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pdfDepartment of Energy
U.S. Energy Information Administration
1000 Independence Ave, SW
Washington, DC 20585
OMB No. 1905-0174
Expiration Date: xx/xx/xxxx
Burden: 6.5 minutes
Station ID:
Motor Gasoline Price Survey
Form EIA-878 Schedule B
YOUR RESPONSE IS REQUIRED BY LAW
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.
Form EIA-878 shall be submitted by all scientifically sampled retail motor gasoline outlets. Companies sampled are
notified in writing and by telephone in advance.
PURPOSE
The U.S. Energy Information Administration (EIA) Form EIA-878, Motor Gasoline Price Survey is a mandatory survey
consisting of two parts: Schedules A and B. Schedule A is designed to collect data on the cash, pump price
(including taxes) of self-serve, unleaded gasoline, by grade of gasoline. Schedule B is designed to collect total annual sales volume for each grade of gasoline sold at your station during a full calendar year.Schedule B is conducted
only once when your station was selected in a new sample for the survey, and the data are collected strictly for
internal statistical purposes and will not be published.
The data collected on Schedule A are used to calculate average gasoline prices at the national, regional, and select
state and city levels across all gasoline grades and formulations. These data are point-in-time estimates as of 8:00
a.m. Monday.
HOW TO FILE A RESPONSE
Upload your Schedule B data using Secure File Transfer, fax, or mail:
- Secure File Transfer: https://signon.eia.doe.gov/
upload/form/878
- Fax: 919-541-8812, ATTN: EIA-878 Schedule B
- Mail: U.S. Department of Energy (EI-23)
c/o RTI International
ATTN: DATA CAPTURE - Gas Price Survey
5265 CAPITAL BLVD
RALEIGH, NC 27690-1654
QUESTIONS
For questions about Form EIA-878 Schedule B after reading the instructions, please call our toll free
number 1-877-267-2879.
Page 1
Form EIA-878 Schedule B, Motor Gasoline Price Survey
Department of Energy
U.S. Energy Information Administration
1000 Independence Ave, SW
Washington, DC 20585
OMB No. 1905-0174
Expiration Date: xx/xx/xxxx
Burden: 6.5 minutes
PART 1: IDENTIFICATION INFORMATION
Station ID:
❶ Please enter the name and telephone number and/or email address of the person filling out Schedule B:
Preparer Title:
Preparer Name:
)
Preparer Telephone: (
―
Alternative Preparer Telephone: (
)
―
Preparer Email:
❷ Please enter the contact information for Schedule B, if different from preparer:
The contact person(s) must be able to verify all the information submitted and answer any questions concerning the
information reported on this form.
We will only contact you if needed for official business.
Contact 1 Title:
Contact 1 Name:
Contact 1 Telephone: (
)
―
Contact 1 Email:
Contact 2 Title:
Contact 2 Name:
Contact 2 Telephone: (
)
―
Contact 2 Email:
❸ Please enter current information for the station:
Station Name:
Station Address:
Station State:
Station City:
Station Telephone: (
Station Zip Code:
―
)
❹ If different from station address, please enter mailing information below:
Company Name:
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip Code:
❺ Please enter the contact information for reporting weekly prices in Schedule A:
If we should contact the station by telephone each week to receive prices, check this box:
List any additional information below.
Name:
Telephone: (
Page 2
Title:
)
―
Email:
Form EIA-878 Schedule B, Motor Gasoline Price Surv ey
Department of Energy
U.S. Energy Information Administration
1000 Independence Ave, SW
Washington, DC 20585
OMB No. 1905-0174
Expiration Date: xx/xx/xxxx
Burden: 6.5 minutes
Station ID:
PART 2: ST ATION STATUS
❶ Which of the following best describes your station’s current operating status?
A. Operating and currently selling motor gasoline ~SKIP TO QUESTION 3~
B. Temporarily or seasonally inactive
Enter Expected Date of Reopening: MM / DD / YYYY ~SKIP TO QUESTION 3~
C. Ceased operation
Enter Date of Closure:
MM / DD /
YYYY ~SKIP TO QUESTION 3~
D. Station Sold
Enter Date of Sale: MM / DD / YYYY ~GO TO QUESTION 2~
E. Other - Describe:
❷ If your station sold, please provide any known information about the new owner:
New Owner Name:
New Owner Address:
New Owner City:
New Owner State:
New Owner Telephone (if known): (
)
New Owner Zip Code:
―
❸ Is there a difference between cash and credit card prices for motor gasoline at your station?
A. Yes
B. No
❹ How many vehicles can fill up on motor gasoline at once at your station?
Number of Vehicles
Page 3
Form EIA-878 Schedule B, Motor Gasoline Price Survey
Department of Energy
U.S. Energy Information Administration
1000 Independence Ave, SW
Washington, DC 20585
OMB No. 1905-0174
Expiration Date: xx/xx/xxxx
Burden: 6.5 minutes
Station ID:
PART 3: ANNUAL MOTOR GASOLINE SALES DAT A
❶ Select the octane rating and ethanol content for each grade of MOTOR GASOLINE sold at your
station. Enter the total sales volume for each grade of MOTOR GASOLINE sold for a full calendar or
fiscal year. If the volumes are zero or missing for a particular grade, please select a reason.
How to Report Sales Volumes : Volumes should be repor ted in w hole actual gallons s old (see exam ple below).
Grade
Grade 1
Octane Rating
Ethanol Content
Select one octane
rating below for
Grade 1:
What is the ethanol
content of Grade 1?
Select one:
85
86
87
0%
More than 0%, up to 10%
88
89
90
91
92
93
More than 10%, up to 15%
Annual Sales Volume
Reason if Zero or Missing
Enter station’s annual sales If annual sales volume for Grade 1 is
volume for Grade 1:
zero or missing, select one:
Temporarily do not sell this grade
Blended at the pump
Gallons
Other. Describe in the box below :
Other: _______________
Other _______
Select one octane
rating below for
Grade 2:
Grade 2
85
86
87
88
89
90
91
92
93
What is the ethanol
content of Grade 2?
Select one:
Enter station’s annual sales If annual sales volume for Grade 2 is
volume for Grade 2:
zero or missing, select one:
Temporarily do not sell this grade
0%
More than 0%, up to 10%
More than 10%, up to 15%
Blended at the pump
Gallons
Other. Describe in the box below :
Other: _______________
Other _______
Select one octane What is the ethanol
rating below for content of Grade 3?
Grade 3:
Select one:
Grade 3
85
86
87
88
89
90
91
92
93
Enter station’s annual sales If annual sales volume for Grade 3 is
volume for Grade 3:
zero or missing, select one:
Temporarily do not sell this grade
0%
More than 0%, up to 10%
More than 10%, up to 15%
Blended at the pump
Gallons
Other. Describe in the box below :
Other: _______________
Other _______
Select one octane What is the ethanol
rating below for content of Grade 4?
Grade 4:
Select one:
Grade 4
85
86
87
0%
More than 0%, up to 10%
88
89
90
91
92
93
More than 10%, up to 15%
Enter station’s annual sales If annual sales volume for Grade 4 is
volume for Grade 4:
zero or missing, select one:
Temporarily do not sell this grade
Blended at the pump
Gallons
Other. Describe in the box below :
Other: _______________
Other _______
Page 4
Form EIA-878 Schedule B, Motor Gasoline Price Surv ey
Department of Energy
U.S. Energy Information Administration
1000 Independence Ave, SW
Washington, DC 20585
OMB No. 1905-0174
Expiration Date: xx/xx/xxxx
Burden: 6.5 minutes
Station ID:
PART 3 CONTINUED: ANNUAL MOTOR GASOLINE SALES DAT A
Grade
Grade 5
Octane Rating
Ethanol Content
Select one octane
rating below for
Grade 5:
What is the ethanol
content of Grade 5?
Select one:
85
86
87
88
89
90
91
92
93
Annual Sales Volume
Reason if Zero or Missing
Enter station’s annual sales If annual sales volume for Grade 5 is
volume for Grade 5:
zero or missing, select one:
Temporarily do not sell this grade
0%
Blended at the pump
More than 0%, up to 10%
Other. Describe in the box below :
Gallons
More than 10%, up to 15%
Other: _______________
Other _______
Select one octane
rating below for
Grade 6:
Grade 6
85
86
87
88
89
90
91
92
93
What is the ethanol
content of Grade 6?
Select one:
Enter station’s annual sales If annual sales volume for Grade 6 is
volume for Grade 6:
zero or missing, select one:
Temporarily do not sell this grade
0%
Blended at the pump
More than 0%, up to 10%
Other. Describe in the box below :
Gallons
More than 10%, up to 15%
Other: _______________
Other _______
Select one octane
rating below for
Grade 7:
Grade 7
85
86
What is the ethanol
content of Grade 7?
Select one:
87
0%
More than 0%, up to 10%
88
89
90
91
92
93
Enter station’s annual sales If annual sales volume for Grade 7 is
volume for Grade 7:
zero or missing, select one:
Temporarily do not sell this grade
Blended at the pump
Other. Describe in the box below :
Gallons
More than 10%, up to 15%
Other: _______________
Other _______
❷ Are the sales volumes reported above/on previous page for a full calendar or fiscal year?
Reporting Period:
- Responses should cover a full calendar or fiscal year.
- If data are not available for a full calendar or fiscal year, please provide the reference dates for the reported data.
A. Yes
B. No - Enter the Ref erence Dates: MM / DD / YYYY
to
MM / DD /
YYYY
PART 4: COMMENTS
Please let us know if there is anything that we missed or any feedback that could improve this form.
Page 5
Form EIA-878 Schedule B, Motor Gasoline Price Surv ey
Department of Energy
U.S. Energy Information Administration
1000 Independence Ave, SW
Washington, DC 20585
OMB No. 1905-0174
Expiration Date: xx/xx/xxxx
Burden: 6.5 minutes
Station ID:
Motor Gasoline Price Survey
Form EIA-878, Schedule B additional Information
PROVISIONS REGARDING CONFIDENTIALITY OF INFORMATION
The information you provide on Form EIA-878 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 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.
REPORTING AND ESTIM ATED REPORTING BURDEN
Respondents are not required to file or reply to any Federal collection of information unless it has a valid OMB control
number. Public reporting burden for this collection of information is estimated to average 6.5 minutes per response,
including the time of gathering and maintaining the data needed, and reporting the information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing
this burden to: U.S. Energy Information Administration, Office of Statistical Methods and Research EI-21, 1000 Independence Avenue, SW, Washington, DC 20585; and to the Office of Information and Regulatory Affairs, Office of
Management and Budget, Washington, DC 20503.
SANCTIONS
The timely response of Form EIA-878 Schedule B by those required to report is mandatory under 15 USC 772(b), as
amended. Failure to respond may result in a civil penalty of not more than $10,949 per day for each violation. The
government may bring a civil action to prohibit reporting violations which may result in a temporary restraining order
or a preliminary or permanent injunction without bond. In such civil action, the court may also issue mandatory
injunctions commanding any person to comply with these reporting requirements.
Page 6
Form EIA-878 Schedule B, Motor Gasoline Price Surv ey
| File Type | application/pdf |
| Author | IT\ORTM |
| File Modified | 2021-09-27 |
| File Created | 2021-09-22 |