Form Rg-6 - Assistance Charges Return For Natural Gas Distributors
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Illinois Department of Revenue
RG-6
Assistance Charges Return
REV 3 Form 554
for Natural Gas Distributors
E S ___/___/___
Station 257
NS
DP
CA
RG-6 (R-11/12)
Do not write above this line.
Identify your business
Account ID __ __ __ __ __ __ __ __
Liability period ___ ___/___ ___ ___ ___
Month
Year
Check here if your address has changed.
FEIN
___ ___ - ___ ___ ___ ___ ___ ___ ___
Federal employer identification number
Is this a final (you are no longer in business) return?
License no. GA - ___ ___ ___ ___ ___
yes
no
Name
______________________________________________
Address
____________________________________________
Number and street
___________________________________________________
City
State
ZIP
Step 1: Figure your assistance charges due
Total number
Energy
Renewable
of accounts
Assistance Charge
Energy Charge
1
Total number of accounts to which you delivered residential gas
service and from which you collected the assistance charges
1
during this liability period.
_____________
2
2
Multiply Line 1 by the appropriate rate. See instructions.
__________|___
3
3
Multiply Line 1 by $0.05.
__________|___
4
Write the total number of accounts
• to which you delivered nonresidential gas service,
• to which you delivered less than 4 million therms of gas during
the previous calendar year, and
• from which you collected the assistance charges.
4
_____________
5
5
Multiply Line 4 by the appropriate rate. See instructions.
__________|___
6
6
Multiply Line 4 by $0.50.
__________|___
7
Write the total number of accounts
• to which you delivered nonresidential gas service,
• to which you delivered 4 million or more therms of gas during the
previous calendar year, and
• from which you collected the assistance charges.
7
_____________
8
8
Multiply Line 7 by the appropriate rate. See instructions.
__________|___
9
9
Multiply Line 7 by $37.50.
__________|___
10
10
Energy Assistance Charge - Add Lines 2, 5, and 8.
__________|___
10a
10a
Arrearage Reduction Program subtraction.
__________|___
10b
10b
PIPP Program Administrative & Operation Expense Subtraction.
__________|___
10c
10c
Add Lines 10a and 10b and subtract from Line 10 for your total Energy Assistance Charge.
__________|___
11
11
Add Lines 3, 6, and 9. This amount is your total Renewable Energy Charge due.
__________|___
12
Add Lines 10c and 11. This amount is the total assistance charge due.
12
Make your check payable to “Illinois Department of Revenue.”
__________|___
Step 2: Sign below
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.
_____________________________
________________
(____)____-___________
____/____/________
Title:
Taxpayer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________
(____)____-___________
____/____/________
Firm:
Preparer’s signature and name of the firm or employer (if applicable)
Telephone number (include area code)
Date
Step 3: Mail your return
Mail your completed Form RG-6 and payment to: Assistance Charges, Illinois Department of Revenue, PO Box 19019, Springfield, IL, 62794-9019
Note: You can file Form RG-6 electronically
This form is authorized by the Energy Assistance Act of 1989 and the Renew-
using MyTax Illinois at tax.illinois.gov.
*255401110*
able Energy, Energy Efficiency, and Coal Resources Development Law of 1997.
Disclosure of this information is required.
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