Form Eia-457f - Household Natural Gas Usage Form

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2005 Residential Energy Consumption Survey
Sponsored by the Energy Information Administration
U.S. Department of Energy
Washington, DC 20585
Form EIA-457F (2005) – Household Natural Gas Usage Form
OMB No. 1905-0092, Expiring May 31, 2008
Household Natural Gas Usage Form
Service
Address:
STEP 1
If the customer account number is not shown above, please enter it here.
Customer Account: __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/
STEP 2
Now, please turn the page and provide the requested information for the household
identified above.
Completed forms are due by March 4, 2006. If you have any questions, please call
(toll-free) 1-NNN-NNN-NNNN. Ask for the Supplier Survey Specialist.
This report is mandatory under Public Law 93-275, as amended. See the enclosed
Answers to Frequently Asked Questions for more details concerning confidentiality
and sanctions.
STEP 3
Use the enclosed self-addressed envelope and return the completed form to:
U.S. Department of Energy
c/o The Contractor
Contractor’s Street Address
Contractor’s City, State, and ZIP Code
Or you may FAX the completed form to The Contractor at NNN-NNN-NNNN
Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data records, gathering and maintaining the data needed, and completing and reviewing the form. Send comments
regarding this reporting burden estimate or any other aspect of this data collection, including suggestions for reducing this burden, to the
Energy Information Administration, Statistics and Method Group, EI-70, 1000 Independence Avenue, SW, Washington, DC 20585, and to
the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.

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