Form BLS 473P BLS 473P PPI Pricing Form

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
partner our
statistical
agencies, will at
use the
information you provide for statistical purposes only and will hold the information in confidence to
information
please
website
www.bls.gov/ppi.
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

Jeffrey
Hill searching existing data sources, gathering and maintaining the necessary data, and completing and reviewing the information. If you have any comments regarding this
reviewing instructions,
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.Price
Return theIndexes
survey forms via fax to (877) 237-8070 or (202) 691-7272. The OMB control number for this voluntary survey is
Assistant
Commissioner
forTOProducer
1220-0025. Without a currently valid number BLS would not be able to conduct this survey.
The attached survey asks you to report current price information for select items. This survey is designed to measure changes in
2 0 0 1 0 3 1 2 3 4 5 6 1 2 3 4 5 6 7 8 9 9 9 9

U.S. import and export prices. If you have any questions, please contact the analyst indicated at the top of the attached forms. For
Assistant
Commissioner for Producer Price Indexes
further information on the International Price Program, visit our web site at http://www.bls.gov/mxp/. Thank you for your cooperation.
Please follow these instructions:

Instructions for Completing a PPI Pricing Form

·

Please complete the attached survey and return via fax to (877) 237-8070 (toll free) or (202) 691-7272 as soon as
Please complete
the attached form(s) and return via fax to 1-888-666-6652 as soon as possible,
possible, preferably within one week.
·
Only use black or blue pen when completing these forms. Do not use pencil.
 Only
use black or blue ink when completing these forms. Do not use pencil.
·
Please do not return this cover sheet.
notrequested,
return this
cover
sheet.
· Do
Where
please
fill in the
box completely so the scanner can identify any changes.

even if there are no changes.

Please review
information on
the form.inMake
corrections
necessary.
1.1. Review
the the
instructions
located
Section
1 at where
the top
of each form.
Intracompany Transfer:

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

2. Review the product or service description, adjustments to price, and terms of transaction. Check the box indicating whether
there
have
been: any
Class of
Buyer/Seller
Pleasechanges.
provide the Class of Buyer (Export Items) or Seller (Import Items) if the class affects the price.
Examples of Classes of Buyer/Seller include Parent Company, Affiliate, Subsidiary, Sister Company, Distributor, Dealer, End
 If you
corrections
updates
to theorproduct
or service,
make
changes
in the areas
User,
etc. Ifhave
the price
does not varyor
with
different buyers
sellers, please
enter "Class
doesthe
not affect
the price."

provided.
 If you no longer offer this product or service, select a substitute that is as similar as possible to the original product or
Quantity Ordered: Does the price vary according to the Quantity Ordered? If so, please indicate a quantity for which you will
service. Choose one that you expect to be available for some time. Update the description, adjustments to price, and
consistently provide price information.
terms of transaction to reflect the substitution. Explain the substitution in Section 5.
Exported to

(Export Items Only): Please provide price information for items exported to the specified destination only. If you

previously indicated
the price charged to buyers was the same regardless of destination, 'World' will appear as the
Adjustments
tothat
Price:
destination.
 If any discounts or surcharges have changed, provide the current adjustment and indicate whether it is reflected in the
price
you
provide.
Duty
(Import
Items
Only): Please indicate any duty that is included in the price.
 Examples of discounts include: cash, seasonal, cumulative volume, trade, competitive and negotiated discounts, as well
Discounts/Surcharges: Please indicate discounts or surcharges (quantity discount, commission, fuel surcharge, etc.) and the
as rebates.
percentage or amount (and currency) of each. Specify whether you have already deducted the discount from the price you
 Examples
of you
surcharges
include
fuel and metal charges.
provided
or whether
already added
the surcharge.
 Always exclude taxes from the price. If you cannot exclude taxes from the price, note this in Section 5.
Last Price Received: If this information is incorrect according to your records, please correct it in the Remarks area. (EST
 Exclude freight charges from the price unless delivery is specifically included in the description.
indicates that the previous price was estimated).

3.2. Review
the previously
Please provide
price data. reported prices. Check the box indicating whether you have any updates or corrections. If so, enter
the previous prices in the space provided.
Prices:

4.

Transaction prices are preferred. These are prices at which you actually bought the item (imports) or sold the item
(exports). Please provide the price for the transaction nearest the beginning of the month. If the price has changed from the Last
Check
the box
indicating
not
theinprice
Price Received,
please
enter thewhether
new price inorthe
boxes
#2. has changed.

 If the price has not changed, check the “No” box. Do not enter a price.

Price
: Incoterm
include:
EXW; the
FCA;“Yes”
FAS; FOB;
CPT;the
CIP;current
DAF; DES;
DEQ;in
DDU;
 If Bases
the price
hasexamples
changed,
check
box,CFR;
andCIF;
enter
price
theDDP.
space

Please append the named place or port of shipment or of destination, as appropriate, to the item description.
for tosignificant
price changes in Section 5.
Forreason(s)
definitions, refer
http:/www.iccwbo.org/incoterms/.

provided. Please provide the

therethis
has been
no change
in the additional
price, please fill
in the box to the
right ofchanges
#3.
5.3. IfUse
section
to report
information
about
to the product or service characteristics, or explanations of
significant
price
changes.
If
the
change
made
to
the
description
resulted
in a change to your production costs, please
4. If the item was not traded this month, please fill in the box to the right of #4. Even though the item was not traded, please
providein an
value
thebeen
change.
is the production cost difference including your standard markup.
estimate
box estimated
#2 the price that
wouldofhave
chargedThis
for anvalue
actual transaction.
The Bureau
of
Labor
Statistics,
its employees,
agents,
andresulted
partnerfrom
statistical
agencies
information
you of the
ThisPlease
report
is authorized
by law
U.S.C.
§2.
enter
thecontact
change
ininformation
production
costand
that
a modification
towill
theuse
physical
characteristics
item.
do
6.5. Please
Review
the
provide
updates
in Section
5.theYou
only need
to report
contact
changes
on 29
one
form.
provide for statistical
will in
hold
theunless
information
confidence
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 to
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
Federal laws,
responses
will notcall
bethe
disclosed
identifiable
form
without
and timely.
6. If the
hasapplicable
been discontinued,
fill inyour
the box
in #6. Please
analyst in
listed
to provide
more
specific information
your informed
consent.the
Per
the Cybersecurity
Act of
2015,enter
Federal
information
systems under
are #1.
regarding
discontinuation.
If the Enhancement
item was replaced,
please
the new
item description
protected from malicious activities through cybersecurity screening of transmitted data.
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. BLS-3007D
Do not send the completed form to this address.

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

OMB No. 1220-0025
Expires Oct. 31, 2012

BLS 473-P September 2013

INFORMATION FOR THE PRODUCER PRICE INDEX
www.bls.gov/ppi
201702 RC:

IC:

NAICS:

BLS 473-P

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****

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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.

OCT 11, 2016

,

,

.

NOV 15, 2016

,

,

.

DEC 13, 2016

,

,

.

JAN 10, 2016

,

,

.

No

4. Has the price changed between JAN 10, 2017 and FEB 14, 2017?

$

,

,

.

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:

Yes

If yes, enter the
current price below.

INFORMATION FOR THE PRODUCER PRICE INDEX
www.bls.gov/ppi
201702 RC:

IC:

NAICS:

BLS 473-P

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.

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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: