Form EIA-112 Residential Utility Disconnections Survey

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Overview

INSTRUCTIONS
SCHEDULE 1
SCHEDULE 2

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Sheet 1: INSTRUCTIONS

			FORM EIA-112 Residential Utility Disconnections Survey
							OMB NO.: xxxx-xxxx Expiration Date: x/xx/20xx Burden Hours: 2.0 Version: 2024.01 Due Date: Feb 28, [yyyy]
NOTICE: This report is mandatory under 15 U.S.C. §772(b). Failure to comply may result in criminal fines, civil penalties, and other sanctions as provided by law. For further information concerning sanctions and data protections, see the provision on sanctions and the provision concerning the confidentiality of information in the instructions. Title 18 U.S.C. §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.
INSTRUCTIONS
PURPOSE The U.S. Energy Information Administration’s (EIA) Form EIA-112, Residential Utility Disconnections Survey, collects information on customer counts, final notices, disconnections, and reconnections in all 50 states plus the District of Columbia and Puerto Rico. Information based on the data collected from this form will be made available in EIA publications and databases. The data collected on this form are used to monitor the status and trends of utility disconnections. The EIA-112 aims to better inform policymakers with authority over the Low-Income Home Energy Assistance Program (LIHEAP), (previously named the Low-Income Heating Energy Assistance Program). Data from the new survey will aid in setting appropriate levels of budgetary support for the LIHEAP by providing reliable metrics on the frequency of utility disconnections among commodities and between states.
YOUR RESPONSE IS REQUIRED BY LAW This report is mandatory under Title 15 U.S.C. §772(b). Failure to comply may result in criminal fines, civil penalties and other sanctions as provided by Title 15 U.S.C. §797. Title 18 U.S.C. §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.
REQUIRED RESPONDENTS Form EIA-112 must be completed annually by electric power entities and natural gas entities that serve residential customers. During the first collection cycle, these entities will comprise the frames of Form EIA-861 (small entities filing EIA-861S are excluded) and Form EIA-176. For the following two cycles, these entities will comprise the combined samples of Form EIA-861M and Form EIA-857.
RESPONSE DUE DATE Submit the completed Form EIA-112 to EIA by February 28, following the end of the calendar year.
HOW TO FILE A RESPONSE Respondents should transmit using one of two modes of submission. EIA Respondent Portal (PREFERRED) With the Internet‐based option, EIA uses security protocols to protect the information against unauthorized access during trans‐mission. https://survey.eia.gov Further instructions on how to register of the EIA Respondent Portal, along with more information on Form EIA-112, are available at https://www.eia.gov/survey/#eia-112. A PD document with detailed instructions for the EIA Respondent Portal are available here. Secure File Transfer Secure transmission is an industry standard method to send information over the internet using encrypted processes. The secure hypertext transfer protocol (HTTPS) is a communications protocol designed to transfer encrypted information between computers over the Internet. Files must be saved to your personal computer. EIA does not accept email, fax, or mailed paper forms. https://signon.eia.doe.gov/upload/noticeoog.jsp Copies in spreadsheet format (XLS) are available on EIA's website. You may access the materials here: https://www.eia.gov/survey/#eia-112
SANCTIONS Form EIA-112 is mandatory under 15 U.S.C. §772(b), as amended. Failure to respond may result in a civil penalty of not more than $12,937 each day for each violation. The government may bring a civil action to prohibit reporting violations, which may result in a temporary restraining order or a preliminary or permanent injunction without bond. In such civil action, the court may also issue mandatory injunctions commanding any person to comply with these reporting requirements.
REPORTING BURDEN Public reporting burden for this collection of information is estimated to average two (2) hours per respondent, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Energy Information Administration, Office of Statistical Methods and Research, EI-21, 1000 Independence Avenue SW, Forrestal Building, Washington, DC 20585–0670; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. A person is not required to respond to the collection of information unless the form displays a valid OMB number.
DISCLOSURE OF INFORMATION The following information reported on this survey will be protected and not disclosed to the public to the extent that it satisfies the criteria for exemption under the Freedom of Information Act (FOIA), 5 U.S.C. §552; the U.S. Department of Energy (DOE) regulations, 10 C.F.R. §1004.11, implementing the FOIA; and the Trade Secrets Act, 18 U.S.C. §1905: All information associated with the “Survey Contact” and the “Supervisor Information” on Schedule 1. All other information reported on Form EIA-112 is considered public information and may be publicly released in company identifiable form. The Federal Energy Administration Act requires EIA to provide company-specific data to other federal agencies when requested for official use. The information reported on this form may also be made available, upon request, to another component of DOE, any committee of Congress, the Government Accountability Office, or other federal agencies authorized by law to receive such information. A court of competent jurisdiction may obtain this information in response to an order. The information may be used for any nonstatistical purposes such as administrative, regulatory, law enforcement, or adjudicatory purposes.
SCHEDULE 1 PART 1: IDENTIFICATION For respondents using the Secure File Transfer option, Part 1 shall be completed in its entirety. For those using the EIA Respondent Portal option, you may verify your contact and other information within the portal itself. Enter your “Entity Name” as it appears in the opening email. Enter the EIA ID Number. Please refer to your emailed survey letter for your unique ID. If you do not have a number, please contact us and we will advise you of the number. Enter the contact information for the primary survey contact, who is the person who has primary responsibility in submitting the form with accurate information. If there are any questions about the submitted data, this is the person whom EIA will contact first. Enter the contact information for the primary survey contact’s supervisor. Enter the Respondent Type that best describes your entity. PART 2: SUBMISSION INFORMATION This part contains information on suitable modes of submission. More details are found previously in these instructions. PART 3: STATES AND SERVICES For Question 1, “In how many states does your establishment provide electricity and/or natural gas service to residential customers? Please include the District of Columbia and Puerto Rico, if applicable,” please provide the total number of states for which your utility provides electricity OR natural gas service. This is a total number of states regardless of any customers having any disconnections. For Question 2, “Does your establishment provide only electricity service, only natural gas service, or both electricity and natural gas services to residential customers (in any state)?” please select one and only one option. If you provide both electricity and natural gas in one or more of your states, but only one type of utility in all others, please select “Both electricity & natural gas” as your answer.
SCHEDULE 2 For each state represented in the total states in Schedule 1 – Question 1, complete one table in Schedule 2 – Part 4 for each state. For example, for one state complete only one table in Schedule 2, for two states complete two tables, and so on. If you operate in more than three (3) states, please use the EIA Respondent Portal webform option at https://survey.eia.gov. You may provide both electricity and natural gas services in particular states. Each table in Schedule 2 – Part 4 represents one state by utility type (i.e. electricity OR natural gas) combination, and you shall complete as many tables as state by utility type combinations. For example, if you operate in two states and provide both electricity and natural gas in each of those states, you will need to complete four (4) tables. PART 4: RESIDENTIAL UTILITY TOTAL CUSTOMERS, FINAL NOTICES, DISCONNECTIONS, AND RECONNECTIONS FOR EACH STATE IN EACH MONTH OF THE REPORTING YEAR More detailed definitions of terms are provided previously in this document and on the form itself. For each table in Schedule 2, select ONLY ONE of either “Electricity” or “Gas” depending on what service you provide. Do NOT combine Electricity and Natural Gas customer data in any table. If you provide both electricity and natural gas in one state, please complete two tables. For each table in Schedule 2, select ONLY ONE state in which you provide utilities, including the District of Columbia and Puerto Rico, if applicable. For each table in Schedule 2, please provide data for each month of ONLY the reporting year, starting with January and ending with December. The reporting year is clearly displayed on the form. In Line 1 of each table, enter the total number of residential, including multifamily, customers, regardless of delinquency status. In Line 2 of each table, enter the total number of residential, including multifamily, final notices sent out to customers for bill nonpayment reasons. In Line 3 of each table, enter the total number of residential, including multifamily, disconnections for bill nonpayment reasons. In Line 4 of each table, enter the total number of residential, including multifamily, reconnections for bill nonpayment reasons.
If you encounter any reporting issues, concerns, barriers, or limitations or if you would like to identify any unusual aspects or fluctuations in the information you provided for the reporting year, please use the comment area and provide a detailed explanation of your special situation. These can include disconnection moratoriums, record keeping limitations, difficulty differentiating between electricity vs. natural gas disconnections, difficult differentiating between residential and commercial customers, etc. You may also provide any comment you feel is pertinent to provide context to your unique situation.
ADDITIONAL INSTRUCTIONS FOR SCHEDULE 2 If the area for which you provide services is under a disconnection moratorium, you may enter zeroes as appropriate. Please provide a comment detailing this situation. Do NOT combine electricity and natural gas final notices, disconnections, and reconnections. Different dual-fuel utilities may disconnect one utility before disconnecting another utility. Each of these affected customers shall only be counted once per disconnection type (i.e. no double counting or duplicate reporting.) ONLY report final notices, disconnections, and reconnections for bill nonpayment reasons. Do NOT report other involuntary reasons, such as safety concerns or storm damage. Do NOT report voluntary reasons, such as moving out of the dwelling. ONLY report for residential, including multifamily, customers. Any other customers, including commercial customers, shall not be reported. Furthermore, your utility may recognize commercial dwellings, such as apartment buildings, as a non-residential customer. For the purposes of this survey, these types of customers shall be included in your reported data. If you typically respond to the EIA-861 or the EIA-857 but do not have the appropriate records to report these data, you may need to locate someone else within your entity to complete the survey. Some common departments within responding utilities that may have the disconnection data may include accounting, finance, customer billing, etc. If another department is more apt to report these data, you may notify us with their contact information, and we will send them the necessary information to complete the survey. You may contact us by email at [email protected] or call us at 1-855-EIA4USA.
		For questions or additional information about the Form EIA-112, contact EIA
			Email: [email protected]

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Sheet 2: SCHEDULE 1

FORM EIA-112 Residential Utility Disconnections Survey

OMB NO.: xxxx-xxxx Expiration Date: x/xx/20xx Burden Hours: 2.0 Version: 2024.01 Due Date: Feb 28, [yyyy]

Reporting Year:

NOTICE: This report is mandatory under 15 U.S.C. §772(b). Failure to comply may result in criminal fines, civil penalties, and other sanctions as provided by law. For further information concerning sanctions and data protections, see the provision on sanctions and the provision concerning the confidentiality of information in the instructions. Title 18 U.S.C. §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.

Entity Name:

EIA ID:

Please refer to your emailed survey letter for your unique ID.

PART 1: IDENTIFICATION

Survey Contact: Person to contact with questions about this form.

Contact Information

Name

Title

Address

City

State

Zip Code

Email

Telephone

Supervisor Information

Name

Title

Address

City

State

Zip Code

Email

Telephone

Respondent Type

Cooperative

Political Subdivision

Federal

Private

Investor-Owned

State

Municipal

Other

PART 2: SUBMISSION INFORMATION

Completed form(s) must be filed no later than February 28 following the end of the reporting year.

Form may be submitted using one of the following methods:

Secure File Transfer:

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

EIA Respondent Portal:

https://survey.eia.gov

Questions?

[email protected]

1-855-EIA4USA (1-855-342-4872)

PART 3: STATES AND SERVICES

1. In how many states does your establishment provide electricity and/or natural gas service to residential customers? Please include the District of Columbia and Puerto Rico, if applicable.

Number of states → Complete one table in Schedule 2 for each state. For example, for one state complete only one table in Schedule 2, for two states complete two tables, and so on. If you operate in more than three (3) states, please use the webform option at https://survey.eia.gov.

2. Does your establishment provide only electricity service, only natural gas service, or both electricity and natural gas services to residential customers (in any state)?

Electricity only

Natural gas only

Both electricity & natural gas - In Schedule 2, report Electricity and Gas information in separate tables.

For questions or additional information about the Form EIA-112, contact EIA

Email: [email protected]

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Sheet 3: SCHEDULE 2

FORM EIA-112 Residential Utility Disconnections Survey

OMB NO.: xxxx-xxxx Expiration Date: x/xx/20xx Burden Hours: 2.0 Version: 2024.01 Due Date: Feb 28, [yyyy]

Entity Name:

Harnish, Marc: All blue boxes are to be pre-filled

Reporting Year:

PART 4: RESIDENTIAL UTILITY TOTAL CUSTOMERS, FINAL NOTICES, DISCONNECTIONS, AND RECONNECTIONS FOR EACH STATE IN EACH MONTH OF THE REPORTING YEAR

Electricity

Radio button to pick gas or electric ( )

Gas

( )

State #1

Dropdown menu

JAN [yyyy]

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC [yyyy]

1

Total customers

2

Final notices

3

Disconnections

4

Reconnections

Electricity

( )

Gas

( )

State #2

JAN [yyyy]

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC [yyyy]

1

Total customers

2

Final notices

3

Disconnections

4

Reconnections

Electricity

( )

Gas

( )

State #3

JAN [yyyy]

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC [yyyy]

1

Total customers

2

Final notices

3

Disconnections

4

Reconnections

DEFINITIONS

• CUSTOMER: each utility-owned meter at a residential dwelling or building (except in cases where multiple metering is used for special services (for example, water heating, space heating, etc.) in the same dwelling/building, the customer is the dwelling/building to avoid the potential for duplicate reporting.

• TOTAL CUSTOMERS: grand total sum of residential, including multifamily, customers served regardless of payment status, including non-delinquent customers.

• RESIDENTIAL, INCLUDING MULTIFAMILY: single family dwellings, mobile homes, and individually and master-metered multifamily dwellings where energy is consumed primarily for space and water heating, air conditioning, lighting, refrigeration, cooking, and laundry.

• FINAL NOTICES: the last notice sent to residential customers via mail, email, phone, and/or text a day or more before being disconnected (also called a final notice, disconnect notice, delinquent notice, late notice, shut-off or cut-off notice, or termination notice).

• DISCONNECTIONS: the involuntary shut-off of a residential customer's electricity and/or natural gas service(s) (also called a service disconnect, cut-off or turn-off, or termination) due to bill nonpayment reasons; excludes voluntary disconnections.

• RECONNECTIONS: the turning back on of electricity and/or natural gas service to a residential customer whose service was previously involuntarily disconnected (also called a service reconnect, reactivation, or turn-on).

• BILL NONPAYMENT REASONS: situations when residential customers are unable to or fail to pay their account balance, are in arrears or debt, and their electricity and/or natural gas service will be, is, or has been disconnected as a result.

Additional Comments: Explain any reporting issues, concerns, barriers, or limitations, identify any unusual aspects or fluctuations in the information reported for the reference year (like a disconnection moratorium, etc.), or any other comments you want to provide. (To separate one comment from another, press ALT + ENTER.)