Parts I through V Specific Instructions (Same as the Instructions for the Preparation of Form CLC-22 except add the following paragraph to the Special Instructions for the Preparation of Form CLC-22 as a Prenotification Document) 3. Firms prenotifying a price increase pursuant to 6 CFR, Part 150, Subpart L. must use a separate Form CLC-22 to prenotify price increases on covered products as defined. For purposes of a Form CLC-22 used to prenotify price increases on covered products, the terms "base price" used in computing the entries in columns (d), (e), and (g) and "base cost" used in computing the entry in column (f) are as defined in 6 CFR 150.352 and 150.358 respectively. However, the adjusted freeze price may not be used in calculating the entry in column (g). Part VI (Same as the Instructions for the Preparation of Form CLC22 except add the following paragraph) For purposes of reporting price and cost data on covered products as defined in 6 CFR, Part 150, Subpart L: (1) the base price for purposes of calculating the entries in columns (d), (e), and (g) is the base price as defined in 6 CFR, Part 150, Subpart L, (2) the base cost period for purposes of com- (3) the adjusted freeze price may not be used (5) only the data required for columns (a), (b), (6) Sales of the entity from reselling and retailing activities are included in Item 28. If the entry in Item 28 includes sales of other than covered products a supporting schedule must be attached which provides the dollar amount of sales of covered products that is included in the entry in Item 28. 1. (a) Name of parent or unconsolidated entity (as shown on part 1 2. (a) Name of pricing entity line 3(a) Form CLC-22) Identification Number Parent Unconsolidated Entity Internal Use Only STANDARD FORM NO. 83 OFFICE OF MANAGEMENT CLEARANCE REQUEST AND NOTICE OF ACTION FOR O.M.B. USE (Under Federal Reports Act and Bureau of the Sudget Circular No. A-40, as amended) 7-cci J IMPORTANT - Submit the required number of copies of SF-83, together PART A REQUEST BY FIDERAL AGENCY 1. SEND "NOTICE OF ACTION" TO: Name and mailing address James W. McLane, Deputy Director 4. Title of form or document submitted CLEARANCE OFFICER OFFICE OF MANAGEMENT AND BUDGET FOR CLEARANCE or recordkeeping requirements 9100 2. Bureau and division or office originating Cost of Living Council 3. Name(s), title(s), and telephone numbers of Fred Laughlin 25-48690 5. Agency Form Number(s) " FORM OR Semi-annually Other (See instructions) (Check as many as apply) Mail 2 Personal interview Expiration date N/A 8. Requested expiration date April 30. 1974 4 (No change) Reinstatement 11. Related forms or documents (Give O.M. B. number. Enclose in 1724-2001, 172-072001, 172-50002 12. Catalog of Federal Domestic Assistance program number (if applicable Other Describe Government agencies Other Describe 7 14b. Brief description of respondents 15. Summary of estimated a. Estimated number of b. If sample, approximate c. Reports filed annually by d. Total annual responses (a x c) e. Estimated average number of Number 3300 13. 53,200 2000 105.400.03 f. Estimated TOTAL MAN-HOURS [X Yes - If "yes," fdentify persons and describe outcome in CERTIFICATION BY AUTHORIZED OFFICIALS SUBMITTING REQUEST We certify that the form or other document submitted for approval is |