Form EIA-14 Form EIA-14 Refiners’ Monthly Cost Report

OMB No. 1905-0174
Expiration Date: XX/XX/XXXX
Burden: 1.75 hours
Version No.: 2019.02
FORM EIA-14
REFINERS' MONTHLY COST REPORT
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. RESPONDENT INFORMATION

PART 2. SUBMISSION INFORMATION
Please provide a comment below regarding the resubmission.

REPORT PERIOD:

Month

Due Date: A completed form must be filed by the 30th calendar
day following the end of the report month.

Year

EIA ID NUMBER:
If any Respondent Identification Data has changed since the last
report, enter an "X" in the box:
Company Name:

Forms may be submitted using one of the following methods:
Secure File Transfer:
https://signon.eia.doe.gov/upload/noticeoog.jsp

Physical Address (e.g., Street Address, Building Number, Floor, Suite):
Fax: (202) 586-9772
Mailing Address of Contact (e.g., PO Box, RR):
Questions?
City:

State:

Zip:

Call 1-855-342-4872

-

Contact Name:
Phone No.:

Ext:

Fax No.:
Email address:

Date of this Report:

Month:

Day:

Year:

Type of Report (Check one)
Original

Please select only one Type of Report

Resubmission
Revision to Report:

Month:

Day:

Year:

PART 3. SUMMARY OF CRUDE OIL COSTS AND VOLUMES
MONTHLY ACQUISITIONS
PAD District

Domestic Crude Oil
Total Cost
(thousands of dollars)

Total Volume
(thousands of barrels)

Imported Crude Oil
Total Cost
(thousands of dollars)

PADD 1
PADD 2
PADD 3
PADD 4
PADD 5
Other
Total U.S.
Comments: (Unusual occurrences which may explain variations in the data and/or explanation of 'Other'.)

Total Volume
(thousands of barrels)