Form EIA-856 Monthly Foreign Crude Oil Acquisition Report

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Overview

Coverpage
Page 1

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Sheet 1: Coverpage

OMB No. 1905-0174

Expiration Date: XX/XX/XXXX

Burden: 6.1 hours

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

Due Date: A completed form must be filed by the 30th calendar day following the end of the report month.

since the last report, enter an "X" in the block:

Mo

Year

Report Period:

EIA ID NUMBER:

How to Submit Forms:

Company Name:

Instructions:

http://www.eia.gov/survey/form/eia_856/instructions.pdf

Physical Address:

(e.g., Street Address, Bldg, Floor, Suite)

Appendix A:

Mailing Address:

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

(e.g., PO Box, RR)

City:

Appendix B:

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

State:

Zip Code

-

Contact Name:

Secure File Transfer option available at:

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

Phone No.:

-

-

Ext:

Fax form to: (202) 586-9772

Email address:

Mail form to:

Oil & Gas Survey

Mo

Day

Year

U.S. Department of Energy (EI-25)

Attn: EIA-863

Date of this Report:

Ben Franklin Station

Type of Report (Check One):

PO Box 279

(1)

Original

Washington, DC 20044-0279

(2)

Resubmission

Mo

Day

Year

Revision to Report:

Questions? Call toll free: 1-800-638-8812

PART 2. SUMMARY DATA

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

Barrels

column (l), Part III, excluding resubmission.)

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

Barrels

end of the report month.)

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Sheet 2: Page 1

OMB Number: 1905-0174

Expiration Date: XX/XX/XXXX

Burden: 6.1 hours

FORM EIA-856

MONTHLY FOREIGN CRUDE OIL ACQUISITION REPORT

Page

of

PART 3. TRANSACTIONS

EIA ID NUMBER:

Report Period:

Mo

Year

Date submitted:

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(I)

(j)

(k)

(l)

(m)

(n)

(o)

(p)

Trans-

Port

Date of

Con-

Volume

Acquisi-

Other

Landed

Name of Vendor

action

Type of

Country/

Date of

Port

of

Landing

tract/Point

Acquired

tion Price

Cost

Cost

Days

Num-

Trans-

Crude Code

Crude Type

Gravity

Loading

of

Desti-

(YYMM)

Vessel/Carrier

Code

(BBLs)

($/BBLs)

($/BBL)

($/BBL)

Credit

Name of Vendor

ber

action

(YYMMDD)

Loading

nation

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