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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.

Part VI

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).

(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-
pleting column (f) and the requirer Sched-
ules C is the base cost period as defined in
6 CFR, Part 150, Subpart L,

(3) the adjusted freeze price may not be used
in calculating the entry in column (g).
(4) price and cost data on covered products that
the entity sells as a refiner are entered in
Item 24,

(5) only the data required for columns (a), (b).
and (c) of Item 24 need be entered for the
covered products that the entity sells as a
producer, and

(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.

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STANDARD FORM NO. 83
OFFICE OF MANAGEMENT
AND BUDGET
03-105

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) 173-ktc07

IMPORTANT -Submit the required number of copies of SF-83, together
with the material for which approval is requested to:

READ INSTRUCTIONS BEFORE COMPLETING FORM

CLEARANCE OFFICER

OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503

FOR CLEARANCE

PART A REQUEST BY FIDERAL. ACENCY
Items marked with asterisk may be omitted for preliminary plans or recordkeeping requirements

1. SEND "NOTICE OF ACTION" TO: Name and mailing address

James W. McLane, Deputy Director
Cost of Living Council
Washington, D.C. 20508

9150

2. Bureau and division or office originating
request

Cost of Living Council
Office of Price Monitoring

3. Name(s), title(s), and telephone numbers of
person(s) who can best answer questions
regarding request.

Fred Laughlin 25-48690
'or Sivikylkigans

5. Agency Form Number(s)

"

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11. Related forms or documents (Give O.M. B. number. Enclose in

parentheses any to be replaced)

172-2001, 172-072001, 172-30002

12. Catalog of Federal Domestic Assistance program number (if applicable

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14a. Type of respondents involved
(Check predominant one)

Individuals or households
Business firms (non-farm)
Farms

Government agencies
sOther - Describe

14b. Brief description of respondents
(i.e., "households in 50 largest
SMSA's; "retail grocery stores")
Manufacturers &
Service Organization's

Mandatory? Çite statute

1

Voluntary?

2 Required to obtain benefit?

17. In developing the report form or other documents, were
consultations held with individuals or organizations
outside your agency?

15. Summary of estimated
respondent burden

a. Estimated number of
respondents

b. If sample, approximate
number in universe

c. Reports filed annually by
each respondent (item 10)

d. Total annual responses (a X c)

e. Estimated average number of
man-hours required per response

Number

3300

13.

53,200

2000

105.400.03

1. Estimated TOTAL MAN-HOURS
of respondent burden (d x e)
16b. Does your agency pledge
confidentiality?

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[X Yes - If yes," fdentify persons and describe outcome in
SUPPORTING STATEMENT. (See instructions)
2) No

CERTIFICATION BY AUTHORIZED OFFICIALS SUBMITTING REQUEST We certify that the form or other document submitted for approval is
necessary for the proper performance of this agency's functions, that the information requested is not available from any other source, to the best
of our knowledge, and that the request is consistent with applicable O.M.Dnd agency policy directives. Signature and title of:

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