Form Eia-7a - Annual Survey Of Coal Production And Preparation Page 2
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16Department of Energy
OMB No. 1905-0167
U.S. Energy Information Administration
Expiration Date: XX/XX/XXXX
1000 Independence Ave., S.W.
Burden: 3.25 hours
Washington, DC 20585
MSHA ID#:
PART 1: PREPARER CONTACT INFORMATION
Reporting for Calendar Year:
❶
What is the contact information for the preparer?
Preparer’s Name:
Title:
Company Name:
Street Address:
City:
State:
Zip Code:
Preparer’s Telephone:
(
)
―
Preparer’s Fax:
(
)
―
Preparer’s Email:
Report any changes to the pre-populated preparer’s contact information below:
❷
What is the contact information for the preparer’s supervisor?
Supervisor’s Name:
Title:
Company Name:
Street Address:
City:
State:
Zip Code:
Supervisor’s Telephone:
(
)
―
Supervisor’s Fax:
(
)
―
Supervisor’s Email:
Report any changes to the pre-populated preparer’s supervisor contact information below:
Page 2
Form EIA-7A, Annual Survey of Coal Production and Preparation
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