EIA-14 Refiner's Monthly Cost Report

WHICH VERSION: See number 14 on page 7.

OMB No. 1905-0174

Expiration Date: 11/30/200#

Draft

FORM EIA-14

REFINERS' MONTHLY COST REPORT

This report is mandatory under 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 I. RESPONDENT IDENTIFICATION

If any Respondent Identification information is changed

Mo

Year

since the last report, enter an "X" in the block:

Report Period:

EIA ID NUMBER:

OOG.SURVEYS@eia.doe.gov

Company Name:

Due Date: A completed form must be filed by the 30th calendar day following the end of the report month.

Address 1:

Address 2:

City:

How to Submit Forms:

State:

Zip Code

-

Secure File Transfer option available at:

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

Contact Name:

Electronic Transmission: The PC Electronic

Data Reporting Option (PEDRO) is available.

Phone No.:

-

-

Ext:

If interested in software, call (202) 586-9659.

Fax No.:

-

-

Email form to:

OOG.SURVEYS@eia.doe.gov

Fax form to: (301) 495-8483

E:mail address:

Mail form to: Energy Information Administration

U.S. Department of Energy

Mo

Day

Year

PO Box 8279

Date of this Report:

Silver Spring, MD 20907

Attn: EIA-14

Type of Report (Check One):

(1)

Original

Mo

Day

Year

Questions? Call toll free: 1-800-638-8812

(2)

Revision to Report Dated:

Firms located in the Washington, D.C.

metropolitan area call: (301) 495-8440

PART II. SUMMARY OF CRUDE OIL COSTS AND VOLUMES

Category Description

MONTHLY ACQUISTIONS

Domestic Crude Oil

Imported Crude Oil

Total Cost

Total Volume

Total Cost

Total Volume

PAD DISTRICT

(Thousands of dollars)

(Thousands of barrels)

(Thousands of dollars)

(Thousands of barrels)

(a)

(b)

(a)

(b)

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".)