Form 4058 Production Allocation Schedule Report (PASR)

OMB Control Number 1010-0139
OMB Approval Expires 10/31/2009

U.S. DEPARTMENT OF THE INTERIOR
Minerals Management Service
Minerals Revenue Management

PRODUCTION ALLOCATION
SCHEDULE REPORT
(PASR)
REPORTER USE

MMS USE
PRODUCTION MONTH: (6) MMCCYY

REPORT TYPE:

API GRAVITY: (3) 99.9

____ ORIGINAL
____ MODIFY (DELETE/ADD BY LINE)
____ REPLACE (OVERLAY PREVIOUS REPORT)

ACTION CODE (1)

FACILITY/MEASUREMENT POINT NUMBER: (11)

LINE NUMBER

.

OPERATOR NAME: (30)

OPERATOR/AREA/BLOCK
(30)

OPERATOR FACILITY NAME/LOCATION: (30)

OUTPUT FACILITY/MEASUREMENT POINT: (11)

INJECTOR (O/G/B)

MMS OPERATOR NUMBER: (5)

BTU: (4) 9999

SALES FACILITY/MEASUREMENT POINT: (11)

VOLUMES
MMS LEASE/
AGREEMENT
NUMBER
(11)

METERING POINT
(11)

SALES/TRANSFERS
(9)

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23

OTHER SOURCES

24

OTHER SOURCES
TOTAL: (10)

CONTACT NAME: (First, M.I. , Last) (30)
AUTHORIZING SIGNATURE:

PHONE NUMBER: (10)
(
) (

EXTENSION NUMBER: (5)
-

)
DATE: (8) MMDDCCYY

COMMENTS: (60)
FORM MMS-4058 (revised 07/2009)

PAGE

OF

INSTRUCTIONS
PRODUCTION ALLOCATION SCHEDULE REPORT (PASR)
FORM MMS-4058

Refer to the Minerals Production Reporter Handbook before completing this form.

WHO MUST FILE

A separate report must be filed monthly by each designated operator of a facility/
measurement point for production from a Federal or Indian lease/agreement that is
commingled with production from other sources prior to measurement for royalty
determination.
WHEN TO FILE

Reports must be filed beginning with the month in which production from a Federal
or Indian leases is first commingled. Reports must be received by the 15th of the second
month following the production month (e.g., the report for June is due on August 15).
WHERE TO FILE

Reports must be filed with:
Minerals Management Service
Minerals Revenue Management
P.O. Box 17110
Denver, Colorado 80217-0110

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform
you that we collect this information to corroborate oil and gas production and disposition data with sales and royalty data.
Responses are mandatory (43 U.S.C. 1334). Proprietary information is protected in accordance with standards
established by the Federal Oil and Gas Royalty Management Act of 1982 (30 U.S.C. 1733), the Freedom of Information
Act [5 U.S.C. 552(b)(4)], and Department regulations (43 CFR 2). An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. The
public reporting burden for this form is estimated to average 1 minute per line for electronic reporting and 3 minutes per
line for manual reporting. These estimates include the time for reviewing instructions, gathering and maintaining data,
and completing and reviewing the form. Direct any comments regarding the burden estimate or any other aspect of this
form to the Information Collection Clearance Officer, Minerals Management Service, Mail Stop 5438, 1849 C Street, NW.,
Washington, DC 20240.