Form EIA-863 Petroleum Product Sales Identification Survey

U.S. DEPARTMENT OF ENERGY U.S. Energy Information Administration Washington, DC 20585

OMB No. 1905-0174 Expiration Date: xx/xx/xxxx Burden: 1 hour

YYYY EIA-863: PETROLEUM PRODUCT SALES IDENTIFICATION 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.

Begin here and follow numerical order unless instructed otherwise.
Please provide corrections to company name, address, contact information, and telephone number in items 1 thru 8.
1a. Company Name (only if different than the label)
1b. Is company name change a result of a previous sale, merge, lease, or becoming a subsidiary since 20XX? Yes  No
1c. Doing business as (If different than company name)
2. Name of Contact Person
3. Contact’s Telephone Number
3a. Contact’s Email
4. Physical Address (e.g., Street Address, Building, Floor, Suite)
5. Mailing Address (e.g., PO Box, RR)
6. City	7. State	8. ZIP Code

PART 1. RESPONDENT IDENTIFICATION DATA

Month		Day			Year

The information reported in items 1-8 of Part I, Respondent Identification Data, of the EIA-863 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 Department of Energy (DOE) regulations, 10 C.F.R. §1004.11, implementing the FOIA, and the Trade Secrets Act, 18 U.S.C. §1905. 

With regard to the information reported in items 1-8 of Part I, the Federal Energy Administration Act requires the EIA to provide company-specific data to other Federal agencies when requested for official use.  That information reported in Part I may also be made available, upon request, to another component of the DOE; to 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.  That Part I information may be used for any non-statistical purposes such as administrative, regulatory, law enforcement, or adjudicatory purposes.

The information reported in Part 1 item 9-18, Parts II, Preparer Information, and III, Total Sales Volumes by State, of the EIA-863 will be used for statistical purposes only and is confidential by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2018 and other applicable Federal laws, your responses to Part I item 9-18, Parts II and III of Form EIA-863 will not be disclosed in identifiable form without your consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data. Every EIA employee, as well as every agent, is subject to a jail term, a fine, or both if he or she makes public ANY identifiable information you reported.

9. Which of the following best describes your company’s operating status at the end of 20XX? (Check only 1 box)

a.  Your company is in operation— Skip Items 10 thru 18.

sales include petroleum products. Complete Parts II and III.

b1.  Your company was sold, or Complete items 10 thru you merged with another 18. Also complete Part II

company. and Part III for the portion

of 20XX that you owned

b2.  You leased your company to and operated the

another company. Company.

c. Your company has permanently Complete item 10 (date

ceased operation. ceased) and Part II.

d. Your company is a subsidiary of

another company and all or some

of your sales are reported by Complete items 10 thru 18

another company. Also, complete Part II and

Part III for the portion of

e. Your company is a commissioned 20XX that you owned and

agent for another company and all operated the company.

or some of your sales are reported

by another company.

9. Enter the date your company sold, merged, leased, ceased operation, became a subsidiary, or became a commissioned agent:

11. Enter name of the company you sold to/merged with/leased to/became a subsidiary of or commissioned agent for:

12. Enter name of the contact person of company in Item 11:

13. Contact’s Telephone Number

-

-

14. Physical Address (e.g., Street Address, Building, Floor, Suite)

15. Mailing Address (e.g., PO Box, RR)

f. Your company does not sell any Complete Part II and return petroleum products. (see instructions for “Where to Submit”)

16. City

17. State

18. ZIP Code

For assistance in completing this form call 1-800-638-8812

Company Name		EIA ID Number			Reference Year YYYY				Page______ of______
PART 2. PREPARER INFORMATION
19. Preparer’s Name			20a. Telephone Number				20b. Date
20c. Email Address			21. Fax Number				22. FOR EIA USE ONLY
Comments:
PART 3. TOTAL SALES VOLUMES (BY STATE) FOR 20XX (REPORT IN ACTUAL GALLONS)
23. Did your company sell No. 2 Distillate, No. 5 and No. 6 Residual Fuel Oil, Motor Gasoline, and/or Propane in 20XX? a. Yes . . . . . Answer item 24 b. No . . . . . Skip to item 25
24. Enter below in lines “a” through “p” your company’s total annual sales volumes in each State for the entire year of 20XX (report in actual gallons). Include all sales made by your divisions, branches, outlets, and subsidiaries. Report a sale in the State where the transfer of ownership occurred
PLEASE NOTE: Enter the state you are reporting for in the blocks below using the 2-digit state abbreviation. If you have sales in more than two states make a copy of Part III, record your other states and attach to the original form. State abbreviations are listed on the last page of this form for your convenience.
PETROLEUM CATEGORY
No. 2 Distillate Fuel Oil and No. 2 Diesel – please provide volumes for all that apply.				Volumes (report in actual gallons)				Volumes (report in actual gallons)
a.	No. 2 Residential Fuel Oil sold for heating private homes (Include heating farm houses; Exclude apartments.)
b.	No. 2 Fuel Oil for all other end uses (Include apartment buildings; Exclude diesel fuel oil and gasoline.)
c.	No. 2 Diesel Fuel for all other end uses (Include agricultural use and on-highway use; Exclude gasoline.)
d.	No. 2 Fuel Oil sold to Dealers, Resellers, and Refiners who will resell the product (Exclude gasoline.)
e.	No. 2 Diesel sold to Dealers, Resellers, and Refiners who will resell the product (Exclude gasoline.)
f.	Total No. 2 Fuel Oil and (Add lines a thru e and No. 2 Diesel sold in YYYY. enter amount here)
No. 5 and No. 6 Residual Fuel Oil – please provide volumes for all that apply.				Volumes (report in actual gallons)				Volumes (report in actual gallons)
g.	No. 5 and No. 6 Fuel Oil sold to the Consumer (Examples: to electric utilities, to vessels for bunkering, to industrial and commercial users, to military.)
h.	No. 5 and No. 6 Fuel Oil sold to Dealers, Resellers, and Refiners who will resell the product.
i.	Total No. 5 and No. 6 Fuel Oil (Add lines g thru h and sold in YYYY. enter amount here)
Motor Gasoline and Gasohol – please provide volumes for all that apply. (Report Gasohol and Oxygenated Gasoline under Conventional, and include OPRG under Reformulated.)				Conventional Gasoline (report in actual gallons)		Reformulated Gasoline (report in actual gallons)		Conventional Gasoline (report in actual gallons)		Reformulated Gasoline (report in actual gallons)
j.	Motor Gasoline and Gasohol sold to the Consumer. (Include all grades of gasoline; Exclude No. 2 diesel and aviation gasoline.)
k.	Motor Gasoline sold to Dealers, Resellers, and Refiners who will resell the product. (Include rack and DTW sales.)
l.	Total Motor Gasoline sold (Add lines j thru k and in YYYY. enter amount here)

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EIA-863 (YYYY) Page 3

Company Name		EIA ID Number		Reference Year YYYY	Page ______of _______
PLEASE ENTER THE 2-LETTER STANDARD STATE ABBREVIATION
PETROLEUM CATEGORY
Propane – please provide volumes for all that apply.			Volumes (report in actual gallons)		Volumes (report in actual gallons)
m.	Delivered Residential Propane. (Home heating, including farm houses.)
n.	Propane sold to Customers for all other end uses. (Include commercial, industrial, agricultural, and propane powered motor vehicles.)
o.	Propane sold to Dealers, Resellers, and Refiners who will resell the product.
p.	Total Propane sold in YYYY. (Add lines m thru o and enter amount here)
Does your company sell any of these other petroleum products? Check boxes for all that you sell. (Other does not include No. 2 Fuel Oil and No. 2 Diesel, No. 5 and No. 6 Residual Fuel Oil, Motor Gasoline, and Propane for which you have already reported volumes.) a. Kerosene b. No. 1 Distillate c. Crude Oil d. Other LPG e.  No. 4 Fuel Oil f. Aviation Gasoline g. Jet Fuel h. Other:___________________________ (Specify)
Does your company sell and/or use propane for on-highway transportation use? Check appropriate box(es). a.  Sell b. Use c.  No
Does this firm currently sell (or has it ever sold) distillate fuel oil to railroad companies? a.  Yes b. No
Please submit this form to EIA by March 30, XXXX. For submission by mail: Oil and Gas Survey U.S. Department of Energy (EI-25) Attn: EIA-863 Ben Franklin Station PO Box 279 Washington, DC 20044-0279 by fax: 1-202-586-9772 by secure file transfer: https://signon.eia.doe.gov/upload/noticeoog.jsp See Section 6 in the instructions for additional information on how to file the EIA-863 electronically.

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LIST OF STANDARD STATE ABBREVIATIONS

AL ... Alabama KY ... Kentucky ND ... North Dakota

AK ... Alaska LA ... Louisiana OH ... Ohio

AZ ... Arizona ME ... Maine OK ... Oklahoma

AR ... Arkansas MD ... Maryland OR ... Oregon

CA ... California MA ... Massachusetts PA ... Pennsylvania

CO ... Colorado MI ... Michigan RI ... Rhode Island

CT ... Connecticut MN ... Minnesota SC ... South Carolina

DE ... Delaware MS ... Mississippi SD ... South Dakota

DC ... District of Columbia MO ... Missouri TN ... Tennessee

FL ... Florida MT ... Montana TX ... Texas

GA ... Georgia NE ... Nebraska UT ... Utah

HI ... Hawaii NV ... Nevada VT ... Vermont

ID ... Idaho NH ... New Hampshire VA ... Virginia

IL ... Illinois NJ ... New Jersey WA ... Washington

IN ... Indiana NM ... New Mexico WV ... West Virginia

IA ... Iowa NY ... New York WI ... Wisconsin

KS ... Kansas NC ... North Carolina WY ... Wyoming