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FORM APPROVED OMB NO. 2125-0032 |
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STATE NAME: |
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| STATE MOTOR-FUEL TAX RECEIPTS AND |
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| INITIAL DISTRIBUTION BY COLLECTION AGENCIES |
YEAR ENDING (mm/yy): |
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VOLUME TAXES |
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OTHER |
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GASOLINE |
SPECIAL FUELS |
RECEIPTS |
TOTAL |
| NOTE: This collection of information is required by 23 U.S.C. 104 (b) and 105 (b); and 23 C.F.R. 1.5 and 420.105(b). Public reporting burden is estimated to average12 hours per response, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The Guide data is used by FHWA in administering the Federal-Aid Highway Program; in assessing highway policies, programs and performance of the Nation’s highway transportation system; in identifying future highway system investment needs; and in making policy and program recommendations. Please note that 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 OMB control number for this collection is 2125-0032, which expires on XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Highway Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590. |
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| ITEM |
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(A) |
(B) |
(C) |
(D) |
| 1. Receipts for Year |
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| a. |
(1) Gross collections by distributor |
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| Volume |
(2) Less: distributor allowance for collection expense |
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| Tax |
(3) Gross receipts by State |
(1) - (2) |
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| Collections |
(4) Less: refunds and credits |
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(5) Net receipts |
(3) - (4) |
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| b. |
(1) Distributor and dealer licenses |
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| All Other |
(2) Motor-fuel inspection fees |
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| Receipts |
(3) Fines, penalties, and interest |
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| Under Motor- |
(4) Motor-carrier fuel tax registration (decals) |
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| Fuel Tax |
(5) Alternative fuel tax decals (inlieu of volume tax) |
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| Laws |
(6) |
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(7) |
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(8) |
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(9) |
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(10) Total |
(1) thru (9) |
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| c. Net Total Receipts |
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a. + b. |
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| 2. Nonhighway |
a. |
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| Dedications of |
b. |
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| Volume Tax |
c. |
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| from Nonhighway |
d. |
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| Gasoline |
e. Total |
a. thru d. |
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| 3. Adjusted Total Receipts |
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1 - 2 |
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| 4. Deductions |
a. Expense of Collecting & Administering Volume Taxes |
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| by State |
b. Expense of Inspecting Motor Fuel |
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| Collecting |
c. |
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| Agency ¹ |
d. Total |
a. + b. +c. |
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| 5. Net Proceeds Available for Distribution |
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3. - 4. |
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| 6. Balance Undistributed at End of Previous Year |
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| 7. Total Funds Available for Distribution |
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5. + 6. |
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| 8. Amounts Distributed (Specify Fund or Purpose) |
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| a. |
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| b. |
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| c. |
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| d. |
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| e. |
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| f. |
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| g. |
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| h. |
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| i. |
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| j. |
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| k. Total |
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a. thru j. |
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| 9. Balance Undistributed at End of Year |
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7. - 8. |
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| ¹ If collecting agency activities are funded by another revenue source, note this fact and provide the actual collection and administrative expenses |
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| in a footnote. |
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| Form FHWA-556 (Rev 07-2000) PREVIOUS EDITIONS OBSOLETE |
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Excel |
(Next page) |
| 1 |
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STATE NAME: |
| STATE MOTOR-FUEL TAX RECEIPTS AND |
0 |
| INITIAL DISTRIBUTION BY COLLECTION AGENCIES |
YEAR ENDING (mm/yy): |
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0 |
| RECONCILIATION BETWEEN FHWA-551M VOLUME AND FHWA-556 COLLECTIONS MAY BE SHOWN HERE, OR IN AN ATTACHMENT. |
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| INTERSTATE MOTOR-CARRIER FUEL TAX (FUEL USE TAX) RECEIPTS: |
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Gasoline |
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Special Fuels |
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| IMC fuel tax receipts |
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| Less: IMC refunds and credits |
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| Net IMC fuel tax receipts |
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| Notes and Comments: |
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| COLLECTING AGENCY: |
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| INFORMATION FROM RECORDS OF: |
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| COMPILED UNDER DIRECTION OF: |
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| Form FHWA-556 (Rev. 12-96) |
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| 2 |