Form BLS-473P PPI Pricing Form

Bureau of labor Statistics

The Bureau of labor Statistics, its employees, agents, and rartner statistical
~~r;~~~sin~~:n'::~~~~~';,'g~W3~~~e~~Ut~~~~iI1~::n~t~:if~;~a~~;~~scec':,~;~~:e"~i~~"
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.
Public reporting

burden for this collection

time for reviewing

instructions,

searching

of information
existing

.

U.S. Department of labor

Information for the Producer Price Indexes

is estimated

data sources,

This report is authorized by law 29 US.C. §2.
Your voluntary cooperation is needed to make
.
accurate, and tImely.

to vary from 1 to 30 minutes

gathering

OMB No. 1220-0008

the results of this survey comprehensive

and maintaining

'

per response

the data needed,

with an average

and completing

of

5 minutes

and reviewing

you have any comments regarding this estimate or any other aspect of this information collection, including suggestions for reducing
Bureau of Labor Statistics, Producer Price Index Program, 1220-0008, Room 3840, 2 Massachusetts
Avenue N.E., Washington,
respond to this collection of information unless it displays a currently valid OMB control number.O

per response,

the collection

this burden,
DC 20212.

including the

of information.

If

please send them to the
You are not required to

DO NOT SEND THE COMPLETED FORM TO THE OFFICE SHOWN ABOVE.
Dear Respondent,

Thank you for your continuing participation in the Producer Price Index (PPI) program. The data that you provide are used in computing the Producer Price Indexes and
constitute the basis for analyzing industrial price changes.
Your continued
Commissioner

cooperation

is greatly appreciated.

of Labor Statistics

Instructions for completing a PPI pricing form:
Item/Service

and Transaction

Descriptions:

If the Item/Service Description or the Terms of Transaction, or both, no longer apply, please select a substitute item/service or transaction terms. Item/service substitution
should only occur when the item/service previously reported is no longer available because it is being or has been permanently discontinued. The substitute item/service
should be as similar as possible to the current item/service and should be expected to remain available for some time. The substitute transaction terms should likewise be as
similar as possible to the discontinued transaction terms.
Report these changes
Adjustments

in the closest open area and provide current price information.

to Price:

Following is a list of the more common adjustments to price. The specific Adjustments to Price on the pricing form were selected originally
either the level of an existing adjustment changes or a new adjustment becomes applicable to the item/service and transaction described.
Deductions

and should be changed

only when

from price include:

1. Standard discounts
2. Rebates

(Cash, Seasonal,

Cumulative

Volume,

and Trade)

3. Other recurring discounts
4. Other nonrecurring
Additions

discounts

(Competitive

and Negotiated)

to price include:

1. Surcharges
2. Other charges

added to price

Taxes should always be excluded

from the price. If this exclusion

is not possible,

note this in REMARKS.

Freight charges should be excluded from the price unless delivery was selected originally as part of the product. Make changes if the currently described freight terms no
longer exist.
QUESTIONS:
Answer whether changes

have (YES) or have not (NO) been made to the Item/Service

Description,

Terms of Transaction,

Adjustments

to Price, or Previously

Reported Prices.

Answer YES or NO depending on whether the shipment/transaction price of the item/service described changed (YES) between the two dates listed or whether the
shipment/transaction price did not change (NO) during the time period. If the answer is NO, the form has been completed and is ready for faxing/mailing.
DO NOT ENTER A PRICE IF THE PRICE HAS NOT CHANGED!
If the answer is YES, please also enter the new price.
Write in any corrections

to the terms or the address to whom this form should be sent in the future. Name and address

- - - -- - - - - - - - - - - - - - - - - - - n - - - - n - - - - - - - - - - - - - - - - n-

- - - - - - - - - n-

changes

need to be made on only one form.

- - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - n - - - - - - -- - - -- - - - - n n - - n-

Please complete and return within 5 business days all of the pricing forms even if there are no changes.
- - - - - - - - n - - - - - - - - - - - _n- - - - -- - - - - - - - - - - - n n- - - --- - - - - - - - - n - - -- - - - - - - _n - - - - - - - - - - - - - - - n - - - n-

- - - - - - - - - n - - -- - - - - - - - - - - - - - - n - h-

--

" you anticipate a change in any of the information you provide, please indicate in REMARKS. List the anticipated changes and when they will occur.
- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - n - - - -- - - - un
- - - -- - - - - - - - - - - - n - - - -- - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - ---

Any questions you have regarding the pricing form or its completion may be resolved by calling the person listed on the reverse side of this form.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - n-

BLS 473P (Sept. 2013)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - u - - - - - - ---

7 ,r"-'. 'j 8"loo'...
IT ,..
LrJF;1

Have the Item/Service Description, Adjustments to Price, Terms of Transaction,
or Previously Reported Prices changed since your last report?
I
If "YES," please also enter the necessary changes.

, -'"

[\~
No

- ----

THIS FORM IS MACHINE PROCESSED.
Please use BLACK pen/pencil only.
This item/service has been selected for use
in the Producer Price Index. You are asked
to provide a price each month for the
item/service described under the terms and
adjustments shown.
Please review each section of this form. If
your firm no longer sells this specific
item/service
under
the terms
and
adjustments, revise the description, terms,
and/or adjustments indicating when the
changes were made.
If the change made to the description
resulted in a change to your production
costs, please provide an estimated value of
the change for Bureau staff to use in
making appropriate
adjustments.
This
value is the production cost difference
including your standard mark-up.
If you have any questions concerning
completion of this form, please call collect:

Please fax to 1-800-553-6024 or, if you are
unable to fax, use the postage-free
envelope to send to:
U.S. Department of labor
Bureau of labor Statistics
Producer Price Index, Mail Code 47
61 Forsyth SI. SW., Suite 7T50
Atlanta, GA 30303-9856

- --

'-

L- -

!wI:

--

- -

PRICE INFORMATION

THE LA TEST

TYPE

OF PRICE

WAS (Prices for actual shipments/transactions are desired.):

REPORTED

PREVIOUSL Y REPORTED PRICES

Please review the Previously Reported
Prices. Enter missing prices if available or
correct any incorrect prices that are shown.

CORRECTIONS

Please enter the current price in the boxes
provided ONLY if there has been a change
from the price you previously reported.

bid the price change betWeen -

i--

I

[

- - -

Nv

If "YES," please report the price of the last shipment since
If there was no shipment in
price you would have charged on

USE BLACK PEN/
PENCIL ONL Y.
DO NOT USE BLUE.

T

r
L

, please estimate

T

I

I

J

l

the

1/ \J

[/-

em:

- - T
I

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

INFORMATION FOR THE PRODUCER PRICE INDEX
www.bls.gov/ppi
201202 RC:

IC:

NAICS:

OMB NUMBER 1220-0008

1. Instructions: See full instructions on page 1.

2. Continuation of PPI Item :
If you have updates to the following information, please check “Yes” in Section 2 on page 1 and report your updates below.

___
___
___
___
___
___
___
___
___
___
___
___
___
___

5. Please provide reason(s) for significant price changes and/or other remarks.

6. Please review contact information and make corrections in Section 5 above.
NAME
TITLE
ESTABLISHMENT NAME
ADDRESS

Phone:
Fax:
Email:

PPI Item Code:

BLS 473-P

INFORMATION FOR THE PRODUCER PRICE INDEX
www.bls.gov/ppi
201202 RC:

IC:

NAICS:

OMB NUMBER 1220-0008

1. Instructions: Complete the form and fax to (000) 000-0000 or return to U.S. Department of Labor, Bureau of Labor Statistics,
Code 7, Washington, DC 20212. For assistance, contact IA NAME at IA PHONE or IA EMAIL.

2. Has the Description for this item or service changed? ………………………………...

No

Yes

If Yes, please
update below

___
___
___
___
___
___
___
___
___
___
___
___
___
___

No

Yes

3. Are there any updates to your Previously Reported Prices?

If yes, please update below.

March 13, 2012

,

,

.

April 10, 2012

,

,

.

May 15, 2012

,

,

.

June 12, 2012

,

,

.

No

4. Has the price changed between June 12, 2012 and July 10, 2012?

$

,

,

.

Yes

If yes, enter the
current price below.

Per:
Type of Price:

cents

5. Please provide reason(s) for significant price changes and/or other remarks.

6. Please review contact information and make corrections in Section 5 above.
NAME
TITLE
ESTABLISHMENT NAME
ADDRESS

Phone:
Fax:
Email:

PPI Item Code:

BLS 473-P

INFORMATION FOR THE PRODUCER PRICE INDEX
www.bls.gov/ppi
201202 RC:

IC:

NAICS:

OMB NUMBER 1220-0008

1. Instructions: Complete the form and fax to (000) 000-0000 or return to U.S. Department of Labor, Bureau of Labor Statistics,
Code 7, Washington, DC 20212. For assistance, contact IA NAME at IA PHONE or IA EMAIL.

No

Yes

If Yes, please
update below

2. Have the Description, Adjustments to Price, or Terms of Transaction changed?
***Continued on next page****

___
___
___
___
___
___
___
___
___
___
___
___
___
___
Adjustments to Price
Type of Discount

Value/Terms

Type of Surcharge

Value/Terms

Reflected in the
price below?

No

Terms of Transaction
Type of Sale:
Domestic\Foreign Buyer:
Type of Buyer:
Contract Terms:
Size of Shipment:
Unit of Measure:
Freight:

Yes

3. Are there any updates to your Previously Reported Prices?

If yes, please update below.

January 10, 2012

,

,

.

February 14, 2012

,

,

.

March 13, 2012

,

,

.

April 10, 2012

,

,

.

No

4. Has the price changed between April 10, 2012 and May 15, 2012?

$

,

,

.

Yes

If yes, enter the
current price below.

Per:
Type of Price:

cents

5. Please provide reason(s) for significant price changes and/or other remarks.

6. Please review contact information and make corrections in Section 5 above.
NAME
TITLE
ESTABLISHMENT NAME
ADDRESS

Phone:
Fax:
Email:
BLS 473-P

PPI Item Code: