### Due Date: 2013 Form Approval: OMB No. 1905-0129 Approval Expires: 12/31/2015 Burden hours: 0.75



# SCHEDULE 1. IDENTIFICATION Contact Information Form EIA-861S ANNUAL ELECTRIC POWER INDUSTRY REPORT (Short Form) NOTICE: 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. For further information concerning sanctions and data protections see the provisions on sanctions and the provisions concerning the confidentiality of information in the instructions.Title 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. Entities that report using the Form EIA-861 donot complete the Form EIA-861S. For information on which entities are required to file the Form EIA-861 or EIA-861S survey forms, see the instructions for Form EIA861S. Entity Name: Entity ID: First Name: Last Name:

Title: Telephone: FAX: Title:
First Name: Last Name: Telephone: FAX: Email: Supervisor Information

Cooperative Legal Name of Entity: Current Address of Entity's Principal Business Office: Current Address of Preparer's Office (If Different From Current Address of Entity's Principal Business Office): Preparer's Legal Name (If Different From Entity's Legal Name): 

# Entity and Preparer Information Email:



# FAX Number: (202) 287-1938 For questions or additional information about the Form EIA-861S contact the Survey Managers, preferably by email at EIA-861@eia.gov. Jorge Luna-Camara Stephen Scott Phone: (202) 586-3945 Phone: (202) 586-5140 Respondent Type

(check one) Federal State Political Subdivision Municipal Municipal Marketing Authority Investor-OwnedDue Date: 2013 Form Approval: OMB No. 1905-0129 Approval Expires: 12/31/2015 Burden hours: 0.75 Hours Entity Name: ABC Company Entity ID: 0000000 Data Year: 2012
Did you have voluntary Retail Green Pricing Programs during the reporting year? [ ] YES [ ] NO
Did you have Net Metering Programs during the reporting year? [ ] YES [ ] NO
State Revenue (1000$) Retail Sales (Mwh) Number of Customers

Was your entity a part of a merger or acquisition during the reporting year? [ ] YES [ ] NO Did you have company-administered Demand-Side Management programs during the reporting year? [ ] YES [ ] NO
Did you operate any time-based rate programs which are administered through a tariff during the reporting year? [ ] YES [ ] NO If yes provide: Residential (a) Commercial (b) Industrial (c) Transportation (d) Total (e) 1 Number of Customers 0.000
Did you operate any AMR during the reporting year? [ ] YES [ ] NO If yes provide: Residential (a) Commercial (b) Industrial (c) Transportation (d) Total (e) 1 Number of AMR Meters 0 Did you operate any AMI during the reporting year? [ ] YES [ ] NO If yes provide: 2 Number of AMI Meters 0 3 Energy Served Through AMI 0 Schedule 6. Part A. Demand-Side Management Information Schedule 5. Merger and Acquisitions

STATE STATE Schedule 6. Part D. Advanced Metering AMR- data transmitted one-way, from customer to utility. AMI- data can be transmitted in both directions, between the delivery entity and the customer. Schedule 6. Part C. Time-Based Rate Programs (Dynamic Pricing Programs) Time based rate programs include real-time pricing, critical peak pricing, variable peak pricing and time-of-use rates, also known as dynamic pricing programs. SCHEDULE 2. PART D. NET METERING

Provide total Revenue in thousand of dollars, megawatt hours of Retail Sales, and customer counts by state. Form EIA-861S ANNUAL ELECTRIC POWER INDUSTRY REPORT (Short Form)

SCHEDULE 2. PART C. GREEN PRICING Green Pricing programsare voluntary retail programs where customers pay an extra fee to purchase electricity generated from renewable sources. DO NOT include RPS here.

Schedule 4. Part A Sales to Ultimate Customers. Full Service-Energy and Delivery Service (Bundled) Net Metering programsallow customers to sell excess power they generate back to the electrical grid to offset consumption. For net metering applications of 2 MW nameplate capacity and less, provide the information about programs.