this report was prepared by me or under my supervision and that I have carefully examined it and on the basis of my knowledge, belief, and verification declare it to be full, true and correct. |
| 1 Include fuel for freight, yard and work train locomotives. Include fuel charged to train and yard service (function 67-Locomotive Fuels). Include all other fuel used for railroad operations and maintenance, including mot or vehicles and power equipment not charged to function 67 - Locomotive Fuels. |
| 2 Show the total increase or decrease in fuel cost over previous quarter. |
| 3 Show Fuel surcharges billed for all traffic (line 4) and for only regulated traffic (line 5). |
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| SUPPLEMENTAL INFORMATION ABOUT THE FUEL SURCHARGE REPORT |
| The following information is provided in compliance with OMB requirements, pursuant to the Paperwork Reduction Act of 1995, 44 U.S.C. 3501 etseq.: |
| Information in this report is intended to permit the Board to monitor the fuel surcharge practices of Class I carriers. |
| The estimated annual hourly, per respondent burden for filing this report is 12 hours. |
| This report is mandatory for Class I carriers. |
| Information collected through this report is published on the Board’s website and is maintained by the agency for at least 2 years. |
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| The display of a currently valid OMB control number for this collection is required by law. |
| Under 5 CFR 1320.5(b), persons are not required to respond to this collection of |
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| information unless it displays a currently valid OMB control number. |
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