EIA-176 Annual Report of Natural and Supplemental Gas Supply and

OMB No. 1905-XXXX
Expiration Date: 12/31/20XX
Version No.: 20XX.01
Burden: 12.0 hours
ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION
FORM EIA-176
This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93-275). Failure to comply may result in criminal fines, civil penalties and
other sanctions as provided by law. For the sanctions and the provisions concerning the confidentiality of information submitted on this form, see instructions. 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.

PART 1. RESPONDENT IDENTIFICATION DATA
REPORT PERIOD:
EIA ID NUMBER:

Year:

PART 2. SUBMISSION INFORMATION
A completed form must be filed by March 1

2 0

Form may be submitted using one of the following methods:

1 7 6

If this is a resubmission, enter an "X" in the box:
Mail to:

EIA-176
U. S. Department of Energy

If any Respondent Identification Data has changed since the last report,

Oil & Gas Survey

enter an "X" in the box:

Ben Franklin Station
P.O. Box 279

Company Name:

Washington, DC 20044-0279

Operations in (State):
Contact Name:
Ext:

Phone No.:

Email:

OOG.SURVEYS@eia.gov

Fax:

(202) 586-1076

Secure File Transfer:
https://signon.eia.doe.gov/upload/noticeoog.jsp

Fax No.:
Address 1:
Address 2:
City:

State:

Zip:

-

Questions?

Call: (877) 800-5261

Email address:
PART 3. COMPANY CHARACTERISTICS
A. Type of Operations (check all that apply)
1.

Distribution company - investor owned

8.

Storage operator

2.

Distribution company - municipally owned

9.

Synthetic natural gas (SNG) plant operator

3.

Distribution company - privately owned

10.

4.

Distribution company - cooperative

11.

Producer
Gatherer

5.

Distribution company - other ownership

12.

Liquefied natural gas (LNG) peak facility operator

6.

Interstate pipeline (FERC regulated)

13.

Liquefied natural gas (LNG) marine terminal

7.

Intrastate pipeline

14.

Other (specify)

B. Vehicles Powered by Alternative Fuels
1. Does your company's vehicle fleet include vehicles powered by alternative fuels?

Yes

No

2. If yes, how many vehicles in your company's fleet are powered by alternative fuels?
C. Customer Choice Program
If there is a Customer Choice program available in your service territory, enter the number
of customers currently eligible for and participating in the Customer Choice program at
the end of the calendar year.

D. Sales/Acquisitions
1. Did your distribution territory increase or decrease in size in the report State due to acquisition
or sale this year? If Yes, please describe the sale or acquisition in the Comments box below.

Eligible

Participating

Residential

Residential

Commercial

Commercial

Yes

No

Comments: (To separate one comment from another, press ALT+ENTER)

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OMB No. 1905-XXXX
Expiration Date: 12/31/20XX
Version No.: 20XX.01
ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION
FORM EIA-176
2
0
REPORT PERIOD:
Year:
COMPANY NAME:
Resubmission
EIA ID NUMBER: 1 7 6
PART 4. NATURAL AND SUPPLEMENTAL GAS SUPPLY FOR THE REPORT STATE
VOLUME
(Mcf @ 14.73
o
psia and 60 F)

ITEM DESCRIPTION

NOTES*
E
F

1.0 If you are a producer, report production within the report State of:
1.1 Natural gas** (if reporting natural gas production, lease use data should also be reported on
line 15.0) …………………………………………………………………………………………………
1.2 Synthetic natural gas (SNG) …………………………………………………………………………….
2.0 If you are a storage operator, report operations within the report State of:
2.1 Underground storage withdrawals

……………………………………………………………………..

2.2 Liquefied natural gas (LNG) storage withdrawals (peaking facilities only)
2.3 Above ground storage withdrawals

………………………..

………………………………………………………………….

3.0 If you are an interstate pipeline company or other company receiving physical custody at State
lines or U.S. borders, report receipts

……………………………………………………………………..

From Company

1

1

In neighboring State or Country

1

1

From Company

1

1

In neighboring State or Country

1

1

From Company

1

1

In neighboring State or Country

1

1

From Company

1

1

In neighboring State or Country

1

1

4.0 If you are a distributor, report receipts at city gates within the report State …

……………………………
………

5.0 Report any other receipts of natural gas within the report State (excluding Federal Offshore) ..
6.0 Supplemental gaseous fuels supplies (Specify type)

1

1

1
7.0 Total supply within report State (sum of all items in lines 1.0 through 6.0) …..

1
………………………..

PART 5. LIQUEFIED NATURAL GAS (LNG) STORAGE INVENTORY
8.0 If you operate a LNG facility, report LNG inventory as of December 31 of the report year

…………….

*Check E if data reported are an estimate; check F if you are providing a footnote in Part 7 for this data item.
**If reporting Natural Gas Production (1.1), data should also be reported on lease use (15.0).

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OMB No. 1905-XXXX
Expiration Date: 12/31/20XX
Version No.: 20XX.01
ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION
FORM EIA-176
REPORT PERIOD:
Year: 2 0
COMPANY NAME:
Resubmission
EIA ID NUMBER:

1 7 6

PART 6. NATURAL AND SUPPLEMENTAL GAS DISPOSITION FOR THE REPORT STATE
9.0 Heat content of gas delivered to consumers

(Btu/cf)
NUMBER OF
CUSTOMERS

ITEM DESCRIPTION

VOLUME
(Mcf @ 14.73
psia and 60o F)

REVENUE
(including taxes)
(whole dollars)

NOTES*
E

10.0 Deliveries of natural gas that you do own to end-use consumers
within the report State (for assistance in determining proper
categorization of customers, see page 3 of instructions)

10.1 Residential ………………………………………………………….
10.2 Commercial ………………………………………………………….
10.3 Industrial

………………………………………………………….

10.4 Electric power

………………………………………………………

10.5 Vehicle fuel ………………………………………………………….
10 6 Other (not included in above categories)
10.6
(Specify type)

11.0 Deliveries of natural gas that you do not own to end-use consumers
within the report State (for assistance in determining proper
categorization of customers, see page 3 of instructions)

11.1 Residential ………………………………………………………….
11.2 Commercial ………………………………………………………….
11.3 Industrial …………………………………………………………….
11.4 Electric power

……………………………………………………..

11.5 Vehicle fuel …………………………………………………………
11.6 Other (not included in above categories)
(Specify type)

*Check E if data reported are an estimate; check F if you are providing a footnote in Part 7 for this data item.

Page 3

F

OMB No. 1905-XXXX
Expiration Date: 12/31/20XX
Version No.: 20XX.01
ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION
FORM EIA-176
2
0
REPORT PERIOD:
Year:
COMPANY NAME:
Resubmission
EIA ID NUMBER: 1 7 6
PART 6. NATURAL AND SUPPLEMENTAL GAS DISPOSITION FOR THE REPORT STATE (continued)
VOLUME
ITEM DESCRIPTION

(Mcf @ 14.73
o
psia and 60 F)

NOTES*
E
F

12.0 Natural gas consumed in your operations:
12.1 Space heat of your facilities

…………………………………………………………………………….

12.2 New pipeline fill …………………………………………………………………………………………..
12.3 Pipeline distribution or storage compressor use
12.4 Other

……………………………………………………..

……………………….. (Specify type):

1 ……………………….

13.0 If you are a storage operator, report operations within the State:
13.1 Underground storage injections (including new fields)

………………………………………………

13.2 Liquefied natural gas (LNG) storage injections (peaking facilities only)
13.3 Above ground storage injections

……………………….

…………………………………………………………………….

14.0 If you are an interstate pipeline company or other company moving gas across or to State lines or
U.S. borders, report volumes transported. (See instructions if additional lines are needed.)
To Company

In neighboring State or Country

1

1

To Company

In neighboring State or Country

1

1

To Company

In neighboring State or Country

1

1

To Company

In neighboring State or Country

15.0 Lease use (reported by producers only)

…………………………………………………………………….

16.0 Returned to oil and/or gas reservoirs, used for repressuring, reinjection (reported by producers only)
17.0 Losses from leaks, damage, accidents, migration and/or blow down within the report State: …………
18.0 Other disposition within the report State (not included above):
18.1 To distribution companies

…………………………………………………………………………….

18.2 To other pipelines in the report State
18.3 To storage operators in the report State
18.4 To other

…………………………………………………………………
……………………………………………………………..

…………………… (specify type)

……………………
……………………

19.0 Total disposition (sum of all items 10.1 through 18.4)
20.0 Difference between gas supply (+) and disposition (-) (Part 4 line 7.0 minus Part 6 line 19.0)
(this value may be a negative number)
*Check E if data reported are an estimate; check F if you are providing a footnote in Part 7 for this data item.

Page 4

OMB No. 1905-XXXX
Expiration Date: 12/31/20XX
Version No.: 20XX.01
ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION
FORM EIA-176
REPORT PERIOD:
Year: 2 0
COMPANY NAME:
Resubmission
EIA ID NUMBER: 1 7 6
PART 7. FOOTNOTES
Part
Item
No.
No.

Footnote

Page 5