Form -- Rail Fuel Surcharge

OMB Control No. 2140-0014
Expires 09-30-2023

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.

Data
(a)

LINE
NO.

1

Total fuel cost 1

2

Total gallons of fuel consumed 1

3

Total increase or decrease in cost of fuel2

4

Total revenue from fuel surcharges3

5

Revenue from fuel surcharges on regulated traffic

Amount
(in thousands)

(b)

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.
Include fuel for freight, yard and work train locomotives. Include fuel charged to train and yard service (function 67Locomotive Fuels). Include all other fuel used for railroad operations and maintenance, including mot or vehicles a nd power
equipment n o t charged to function 6 7 - L o c o m o t i v e Fuels.
2 Show the total increase or decrease in fuel cost over previous quarter.
1

3

Show Fuel surcharges billed for all traffic (line 4) and for only regulated tr affic (line 5).

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.
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 information
unless it displays a currently valid OMB control number.