A. Purpose

1. Form CLC-22 is designed to provide the data necessary for the Cost of Living Council (CLC) and the Internal Revenue Service (IRS) to execute their role in monitoring the performance of the economy pursuant to Executive Order 11730.

2. Form CLC-22 provides the means by which certain firms subject in whole or in part to 6 CFR, Part 150, report price adjustments and related costs and profits on a quarterly basis. In addition, Form CLC-22 provides the means by which a firm prenotifies certain price adjustments.

B. Who Must Use Form CLC-22

1. Each price category I or II firm, as defined in 6 CFR, Part 150, Subpart C, must submit quarterly reports on Form CLC-22 and each price category | firm shall prenotify price increases on Form CLC-22 to the IRS in accordance with regulations issued by the CLC.

2. All firms are encouraged to prepare and maintain Form CLC-22 in the firm's records to assist in complying with Phase IV regulations.

3. General Rules. The following rules apply for the purpose of determining who must use Form CLC-22:

a. Determination of "Firm." If a firm is not directly or indirectly controlled by another firm, that firm is called a "parent" for the purposes of this Form CLC-22. The parent and the consolidated and unconsolidated entities (if any) which it directly or indirectly controls taken all together, constitute the "firm" for the purpose of paragraphs B.1. and B.2, above.

b. Parent and Consolidated Entities. Once the prenotification or reporting status is determined, only the sales or revenues of the parent and the sales or revenues of the controlled entities (if any), consolidated with the parent in its financial statements prepared in accordance with generally accepted accounting principles are combined for purposes of preparation of the Form CLC-22 applicable to the "Parent and Consolidated En

tities." The Form CLC-22 is prepared by the parent for and on behalf of the entire consoli. dated group for submission to the IRS.

c. Unconsolidated Entity. In addition to preparing Form CLC-22 for and on behalf of the entire consolidated group, the parent must prepare a separate Form CLC-22 for and on behalf of each unconsolidated entity with annual sales or rev. enues of $10 million or more. An "unconsolidated entity" is any entity directly or indirectly controlled by a parent but not consolidated with the parent for purposes of financial statements prepared in accordance with generally accepted accounting principles. An "unconsolidated entity" includes any entity consolidated with that unconsolidated entity for purposes of financial statements prepared in accordance with generally accepted accounting principles.

d. Entity. For purposes of this form and all supporting schedules, entity means the "parent and consolidated entities" or an "unconsolidated entity."

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4. Certification of No Price Increase. Any entity that would otherwise be required to file the Form CLC-22 a quarterly basis which has not increased any price in excess of the greater of the base price or the adjusted freeze price, must submit within 30 days of the end of the entity's fiscal quarter, a Form CLC-22 with Parts I, IV, and V completed in accordance with these instructions, and, with the following certification typed in Part VI, Item 24, Lines (1) through (33):

I certify that as of (a), (b) has not at any time since (c); (1) charged a price in excess of the greater of the adjusted freeze price defined in accordance with 6 CFR, Part 150, Subpart E or the base price established in accordance with 6 CFR, Part 150, Subpart F, (2) charged a price for any custom product or service as defined in 6 CFR 150.104, or, if it has charged such a price, that the annual sales or revenues attributable to all its custom products or services will represent less than $10 million and less than

1 percent of the entity's annual sales or revenues, or, (3) increased a price pursuant to the special rule for volatility in 6 CFR 150.156.

the Phase IV regulations. Late filing, failure to file, failure to keep records, or failure otherwise to comply with these instructions, may result in criminal fines, civil penalties, and other sanctions as provided by law.

Chief Executive Officer (or other authorized executive officer

The following information is entered in the appropriate blanks of the certification:

(a) the reporting period ending date

(b) the name of the entity to which the Form CLC22 applies

(c) the date of the last day in base price period.

C. When to Submit Form CLC-22

Firms required to prenotify price increases must file a Form CLC-22 at least 30 days prior to charging a price for which prenotification is required pursuant to 6 CFR, Part 150, Subpart H. Firms required to file Form CLC-22 as a report of price adjustments, and related costs and profits, must submit such report to the IRS not later than 45 days after the last day in the entity's fiscal quarter and 90 days after the last day in the entity's fiscal year.

D. What to Submit or Prepare

This form and instructions require only basic information. However, the CLC and the IRS may request additional data in particular cases. Firms must submit 2 copies of the Form CLC-22, Schedules C, R, and T, as required, and all other supporting schedules and documentation indicated in the instructions. Firms which submit a Form CLC-22 which contains incomplete or incorrect information will be required to submit a corrected Form CLC-22 and will be considered in violation of the reporting requirements if a complete and correct form is not submitted within the time period prescribed.

E. Where to Submit

Firms required to file must forward Form CLC-22 and attachments to the IRS office designated in the table at the end of these instructions.

F. Suggestions for Improvement

The CLC welcomes suggestions for improving this and other forms, and seeks ways of obtaining the information it needs to exercise its responsibilities under Phase IV of the Economic Stabilization Program with the minimum amount of public burden. Suggestions should be submitted to:

Cost of Living Council

Office of the Executive Secretariat 2000 M Street, N.W.

Washington, D. C. 20508

G. Rounding

For purposes of this form, all percentages must be expressed to the nearest two decimal places (such as 15.92%). All dollar entries must be rounded to the nearest $1000 and the 000 should be omitted (such as $1,750,803 entered as $1,751).

H. Sanctions

The timely submission of a Form CLC-22 by a firm as a report or prenotification is a mandatory requirement under

Specific Instructions

PART I-Identification Data

Item la or b. Organization/Status. Check the box which indicates the status of the organization to which this form applies.

Item 2. Type of Submission

Prenotification-Check box (a) if Form CLC-22 is used to prenotify a price adjustment.

Quarterly Report-Check box (b) if Form CLC-22 is
used to make a quarterly report.

Certification-Check box (c) if a Certification of
No Price Increase is to be typed in Part VI (See
General Instructions, paragraph B 4).

Other Check box (d) if Form CLC-22 is used for
purposes other than in 2 (a), (b), or (c) and explain
the purpose on the line provided.

Item 3. Name, Address, and Chief Executive Officer Name. If item 1(a) is checked enter the legal name of the parent. If item 1(b) is checked enter the legal name of the unconsolidated entity.

Address. Enter the address of the executive office. Chief Executive Officer. Enter the name and title of the Chief Executive Officer.

Parent. If item 1(b) is checked, enter the legal name of the parent.

Item 4. Is this a resubmission? Answer Item 4 "yes" if you are supplying additional information or are resubmitting a report. In either case, the form must be com pleted in its entirety.

Item 5. Ending date of most recently completed fiscal year. Enter the date of the last day of the most recently completed fiscal year of the entity. If the fiscal year end ing date has changed, enter the word "change" and attach a letter explaining the change.

Item 6. Reporting Period Ending Date. Enter the date of the last day in the reporting period. The reporting period must conform with the entity's most recently completed fiscal quarter.

Item 7. Annual Sales or Revenues (To be completed by Parent only). Enter for the most recently completed fiscal year, the total of the annual sales or revenues (as defined in 6 CFR, Part 150, Subpart B) of the parent and its consolidated and unconsolidated controlled firms PART II

Calculation of Base Period Profit Margin

This part must be completed at the time the initial Form CLC-22 is prepared. Thereafter, this part must be complete only if the base period profit margin is restated. If the firm received an order granting a request for an exception affectin its base period profit margin, it may use the provisions o

such an order in calculating the base period profit margin in accordance with the instructions to this Part. In such cases, the firm must enclose a copy of the exception order and document its use and dollar effect. The term "base period" means any two, at the option of the entity, of that entity's fiscal years ending on or after August 15, 1968, other than the fiscal year for which compliance is being measured. A fiscal year in which it is determined that the entity unlawfully exceeded its base period profit margin can be a base period fiscal year except that operating income for that year must be reduced by the amount of operating income derived from prices in violation or the dollar value of the excess profit margin, whichever is less. In determining a base profit period for the purpose of computing a base period profit margin a weighted average of profits during the two years chosen must be used. The entries made in Items 8, 9, 11, and 12 must be reconciled on the Schedule R to Form CLC-22 with the corresponding entries reported on the supporting Form 10-K or other financial statements required in the Instructions to the Schedule R. Any required R must be attached to the Form CLC-22.

Items 8 and 9. Net Sales. Enter, from the appropriate Schedule R, the amount on Line 12.

item 10. Total. Enter the sum of Items 8 and 9.

Items 11 and 12. Operating Income. Enter, from the appropriate Schedule R, the amount on Line 13.

Item 17. Target Cumulative Period Profit. Enter the target amount of cumulative period profit determined by multiplying Item 15 by Item 16.

Item 18. Actual Operating Income. Enter, from appropriate Schedule R, the amount on Line 13.

Item 19. Cumulative Period Profit Under (Over) Target
Profit. This entry is determined by subtracting Item 18
from Item 17.

PART IV-Additional Information-
Self explanatory

PART V-Certification

Type the name and title of the individual who has signed the certification and the date of signing. The individual who signs and certifies this Form CLC-22 must be the Chief Executive Officer of the Parent or such other executive officer of the entity as authorized by the Chief Executive Officer to sign for him for this purpose. Such authorization in the following format must be received by the appropriate IRS office as indicated in the table at the end of these instructions.

Delegation of Authority to Sign and Certify

(Typed date of signing)

Item 13. Total. Enter the sum of Items 11 and 12.

Item 14. Base Period Profit Margin. The base period profit margin is calculated by dividing Item 13 by Item 10.

PART III Calculation of Profit Variation

This part must be completed by the entity each time Form CLC-22 is prepared as a quarterly report. The entries made in Items 15 and 18 must be reconciled on the Schedule R to Form CLC-22 with the corresponding entries reported on the supporting Form 10-K, Form 10-Q, or other financial statements required (see instructions to Schedule R). Schedule R must be attached to the Form CLC-22. If the entry in Item 19 shows the Cumulative Period Profit over the Target Profit, the entity must attach on explanation as to why it does not appear to be conforming with the general price rules in 6 CFR, Part 150, Subpart E and Subpart K.

Item 15. Net Sales. Enter, from appropriate Schedule R, the amount in Line 12.

!tem 16. Base Period Profit Margin. Enter the base period profit margin from Part II, Item 14, or if Item 14 is not completed, enter the base period profit margin from the most recently completed Form CLC-22 with a completed Part II.

If the entity is allowed a profit margin pursuant to the Loss and Low Base Period Profit Margin rule of 6 CFR 150.202, it should enter that profit margin in Item 16 and attach a supporting schedule to document the computa. tion of the capital turnover ratio using net sales determined in accordance with 6 CFR 150.202. However, the completion of Part II, Form CLC-22, in accordance with the instructions, continues to be a requirement.

of the above-named parent; and that, as such, I am authorized to sign documents and to certify, on behalf of said parent, the accuracy and completeness of all the information in such documents. Pursuant to the power vested in me, I hereby delegate all or, to the extent indicated below, a portion of that authority to the person(s) listed below, who is (are) executive officers of the above-named parent or entity of the firm. This delegation is effective until it is revoked in writing, and the Internal Revenue Service is so notified.