4136 Schedule A Business Activity Report for Credit for Federal Tax Paid

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TREASURY/IRS AND OMB USE ONLY DRAFT
SCHEDULE A
(Form 4136)
(December 2025)

Business Activity Report for Credit
for Federal Tax Paid on Fuels

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0162

Attach to your Form 4136.
Taxpayer identification number

Name (as shown on your income tax return)

Business name (if applicable)

Principal Business Activity Code

EIN (if applicable)

Enter the information for the equipment for which most of the fuel was used for this business. See instructions.
(ii) Model
(i) Make
(iii) Type of equipment
Caution:

You have the name and address of the person who sold the fuel to you and the dates of purchase. For claims on lines 1c and 2b (type of use
13 or 14), 3d, 4c, and 5, you haven’t waived the right to make the claim. For claims on lines 1c and 2b (type of use 13 or 14), a certificate
hasn’t been provided to the credit card issuer. For type of use 2, the equipment or vehicle used wasn’t a highway vehicle, which generally
means that it wasn’t registered or required to be registered for use on public highways.

1

Note: CRN is the credit reference number.

Nontaxable Use of Gasoline

a
b
c
d

2

(a)
Type
of use

(b)
Rate

2
1

$.183
.183
.183

Off-highway business use
Use on a farm for farming purposes
Other nontaxable use (see Caution above line 1)
Exported

3

.184

3
9

$.15
.193
.194
.001

(c)
Qualified gallons

}

(d)
Actual fuel cost
from your records

(e)
Amount of credit

(f)
CRN

362
$

$
411

Nontaxable Use of Aviation Gasoline
a
b
c
d

3

Use in commercial aviation (other than foreign trade)
Other nontaxable use (see Caution above line 1)
Exported
LUST tax on aviation fuels used in foreign trade

$

$

354
324
412
433

Nontaxable Use of Undyed Diesel Fuel
You certify the following. The diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here

a
b
c

(b)
Rate

(c)
Qualified gallons

1

$.243
.243
.243

}

Nontaxable use
Use on a farm for farming purposes
Use in trains

d

Use in certain intercity and local buses (see
Caution above line 1)

e

Exported

4

(a)
Type
of use

3

(d)
Actual fuel cost
from your records
$

.

.

(e)
Amount of credit

(f)
CRN

360

$

353

.17
.244

350
413

Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)
You certify the following. The kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here
(a)
Type
of use
a
b

Nontaxable use taxed at $.244
Use on a farm for farming purposes

c

Use in certain intercity and local buses (see
Caution above line 1)
Exported
Nontaxable use taxed at $.044
Nontaxable use taxed at $.219

d
e
f

For Paperwork Reduction Act Notice, see the separate instructions.

1

(b)
Rate
$.243
.243
.17

3

(d)
Actual fuel cost
from your records

(c)
Gallons

.244
.043
.218
Cat. No. 95469P

}

$

.

(e)
Amount of credit

$

.
(f)
CRN

346
347
414
377
369

Schedule A (Form 4136) (12-2025) Created 10/8/25

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

The person(s) signing the return with which this form is filed are declaring, under penalty of perjury, that the return and accompanying
schedules, statements, and any other attachments are true, correct, and complete to the best of the signer’s knowledge and belief. That
declaration includes all amounts reported and all credits claimed on this form. It also includes certifying that all the statements for certain lines
below are true as well.

TREASURY/IRS AND OMB USE ONLY DRAFT
Page 2

Schedule A (Form 4136) (12-2025)

5

Kerosene Used in Aviation
(a)
Type
of use
a
b
c
d
e

(c)
Qualified gallons

(d)
Actual fuel cost
from your records

(e)
Amount of credit

(f)
CRN

Kerosene used in commercial aviation (other than
foreign trade) taxed at $.244

$.200

Kerosene used in commercial aviation (other than
foreign trade) taxed at $.219

.175

355

Nontaxable use (other than use by state or local
government) taxed at $.244

.243

346

.218
.001

369
433

Nontaxable use (other than use by state or local
government) taxed at $.219
LUST tax on aviation fuels used in foreign trade

9

$

$

417

Registration No.

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

If you don’t have the registration number, STOP; you’re not eligible to make Form 4136 claims if you haven’t yet filed Form 637 and received
your registration number and placed it on this line.
You certify the following. You sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or have obtained the written
consent of the buyer to make the claim, and that the diesel fuel didn’t contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here
(b)
Rate
a
b

7

Use by a state or local government
Use in certain intercity and local buses

(d)
Actual fuel cost
from your records

(c)
Gallons

$.243
.17

$

Sales by Registered Ultimate Vendors of Undyed Kerosene
(Other Than Kerosene for Use in Aviation)

.

.

(e)
Amount of credit

(f)
CRN

$

360
350

Registration No.

If you don’t have the registration number, STOP; you’re not eligible to make Form 4136 claims if you haven’t yet filed Form 637 and received
your registration number and placed it on this line.
You certify the following. You sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or have obtained the written
consent of the buyer to make the claim, and that the kerosene didn’t contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here

a
b
c

8

Use by a state or local government
Sales from a blocked pump
Use in certain intercity and local buses

(b)
Rate

(c)
Qualified gallons

$.243
.243
.17

}

Sales by Registered Ultimate Vendors of Kerosene for Use in Aviation

(d)
Actual fuel cost
from your records
$

.

(e)
Amount of credit

$

.
(f)
CRN

346
347

Registration No.

If you don’t have the registration number, STOP; you’re not eligible to make Form 4136 claims if you haven’t yet filed Form 637 and received
your registration number and placed it on this line.
You certify the following. You sold the kerosene for use in aviation at a tax-excluded price and you haven’t collected the amount of tax from
the buyer, repaid the amount of tax to the buyer, or you’ve obtained the written consent of the buyer to make the claim. See the instructions for
additional information to be submitted.
(a)
Type
of use
a
b
c
d
e
f

Use in commercial aviation (other than foreign
trade) taxed at $.219

$.175

Use in commercial aviation (other than foreign
trade) taxed at $.244
Nonexempt use in noncommercial aviation
Other nontaxable uses taxed at $.244
Other nontaxable uses taxed at $.219
LUST tax on aviation fuels used in foreign trade

(b)
Rate

9

.200
.025
.243
.218
.001

(c)
Qualified gallons

(d)
Actual fuel cost
from your records
$

(e)
Amount of credit

$

(f)
CRN

355
417
418
346
369
433

Schedule A (Form 4136) (12-2025)

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

6

(b)
Rate

TREASURY/IRS AND OMB USE ONLY DRAFT
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Schedule A (Form 4136) (12-2025)

9

Reserved for future use

10

Reserved for future use
(b)
Rate
a
b
c
d

11

(c)
(d)
Number of gallons Actual fuel cost
sold or used
from your records

Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use

$

(e)
Amount of credit

(f)
CRN

$

Nontaxable Use of Alternative Fuel
Caution: There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See instructions.

a
b
c
d
e
f
g
h

12

Liquefied petroleum gas (LPG) (see instructions)
“P Series” fuels
Compressed natural gas (CNG) (see instructions)
Liquefied hydrogen
Fischer-Tropsch process liquid fuel from coal
(including peat)
Liquid fuel derived from biomass
Liquefied natural gas (LNG) (see instructions)
Liquefied gas derived from biomass

(b)
Rate

(c)
(d)
Gallons, or
Actual fuel cost
gasoline or diesel
gallon equivalents from your records

$.183
.183
.183
.183

$

(e)
Amount of credit
$

(f)
CRN
419
420
421
422

.243
.243
.243
.183

423
424
425
435

Reserved for future use
(b)
Rate
a
b
c
d
e
f
g
h
i

13

(c)
(d)
Gallons, or
Actual fuel cost
gasoline or diesel
gallon equivalents from your records

Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use

$

Registered Credit Card Issuers

(e)
Amount of credit

(f)
CRN

$

Registration No.

If you don’t have the registration number, STOP; you’re not eligible to make Form 4136 claims if you haven’t yet filed Form 637 and received
your registration number and placed it on this line.
(b)
Rate
a
b
c

Diesel fuel sold for the exclusive use of a state or local
government

$.243

Kerosene sold for the exclusive use of a state or local
government

.243

Kerosene for use in aviation sold for the exclusive use of a
state or local government taxed at $.219

.218

(c)
Qualified gallons

(d)
Actual fuel cost
from your records
$

(e)
Amount of credit

$

(f)
CRN

360
346
369

Schedule A (Form 4136) (12-2025)

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

(a)
Type
of use

TREASURY/IRS AND OMB USE ONLY DRAFT
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Schedule A (Form 4136) (12-2025)

14

Nontaxable Use of a Diesel-Water Fuel Emulsion
Caution: There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See instructions.
(a)
Type
of use
a
b

15

Nontaxable use
Exported

3

(b)
Rate
$.197
.198

a

Blender credit

(e)
Amount of credit
$

(f)
CRN
309
306

Registration No.
(b)
Rate

(d)
Actual fuel cost
from your records

(c)
Qualified gallons

$.046

$

(e)
Amount of credit
$

(f)
CRN
310

Exported Dyed Fuels and Exported Gasoline Blendstocks
(b)
Rate
a
b

17

Exported dyed diesel fuel and exported gasoline blendstocks
taxed at $.001
Exported dyed kerosene

(d)
Actual fuel cost
from your records

(c)
Qualified gallons

$.001
.001

Total income tax credit claimed. Add lines 1 through 16, column (e) .

$

.

.

.

.

(e)
Amount of credit

$

.

(f)
CRN

415
416

17 $
Schedule A (Form 4136) (12-2025)

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

$

Diesel-Water Fuel Emulsion Blending

16

(d)
Actual fuel cost
from your records

(c)
Qualified gallons