+-----------------------------------+-----------------------------------+
| CEII REQUEST FORM                 |                                   |
|                                   |                                   |
| Submit form to CEII Coordinator   |                                   |
|                                   |                                   |
| 888 First Street, NE              |                                   |
|                                   |                                   |
| Washington, DC 20426              |                                   |
|                                   |                                   |
| Or via facsimile at 202-208-2106  |                                   |
+-----------------------------------+-----------------------------------+
| REQUESTER'S INFORMATION           | EMPLOYER/CLIENT INFORMATION       |
+-----------------------------------+-----------------------------------+
| Requester's name & title:         | Name of entity on whose behalf    |
|                                   | request is filed:                 |
+-----------------------------------+-----------------------------------+
| Any other names, e.g., maiden     | Address of entity listed above:   |
| name, used by requester and dates |                                   |
| used:                             |                                   |
+-----------------------------------+-----------------------------------+
| Requester's address:              | Phone number of entity listed     |
|                                   | above:                            |
+-----------------------------------+-----------------------------------+
| Requester's phone number:         |                                   |
+-----------------------------------+-----------------------------------+
| Requester's date of birth:        |                                   |
+-----------------------------------+-----------------------------------+
| Requester's place of birth:       |                                   |
+-----------------------------------+-----------------------------------+
| Requester's social security       |                                   |
| number (optional):                |                                   |
+-----------------------------------+-----------------------------------+
| Description of information        |                                   |
| requested:                        |                                   |
+-----------------------------------+-----------------------------------+
| Statement explaining need and     |                                   |
| intended use of the information:  |                                   |
+-----------------------------------+-----------------------------------+
| Are you willing to sign and abide |                                   |
| by an appropriate agreement       |                                   |
| limiting your use and disclosure  |                                   |
| of the information requested?     |                                   |
|                                   |                                   |
| Yes □ No □                        |                                   |
+-----------------------------------+-----------------------------------+
| Signature:                        | Date:                             |
+-----------------------------------+-----------------------------------+

Where to Send Comments on Public Reporting Burden.

The public reporting burden for this collection of information is
estimated to average 15 minutes per response including the time for
reviewing instructions, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments
regarding this burden estimate or any aspect of this collection,
including suggestions for reducing this burden to the Federal Energy
Regulatory Commission, 888 First St., NE, Washington, DC 20426 (Attn:
Mr. Michael Miller) and to the Office of Information and Regulatory
Affairs, Office of Management and Budget, Washington, DC 20503 (Attn:
Desk Officer for the Federal Energy Regulatory Commission).