EIA-878 Motor Gasoline Price Survey

U. S. DEPARTMENT OF ENERGY
U. S. ENERGY INFORMATION ADMINISTRATION
Washington, D.C. 20585

OMB Number: XXXX-XXXX
Expiration Date: XX/XX/XX
Version No.: 2013.01

EIA-878
MOTOR GASOLINE PRICE SURVEY
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. 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 1. IDENTIFICATION DATA
Company Name

Name of Contact Person
Contact’s Telephone Number
City

State

Zip Code

Prices for:
Month

EIA ID No.

PART 2. PRICE DATA
(Enter the retail price of self-service, cash only, gasoline for each grade, including all taxes)

Grade

Regular

Midgrade

Premium

Comments:

Price
($0.000 per gallon)

Day

Year