Form EIA-878 (Schedule EIA-878 (Schedule Motor Gasoline Price Survey (Schedule A)

Petroleum Marketing Program

eia-878_f_07_18_17_SchedA

Motor Gasoline Price Survey

OMB: 1905-0174

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U.S. DEPARTMENT OF ENERGY

U.S. ENERGY INFORMATION ADMINISTRATION

Washington, DC 20585


OMB Number: 1905-0174

Expiration Date: XX/XX/XXXX

Burden: 6.5 minutes

EIA-878: MOTOR GASOLINE PRICE SURVEY

Schedule A



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.


Prices for: Shape1 Shape2 Shape3

Month Day Year



PART 1. IDENTIFICATION DATA

  1. Company Name (only if different than label)



  1. Station Name



8. Name of Contact Person

  1. Station’s Physical Address



9. Mailing/Contact’s Address

  1. Station City



  1. Station State

10. Contact’s City

11.Contact’s State

12. Contact’s ZIP Code

  1. Station ZIP Code



  1. Station Telephone Number

13. Contact’s Email Address

14. Contact’s Telephone Number

The information you provide on Form EIA-878 will be used for statistical purposes only. Your responses will be kept confidential and will not be disclosed in identifiable form. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data. By law, every EIA employee, as well as every agent, is subject to a jail term, a fine, or both if he or she makes public ANY identifiable information you reported.

PART 2. PRICE DATA

Enter your station’s total retail price of self-service, cash only, gasoline for each grade, including all taxes.

Grade

Ethanol Content (%)

Price (in dollars per gallon)

Regular (85, 86, 87 octane)


$

Midgrade (88, 89, 90 octane)


$

Premium (91+ octane)


$

Other (specify octane rating)____________


$

Other (specify octane rating)____________


$

COMMENTS









File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleThis report is mandatory under Public Law 93 275
AuthorEIA
File Modified0000-00-00
File Created2021-01-22

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