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

FORM EIA-14
REFINERS' MONTHLY COST REPORT

OMB No. 1905-0174
Expiration Date: XX/XX/XXXX
Burden: 1.75 hours
Version No.: 2019.02

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
REPORT PERIOD:

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

Month

Year

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

EIA ID NUMBER:
If any Respondent Identification Data has changed since the last

Forms must be submitted using the following method:
Secure File Transfer:
https://signon.eia.doe.gov/upload/noticeoog.jsp

report, enter an "X" in the box:
Company Name:
Physical Address (e.g., Street Address, Building Number, Floor, Suite):

Questions?

Mailing Address of Contact (e.g., PO Box, RR):
City:

State:

Zip:

-

Contact Name:
Phone No.:

Ext:

Fax No.:
Email address:

Date of this Report:

Please contact the EIA Survey Support Team using
the following communication methods:
Email: eia4usa@eia.gov
Phone: 1-855-EIA-4USA (1-855-342-4872)
Monday through Friday, 8:00 A.M. to 6:00 P.M. ET

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
Total Volume
(thousands of dollars)
(thousands of barrels)

Imported Crude Oil
Total Cost
Total Volume
(thousands of dollars) (thousands of barrels)

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'.)