Form EIA-14 Form EIA-14 Refiners’ Monthly Cost Report

																							OMB No. 1905-0174
																							Expiration Date: xx/xx/xxxx
																							Burden: 1.75 hours
																							Version No.: 2016.01
FORM EIA-14
REFINERS' MONTHLY COST 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 INFORMATION																			PART 2. SUBMISSION INFORMATION
																			Please provide a comment below regarding the resubmission.
REPORT PERIOD:							Month					Year							Due Date:	A completed form must be filed by the 30th calendar day following the end of the report month.
EIA ID NUMBER:
If any Respondent Identification Data has changed since the last																			Forms may be submitted using one of the following methods:
	report, enter an "X" in the box:																		Secure File Transfer:
Company Name:
																			Fax:	(202) 586-9772
Mailing Address of Contact (e.g., PO Box, RR):
																			Electronic Transmission:
City:										State:			Zip:			-			For the PC Electronic Data Reporting Option (PEDRO) software, call (202) 586-9659.
Contact Name:
Phone No.:															Ext:				Mail:	Oil & Gas Survey
Fax No.:																				U.S. Department of Energy (EI-25) Ben Franklin Station PO Box 279 Washington, DC 20044-0279
Email address:
Date of this Report:										Month:			Day:			Year:
Type of Report (Check one)
				Original		Please select only one Type of Report													Questions?		Call 1-800-638-8812
						Resubmission
							Revision to Report:			Month:			Day:			Year:
PART 3. SUMMARY OF CRUDE OIL COSTS AND VOLUMES
PAD District								MONTHLY ACQUISITIONS
								Domestic Crude Oil												Imported Crude Oil
								Total Cost (thousands of dollars)								Total Volume (thousands of barrels)				Total Cost (thousands of dollars)		Total Volume (thousands of barrels)
PADD 1
PADD 2
PADD 3
PADD 4
PADD 5
Other
Total U.S.
Comments: (Unusual occurrences which may explain variations in the data and/or explanation of 'Other'.)
									0	0	0	0								0	0	0	0
									0	0	0	0								0	0	0	0
									0	0	0	0								0	0	0	0
									0	0	0	0								0	0	0	0
									0	0	0	0								0	0	0	0
									0	0	0	0								0	0	0	0