Draft Classification Index Survey Form

APPROVED BY OMB
XXXX-XXXXX
EXPIRES 01-31-20XX

CLASSIFICATION INDEX SURVEY FORM

Classification Index Survey Form for Railroad Companies that do not file an Annual Report with
the Surface Transportation Board.
Pursuant to 49 C.F.R. § 1201 General Instructions 1-1 and § 1241.15, all railroad companies not
required to file an Annual Report (R-1) shall compute their adjusted revenues using the railroad
revenue deflator formula. If there is a change in a carrier’s classification, this survey form shall
be submitted to the Surface Transportation Board pursuant to Instruction (3) below.

Instructions:
(1) Using the guidelines in 49 C.F.R. § 1201, General Instructions 1-1, carriers should enter their
carrier operating revenues for the calendar years 20—, 20—and 20— . Carrier operating
revenues include those identified in 49 C.F.R. § 1201, Accounts 501 through 503.
(2) Multiply annual carrier operating revenues by the annual deflator factor in Note A of § 1201,
General Instructions 1-1 and enter adjusted operating revenues as identified in the table.
(3) If there is any change in a carrier’s classification, submit this form to the Office of
Economics ([email protected]) by March 31 of the year following the end of the period to
which it relates.

Carrier Name:
Carrier Address:

Year
(a)
20xx
20xx
20xx

Annual Carrier
Operating Revenues
(b)
$
$
$

Annual Deflator
Factor
(c)

Adjusted Operating
Revenues
(d)
$
$
$

APPROVED BY OMB
XXXX-XXXXX
EXPIRES 01-31-20XX

CERTIFICATION
I the undersigned state that this report was prepared by me or under my supervision; that I have
carefully examined it; and on the basis of my knowledge, belief, and verification (when
necessary) I declare it to be a full, true, and correct statement of the operating revenues, and that
the various items reported were determined in accordance with the rules promulgated by the
Surface Transportation Board.

PLEASE TYPE OR PRINT:
_____________________________
(Name of individual preparing this form)
__________________
(Title)