Producer Price Index - Repricing - Private Sector

U.S. Department of Labor
Bureau of Labor Statistics
Producer Price Index Program

OMB NUMBER 1220-0008

Producer Price Index Survey

Dear Respondent,
Thank you for your continuing participation in the Producer Price Index (PPI) program. The data that you provide are used in
U.S. Department of Labor
computing
the
Producer Price Indexes
and constitute
the basis for analyzing industrial price changes. Your continued
Import/Export
Item Price Survey
Bureau of Labor
Statistics
International Price
Program appreciated. If you have any questions, please contact the analyst listed at the top of each form. For more
cooperation
is greatly
The Bureau of Labor about
Statistics, itsPPI,
employees,
agents, andvisit
partnerour
statistical
agencies, willat
use www.bls.gov/ppi.
the information you provide for statistical purposes only and will hold the information in confidence to
information
please
website
the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws,
your responses will not be disclosed in identifiable form without your informed consent. Paperwork Reduction Act Statement. Your voluntary cooperation is needed to make the results of this
survey comprehensive, accurate, and timely. We estimate that completing each form will take an average of 9 minutes (varying from 1 to 30 minutes). This estimate takes into account time for

reviewing instructions,
searching existing data sources, gathering and maintaining the necessary data, and completing and reviewing the information. If you have any comments regarding this
Michael
W. Horrigan
survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Division of International Prices, Paperwork Reduction Project, 1220-0025, Washington, DC
20212. PLEASE DO
NOT RETURN YOUR FORMS
THIS ADDRESS.
the survey
forms via fax to (877)
237-8070 or (202) 691-7272. The OMB control number for this voluntary survey is
Associate
Commissioner
forTOPrices
andReturn
Living
Conditions
(OPLC)
1220-0025. Without a currently valid number BLS would not be able to conduct this survey.

200103123456123456789999

The attached survey asks you to report current price
information for for
selectCompleting
items. This surveyaisPPI
designed
to measure
changes in
Instructions
Pricing
Form
U.S. import and export prices. If you have any questions, please contact the analyst indicated at the top of the attached forms. For
further information
on the
the International
Program,
our web
at http://www.bls.gov/mxp/.
you for
cooperation.
Please
complete
attached Price
form(s)
andvisit
return
viasite
fax
to 1-800-555-5555 Thank
as soon
asyour
possible,
even

if there are no changes.

Please
 follow
Onlythese
use instructions:
black or blue

ink when completing these forms. Do not use pencil.
Please complete the attached survey and return via fax to (877) 237-8070 (toll free) or (202) 691-7272 as soon as
 Do
not return
this
cover
possible,
preferably
within
one sheet.
week.

·
·

Only use black or blue pen when completing these forms. Do not use pencil.

·
Please
do instructions
not return this cover
sheet.in Section 1 at the top of each form.
1. Review
the
located
·

Where requested, please fill in the box completely so the scanner can identify any changes.

2.1. Review
the product or service description, adjustments to price, and terms of transaction. Check the box indicating whether
Please review the information on the form. Make corrections where necessary.
there have been any changes.
Intracompany Transfer:

Is this a transaction between two related companies? (e.g., between subsidiary and parent company)

 If you have corrections or updates to the product or service, make the changes in the areas provided.
Class
of Buyer/Seller
: Please
provide
Class of or
Buyer
(Export Items)
or a
Seller
(Import Items)
theas
class
affects the
 If you
no longer
offer
thisthe
product
service,
select
substitute
thatif is
similar
as price.
possible to the original product or
Examples of Classes of Buyer/Seller include Parent Company, Affiliate, Subsidiary, Sister Company, Distributor, Dealer, End
service.
Choose
one
that
you
expect
to
be
available
for
some
time.
Update
the
description,
adjustments to price, and
User, etc. If the price does not vary with different buyers or sellers, please enter "Class does not affect the price."
terms of transaction to reflect the substitution. Explain the substitution in Section 5.
Quantity Ordered:

Does the price vary according to the Quantity Ordered? If so, please indicate a quantity for which you will

Adjustments
toprice
Price:
consistently provide
information.

If
any
discounts
or
surcharges have changed, provide the current adjustment and indicate whether it is reflected in the
Exported to (Export Items Only): Please provide price information for items exported to the specified destination only. If you
price you
provide.
previously
indicated
that the price charged to buyers was the same regardless of destination, 'World' will appear as the
destination.
 Examples of discounts include: cash, seasonal, cumulative volume, trade, competitive and negotiated discounts, as well
as rebates.
Duty (Import Items Only): Please indicate any duty that is included in the price.
 Examples of surcharges include fuel and metal charges.
Discounts/Surcharges
: Please
indicate
or surcharges
(quantityexclude
discount, commission,
fuelthe
surcharge,
the in Section 5.
 Always exclude
taxes
fromdiscounts
the price.
If you cannot
taxes from
price, etc.)
noteand
this
percentage
or amount
currency)
of each.
whether you
have already
deducted theincluded
discount from
you
 Exclude
freight(and
charges
from
the Specify
price unless
delivery
is specifically
in the
theprice
description.
provided or whether you already added the surcharge.

3. Review
previously
reportedis prices.
Check the
box
indicating
whether
youRemarks
have any
or corrections. If so, enter
Last Pricethe
Received
: If this information
incorrect according
to your
records,
please correct
it in the
area. updates
(EST
indicates
that theprices
previousinprice
estimated).
the
previous
thewas
space
provided.
2.

Please provide price data.

4. Check the box indicating whether or not the price has changed.
 If the
price has
not
check
the “No”
box.
Do notbought
entertheaitem
price.
Prices
: Transaction
prices
arechanged,
preferred. These
are prices
at which
you actually
(imports) or sold the item
(exports).
provide
the price for check
the transaction
nearest
the beginning
of the
month.
If the price
price has
from the
Last
 If the Please
price has
changed,
the “Yes”
box,
and enter
the
current
in changed
the space
provided.
Please provide the
Price Received, please enter the new price in the boxes in #2.
reason(s) for significant price changes in Section 5.
Price Bases:

5.
3.

Incoterm examples include: EXW; FCA; FAS; FOB; CFR; CIF; CPT; CIP; DAF; DES; DEQ; DDU; DDP.
Please
append
the named
place oradditional
port of shipment
or of destination,
as appropriate,
item
description.
Use this
section
to report
information
about
changes totothe
the
product
or service
For definitions, refer to http:/www.iccwbo.org/incoterms/.

characteristics, or explanations of
significant price changes. If the change made to the description resulted in a change to your production costs, please
estimated
of the
change.
This
value
is #3.
the production cost difference including your standard markup.
Ifprovide
there hasan
been
no change invalue
the price,
please
fill in the box
to the
right of

the item was
traded this
month, please
fill inprovide
the box toupdates
the right ofin
#4.Section
Even though
the item
wasneed
not traded,
please contact changes on one form.
6.4. IfReview
thenot
contact
information
and
5. You
only
to report
estimate in box #2 the price that would have been charged for an actual transaction.
The Bureau
of Labor
Statistics,
its employees,
agents,
andresulted
partnerfrom
statistical
agenciestowill
the information
you of the item.
ThisPlease
report do
is authorized by law 29 U.S.C. §2.
5. Please
enter
the change
in production
cost that
a modification
theuse
physical
characteristics
provide for statistical
will in
hold
theunless
information
confidence
to the full extent
Your voluntary cooperation is needed to make the
not simplypurposes
enter the only
total and
change
price
it is theinsame
as the production
cost. permitted by law.
In accordance with the Confidentiality Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public
results of the survey comprehensive, accurate,
Law 107-347)
anditem
other
applicable
Federal laws,
responses
will notcall
bethe
disclosed
identifiable
form
without
and timely.
6. If the
has
been discontinued,
fill inyour
the box
in #6. Please
analyst in
listed
to provide
more
specific information
your informed
consent.the discontinuation. If the item was replaced, please enter the new item description under #1.
regarding
We estimate that it will take an average of 5 minutes per response to complete this form, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this
estimate or any other aspect of this information collection, including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics,
Producer Price Index Program, 1220-0008, Room 3840, 2 Massachusetts Avenue N.E., Washington, DC 20212. The OMB control number for this voluntary
survey is 1220-0008. Without a currently valid number BLS would not be able to conduct this survey. Do not send the completed form to this address.

Company Name
Department
Reporter Name
Title
Street Address
City, State Zip

BLS-3007D
OMB No. 1220-0025
Expires Oct. 31, 2012

BLS 473-P September 2013