Form Eia-910 - Monthly Natural Gas Marketer Survey printable pdf download

OMB No. 1905-0175

Expiration Date: 12/31/2020

Product No.: 2020.01

MONTHLY NATURAL GAS MARKETER SURVEY

Burden: 2.0 hours

FORM EIA-910

This report is mandatory under 15 U.S.C. §772. Failure to comply may result in criminal fines, civil penalties and other sanctions as provided by law. For the sanctions

and the provisions concerning the confidentiality of information submitted on this form, see instructions. 18 U.S.C. §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.

PART 1. RESPONDENT IDENTIFICATION DATA

PART 2. SUBMISSION INFORMATION

Completed form(s) must be filed no later than 30 days after

2 0

REPORT PERIOD:

Month:

Year:

the report month.

Form must be submitted via Secure File Transfer:

9 1 0

EIA ID NUMBER:

https://signon.eia.doe.gov/upload/noticeoog.jsp

If this is a resubmission, enter an "X" in the box:

If any Respondent Identification Data has changed since the last report,

enter an "X" in the box:

Questions?

Call:

(877) 800-5261

Company Name:

Contact Name:

Phone No.:

Ext:

Fax No.:

Address 1:

Address 2:

Zip:

City:

State:

Email address:

PART 3. NATURAL GAS SALES

Please provide the following information for your residential and commercial customers as defined in the instructions:

Report State (Enter one of the following States in the box):

Georgia, New York,

or Ohio. Submit a separate form for each State in which your company has sales

residential and/or commercial end-use customers.

Residential

Commercial

To how many end-use customers did you sell natural gas?

(Number of Customers)

How much natural gas did you sell to these customers?

Do not report negative numbers or decimals. You may report in either Thousand

Residential

Commercial

cubic feet (Mcf) or in Therms. Indicate unit of measure by placing an "X" in the

appropriate box.

Mcf

Therm

For companies reporting sales in all States except Georgia:

What were the gross receipts for the natural gas commodity sold, plus customer

Residential

Commercial

service charges, taxes, and other charges excluding any amount owed to the local

distribution company who transported gas to your customers?

(Dollars)

For companies reporting sales in Georgia:

What were the gross receipts for the natural gas commodity sold, plus customer

Residential

Commercial

service charges, taxes and other charges, including any amount owed to the local

distribution company who transported gas to your customers?

(Dollars)

Comments: Identify any unusual aspects of your reporting month's activity.

Form Eia-910 - Monthly Natural Gas Marketer Survey

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