Form QFR: Class I - Motor Carriers of Property and Household Goods - Quarterly Report - Federal Motor Carrier Safety Administration

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Form QFR: Class I - Motor Carriers of Property and Household Goods - Quarterly Report
	Print

OMB No. 2126-0033
Approval Expires 6/30/2009

Calendar/Fiscal Year

QUARTER

Quarter 1

Quarter 2

Quarter 3

Quarter 4

IDENTIFICATION

Motor Carrier Number
USDOT Number
Name of Company
Trade or Doing Business As
Street Address
City
State
ZIP Code
Telephone Number

CONTACT (for purposes of this report)

Contact Name
Title
Telephone Number

MAILING ADDRESS (if different from above)

Mailing Address
City
State
ZIP Code

AFFILIATED COMPANIES

Parent Name	Motor Carrier Number	USDOT Number
Affiliate Name 1	Motor Carrier Number	USDOT Number
Affiliate Name 2	Motor Carrier Number	USDOT Number
Affiliate Name 3	Motor Carrier Number	USDOT Number
Affiliate Name 4	Motor Carrier Number	USDOT Number

GENERAL INSTRUCTIONS

Use Generally Accepted Accounting Principles (GAAP)
Report dollar values in whole dollars.
Respond to each item. Use "0," "none," or "not applicable" as appropriate.
Explain any unusual items, such as large differences between figures reported in the current report and those for the preceding report.
Use parentheses to indicate negative numbers.

Operating Revenues

Line 1: Freight operating revenue - intercity
Line 2: Household goods carrier operating revenue
Line 3: Other operating revenue
Line 4: Total Operating Revenue (Sum of lines 1 through 3)

Operating Expenses

Line 5: Freight operating expenses
Line 6: Household goods carrier operating expenses
Line 7: Total Operating Expenses (Sum of lines 5 and 6)

Net Income (Loss) Calculation

Line 8: Net Operating Income (Loss) - Line 4 minus line 7
Line 9: Net Non-Operating Income (Loss)
Line 10: Interest expenses - show as a positive number
Line 11: Ordinary income (loss) before taxes - Sum of lines 8 and 9 minus line 10
Line 12: Total provision for income taxes, extraordinary items, effect of accounting changes, and other items
Line 13: Net Income (Loss) - Line 11 minus line 12

Operating Statistics (all carriers)

Line 14: Miles - intercity: highway
Line 15: Miles - intercity: rail, water, and air
Line 16: Tons - intercity
Line 17: Total freight bills (shipments and/or loads) - intercity

Certification

I hereby certify that this report was prepared by me or under my supervision, that I have examined it, and that the items herein reported on the basis of my knowledge are correctly shown.

Name
Signature
Title
Date

Return the completed form to:

Department of Transportation
Federal Motor Carrier Safety Administration
IT Operations Division
1200 New Jersey Avenue SE
Washington, DC 20590
Phone: 202-366-4023
Fax: 202-366-3477

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Federal Motor Carrier Safety Administration
1200 New Jersey Avenue SE, Washington, DC 20590 • 1-800-832-5660 • TTY: 1-800-877-8339 • Field Office Contacts