OMB No. 1220-0050:
U.S. Department of Commerce
NOTICE – Your report to the Census Bureau is confidential by law (title 13, U.S. Code). It
may be seen only by sworn Census employees and may be used only for statistical purposes.
U.S.
D
ENT OF C
TM
O
AR
Please record your expenses
and purchases for the period
CE
ER
M
M
EP
Bureau of the Census
R
EA
EN
UO
F TH E C
S
BU
US
Day
Acting as a collecting agent for
U.S. Department of Labor
Bureau of Labor Statistics
Date
FROM (First day)
Second day
Third day
Fourth day
Fifth day
Sixth day
THROUGH (Seventh day)
I will return on ____________________________________
Record of
Your Daily
Expenses
If you have any questions, please call:
Telephone
Field representative’s name
Area code Number
Regional Office Telephone
Field representative supervisor’s name
Area code Number
OFFICE USE ONLY
PGM 7
1.
Regional
Office
code
Control number
PSU code Segment Segment
number
number
suffix
Sample
designation
Serial
number
Serial
number
suffix
Check
digit
Placement
date
D ___
2. Household number
3. Consumer unit number
4. Week
1
FORM CE-801
(11-1-96)
2
Page 2
FORM CE-801 (11-1-96)
INSTRUCTIONS
I. HOW IS THE CONSUMER EXPENDITURE DIARY USED?
The Consumer Expenditure Diary Survey is sponsored by the Bureau of
Labor Statistics and is used to collect information on household
expenditures. Data collected from the Diary enable government agencies
and private corporations to:
• Calculate the Consumer Price Index (inflation rate) by identifying
current American buying habits
• Help to develop economic policies such as: school programs and
retirement benefits
II. GENERAL INSTRUCTIONS
Use this form to record all your consumer unit’s expenses for the
7-day period indicated on the front page. Beginning on page 10 there are
6 pages for each day. Record each day’s expenses on the appropriate
pages under the most appropriate heading. The day should be entered at
the top of the page as shown in the example below:
ENTER DAY
OF THE WEEK
©
IV. BEST TIME TO RECORD
Most people find that keeping the diary is easiest if they record their
purchases as soon as they return from the store. Each day, the person
who keeps this diary should check with other consumer unit members to
obtain their expenditures during that day.
V. WHAT TO REPORT
Please use this diary to record purchases or expenses, no matter how
small or inexpensive they are.
INCLUDE items such as:
• Food for Home Consumption
• Food Away from Home such as costs for all snacks, beverages, and
meals purchased at restaurants, carry-outs, vending machines, etc.
• Non Food Items such as clothing, shoes and jewelry, personal care
items and services, medicines, and appliances
• Food and non food items purchased as gifts. A gift is any item
purchased for someone other than those persons listed as CU
members
• Any items rented such as tuxedos, videos, cars, etc.
III. WHO TO INCLUDE (CONSUMER UNIT)
Record ALL purchases and expenses for the following persons:
All members of this household
OR
The following persons
• Any items purchased by catalog sales or mail orders
DO NOT INCLUDE these items:
• Expenses of CU members while they are away from home overnight
• Business or farm operating expenses
• Sales tax in the cost of the item, except for Food Away from Home
CREDIT CARD PURCHASES
The persons listed above are the members of your Consumer Unit (CU).
• If an item is purchased on credit through a charge account, record the
full cost of the item on the day it is purchased. Do not record payments
made on billing statements for items purchased on credit or through a
charge account.
VI. WHERE AND HOW TO RECORD EXPENSES
The diary is divided by day. Each day of the diary is divided into 5 parts: Food
For Home Consumption; Food and Beverages Purchased as Gifts; Food Away
From Home; Clothing, Shoes, and Jewelry; and All Other Purchases and
Expenses. Within each of these parts there are category headings with
examples to help you determine where an item should be recorded. Enter all
purchases and other expenses in the most appropriate part on the correct
diary day.
IX. EXAMPLES
The following list shows examples of the type of detailed information needed.
Please record similar types of detail for all expenditures.
Food for Home Consumption
MILK – Specify if whole, skim, half-and-half, condensed, etc.
BREAD – Specify if white, whole-wheat, rye, pumpernickel, etc.
In all cases, the item purchased and the cost of the item are needed.
Additional information is required in the following categories:
BEEF – Specify the cut and describe, such as round roast, porterhouse steak,
ground beef, prime rib, etc.
• Part 1 – Food for Home Consumption. Record whether the item is fresh,
frozen, bottled, canned, or some other type of packaging.
PORK – Specify the cut and describe, such as loin roast, whole ham, spareribs,
bacon, etc.
• Part 2 – Food and Beverages Purchased as Gifts. Record whether the
item is fresh, frozen, bottled, canned, or some other type of packaging.
• Part 3 – Food Away From Home. Record whether alcoholic beverages are
included in the total cost. Also include tax and tips in the total cost.
• Part 4 – Clothing, Shoes, and Jewelry. Specify whether it was purchased
for someone outside your Consumer Unit. Also record the code for the age
and sex of the person for whom the item was purchased.
• Part 5 – All Other Purchases and Expenses. Specify if the item was
purchased for someone outside your Consumer Unit.
It is important that you record complete descriptions of each item purchased.
Please refer to the examples in part IX on this page which show the amount of
information we would like you to record. If you are undecided where to record
a purchase, contact your Census Bureau Field Representative.
VII. ADDITIONAL PAGES
If there is not enough space to record all expenses for a particular day on the
lines provided, enter the additional items on pages 52–57. Be sure to specify
the day on which the expenses occurred in the column headed "Enter Day of
the Week."
CHICKEN – Specify if whole or parts, such as chicken parts, chicken legs,
chicken quarters, etc.
SOFT DRINKS – Specify if cola or other type: if not cola, specify if carbonated or
noncarbonated.
COFFEE – Specify if instant or ground.
OTHER FOOD – Give a complete description, such as boxed scalloped potatoes.
Food Away From Home
MEALS – Specify the type of meal (lunch, snack, etc.). If alcohol is included,
specify type and cost.
Clothing, Shoes, and Jewelry
CLOTHING – Specify type of clothing, and give a description of item purchased.
SHOES – If sports shoes, specify sport, such as football cleats, etc.
JEWELRY – Specify type of jewelry, such as watches, etc.
All Other Purchases and Expenses
DOCTOR BILLS – Specify type of doctor visited, such as general practitioner,
internist, etc.
MEDICINE – Specify if prescription or nonprescription, such as nonprescription
cough syrup, etc.
VIII. PICK UP
Thank you for your cooperation. I will return to pick up your completed diary
on _____________. If you have any questions during the week, please feel free
to call me.
FORM CE-801 (11-1-96)
LAUNDRY/DRY CLEANING – Specify if coin operated or not coin operated;
specify whether household item (such as drapes) or apparel.
TOOLS – Specify if power or hand tool.
Page 3
Page 4
FORM CE-801 (11-1-96)
FIELD REPRESENTATIVE – Review the examples on these pages with the respondent. Ask the
respondent for some typical expenditures and record them on the example pages.
To be completed by field representative only
a
b
PGM 10
d
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
c
Describe item purchased
©
Fresh Frozen
Part 1 – Food for Home Consumption
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
PGM 10
Cents
102
103
104
105
106
107
109
110
111
112
113
114
1
2
3
4
116
117
118
119
120
121
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
E
L
P
M
A
EX
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
d
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
c
Is this item –
Mark (X) one
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal spaghetti, and other pasta, etc.)
101
b
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
FIELD REPRESENTATIVE – Review the examples on these pages with the respondent. Ask the
respondent for some typical expenditures and record them on the example pages.
To be completed by field representative only – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
162
163
164
E
L
P
M
A
X
E
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 5
Page 6
FORM CE-801 (11-1-96)
FIELD REPRESENTATIVE – Review the examples on these pages with the respondent. Ask the
respondent for some typical expenditures and record them on the example pages.
To be completed by field representative only – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
b
PROCESSING
USE
Line
number
PGM 12
Cents
183
184
185
186
187
188
189
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
1
2
3
1
2
3
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
191
192
193
PGM 11
202
203
204
205
206
301
302
303
304
305
E
L
P
M
A
X
E
4
4
4
306
307
308
309
1
2
3
1
2
3
4
1
2
3
4
1
2
3
4
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
d
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
List all meals, snacks, and
beverages purchased
c
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
FIELD REPRESENTATIVE – Review the examples on these pages with the respondent. Ask the
respondent for some typical expenditures and record them on the example pages.
To be completed by field representative only – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 year
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 year
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
E
L
P
M
A
X
425
426
a
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
E
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
b
PROCESSING
USE
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
501
1
2
502
1
2
503
1
2
504
1
2
1
2
1
2
1
2
1
2
1
2
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
Page 7
Page 8
FORM CE-801 (11-1-96)
FIELD REPRESENTATIVE – Review the examples on these pages with the respondent. Ask the
respondent for some typical expenditures and record them on the example pages.
To be completed by field representative only – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
a
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
PROCESSING
USE
511
512
513
PGM 14
NO
1
2
1
2
1
2
1
2
516
517
518
519
520
523
524
525
526
527
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
522
528
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
E
L
P
M
A
X
E
515
521
Part 5 – All Other Purchases and Expenses – Cont.
c
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
2
1
2
1
2
1
2
1
2
1
2
1
2
539
540
541
542
543
544
545
FIELD REPRESENTATIVE – Review the examples on these pages with the respondent. Ask the
respondent for some typical expenditures and record them on the example pages.
To be completed by field representative only – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
a
547
548
549
550
551
552
553
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
555
556
557
560
561
562
563
564
565
FORM CE-801 (11-1-96)
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
567
568
569
570
E
L
P
M
A
X
E
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
PROCESSING
USE
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home owner’s
insurance, maintenance fees, property taxes, garbage/snow removal, heating and
cooling equipment, cable TV service, etc.)
546
b
572
573
575
576
577
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and other school
supplies, day care, etc.)
571
574
1
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, altertation and repair of household furnishings, etc.)
578
579
580
581
582
583
584
585
Page 9
Page 10
FORM CE-801 (11-1-96)
FIRST DAY
PGM 8
1
1
a
None
2
TR
PROCESSING USE
b
Line
number
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Bottled
or
Other
canned
1
102
103
104
105
106
107
109
110
111
112
113
114
Line
number
PGM 10
Cents
116
117
118
119
120
121
M
3
T
W
4
5
Th
6
F
Sa
7
b
PROCESSING
USE
1
2
3
4
c
d
Is this item –
Mark (X) one
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
2
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
S
a
Total cost
Do not include
sales tax
Dollars
VC
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
ENTER DAY OF THE WEEK
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
FIRST DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 11
Page 12
FORM CE-801 (11-1-96)
FIRST DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
PGM 12
Cents
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
c
d
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
List all meals, snacks, and
beverages purchased
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
FIRST DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
2
1
2
1
2
1
2
1
2
1
2
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
501
1
2
502
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
504
1
c
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
503
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
Page 13
Page 14
FORM CE-801 (11-1-96)
FIRST DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
522
523
524
525
526
527
528
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
521
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
2
1
2
1
2
1
2
1
2
1
2
1
2
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
1
539
540
541
542
543
544
545
FIRST DAY – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
a
547
548
549
550
551
552
553
PROCESSING
USE
PGM 14
555
556
557
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and other school
supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
Part 5 – All Other Purchases and Expenses – Cont.
c
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
Describe item purchased
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home
owner’s insurance, maintenance fees, property taxes, garbage/snow removal,
heating and cooling equipment, cable TV service, etc.)
546
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 15
Page 16
FORM CE-801 (11-1-96)
SECOND DAY
PGM 8
2
1
a
None
2
TR
PROCESSING USE
b
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
ENTER DAY OF THE WEEK
Bottled
or
Other
canned
Dollars
VC
a
Total cost
Do not include
sales tax
102
103
104
105
106
107
Line
number
PGM 10
Cents
109
110
111
112
113
114
1
2
3
4
116
117
118
119
120
121
d
Is this item –
Mark (X) one
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
c
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
b
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
SECOND DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 17
Page 18
FORM CE-801 (11-1-96)
SECOND DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
PGM 12
Cents
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
c
d
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
List all meals, snacks, and
beverages purchased
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
SECOND DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
501
1
2
502
1
2
503
1
2
504
1
2
1
2
1
2
1
2
1
2
1
2
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
Page 19
Page 20
FORM CE-801 (11-1-96)
SECOND DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
522
523
524
525
526
527
528
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
521
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
2
1
2
1
2
1
2
1
2
1
2
1
2
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
1
539
540
541
542
543
544
545
SECOND DAY – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
a
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
547
548
549
550
551
552
553
PROCESSING
USE
PGM 14
555
556
557
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and other school
supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
Part 5 – All Other Purchases and Expenses – Cont.
c
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
Describe item purchased
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home owner’s
insurance, maintenance fees, property taxes, garbage/snow removal, heating and
cooling equipment, cable TV service, etc.)
546
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 21
Page 22
FORM CE-801 (11-1-96)
THIRD DAY
PGM 8
3
1
a
None
2
TR
PROCESSING USE
b
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
ENTER DAY OF THE WEEK
Bottled
or
Other
canned
Dollars
VC
a
Total cost
Do not include
sales tax
102
103
104
105
106
107
Line
number
PGM 10
Cents
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
111
112
113
114
116
117
118
119
120
121
© Part 1 – Food for Home Consumption – Cont.
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
2
3
126
127
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
Describe item purchased
129
110
d
Is this item –
Mark (X) one
128
1
109
c
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
b
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
THIRD DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 23
Page 24
FORM CE-801 (11-1-96)
THIRD DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
a
d
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
PGM 12
Cents
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
d
c
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
List all meals, snacks, and
beverages purchased
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
THIRD DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 yearsnl^
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
501
1
2
502
1
2
503
1
2
504
1
2
1
2
1
2
1
2
1
2
1
2
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
Page 25
Page 26
FORM CE-801 (11-1-96)
THIRD DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
522
523
524
525
526
527
528
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
521
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
2
1
2
1
2
1
2
1
2
1
2
1
2
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
1
539
540
541
542
543
544
545
THIRD DAY – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
a
547
548
549
550
551
552
553
PROCESSING
USE
PGM 14
555
556
557
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and other school
supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
Part 5 – All Other Purchases and Expenses – Cont.
c
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
Describe item purchased
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home owner’s
insurance, maintenance fees, property taxes, garbage/snow removal, heating and
cooling equipment, cable TV service, etc.)
546
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 27
Page 28
FORM CE-801 (11-1-96)
FOURTH DAY
PGM 8
4
1
a
None
2
TR
PROCESSING USE
b
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
102
103
104
105
106
107
Line
number
PGM 10
Cents
109
110
111
112
113
114
1
2
3
4
116
117
118
119
120
121
d
Is this item –
Mark (X) one
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
c
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
b
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
VC
a
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
ENTER DAY OF THE WEEK
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
FOURTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
d
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 29
Page 30
FORM CE-801 (11-1-96)
FOURTH DAY – Continued
a
b
PROCESSING
USE
c
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
a
d
Is this item –
Mark (X) one
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
PGM 12
Cents
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
c
d
e
Total cost
Include tax & tip
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
If "YES," –
How much?
Dollars
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
List all meals, snacks, and
beverages purchased
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Dollars
Cents
FOURTH DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
501
1
2
502
1
2
503
1
2
504
1
2
1
2
1
2
1
2
1
2
1
2
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
Page 31
Page 32
FORM CE-801 (11-1-96)
FOURTH DAY – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
a
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
522
523
524
525
526
527
528
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
521
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
2
1
2
1
2
1
2
1
2
1
2
1
2
539
540
541
542
543
544
545
FOURTH DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
547
548
549
550
551
552
553
PGM 14
555
556
557
560
561
562
563
564
565
FORM CE-801 (11-1-96)
Decribe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Part 5 – All Other Purchases and Expenses – Cont.
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
d
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
c
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home
owner’s insurance, maintenance fees, property taxes, garbage/snow removal,
heating and cooling equipment, cable TV service, etc.)
546
PROCESSING
USE
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 33
Page 34
FORM CE-801 (11-1-96)
FIFTH DAY
PGM 8
5
1
a
None
2
TR
PROCESSING USE
b
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
102
103
104
105
106
107
Line
number
PGM 10
Cents
109
110
111
112
113
114
1
2
3
4
116
117
118
119
120
121
d
Is this item –
Mark (X) one
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
c
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
b
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
VC
a
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
ENTER DAY OF THE WEEK
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
FIFTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
d
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 35
Page 36
FORM CE-801 (11-1-96)
FIFTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
a
d
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
PGM 12
Cents
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
c
d
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
List all meals, snacks, and
beverages purchased
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
FIFTH DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
418
419
420
FORM CE-801 (11-1-96)
Total cost
Do not include
sales tax
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
504
1
2
1
2
1
2
1
2
1
2
1
2
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
503
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
417
e
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
502
414
416
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
413
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Page 37
Page 38
FORM CE-801 (11-1-96)
FIFTH DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
524
525
526
527
529
530
531
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
539
521
523
528
532
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
522
Part 5 – All Other Purchases and Expenses – Cont.
c
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
540
541
542
543
544
545
FIFTH DAY – Continued
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
a
547
548
549
550
551
552
553
PROCESSING
USE
PGM 14
555
556
557
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
Part 5 – All Other Purchases and Expenses – Cont.
c
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
Describe item purchased
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home
owner’s insurance, maintenance fees, property taxes, garbage/snow removal,
heating and cooling equipment, cable TV service, etc.)
546
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 39
Page 40
FORM CE-801 (11-1-96)
SIXTH DAY
PGM 8
6
1
a
None
2
TR
PROCESSING USE
b
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
102
103
104
105
106
107
Line
number
PGM 10
Cents
109
110
111
112
113
114
1
2
3
4
116
117
118
119
120
121
d
Is this item –
Mark (X) one
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
c
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
b
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
VC
a
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
ENTER DAY OF THE WEEK
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
SIXTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
d
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 41
Page 42
FORM CE-801 (11-1-96)
SIXTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
PGM 12
Cents
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
d
List all meals, snacks, and
beverages purchased
Total cost
Include tax & tip
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Part 3 – Food Away From Home
Dollars
Cents
e
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
c
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
SIXTH DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
501
1
2
502
1
2
503
1
2
504
1
2
505
1
2
506
1
2
1
2
1
2
1
2
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
507
508
509
Page 43
Page 44
FORM CE-801 (11-1-96)
SIXTH DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
522
523
524
525
526
527
528
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
521
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
2
1
2
1
2
1
2
1
2
1
2
1
2
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
1
539
540
541
542
543
544
545
SIXTH DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
547
548
549
550
551
552
553
PROCESSING
USE
PGM 14
555
556
557
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
Part 5 – All Other Purchases and Expenses – Cont.
c
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
Describe item purchased
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home,
owner’s insurance, maintenance fees, property taxes, garbage/snow removal,
heating and cooling equipment, cable TV service, etc.)
546
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 45
Page 46
FORM CE-801 (11-1-96)
SEVENTH DAY
PGM 8
7
1
a
None
2
TR
PROCESSING USE
b
PGM 10
3
Fresh Frozen
Part 1 – Food for Home Consumption
4
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
102
103
104
105
106
107
Line
number
PGM 10
Cents
109
110
111
112
113
114
1
2
3
4
116
117
118
119
120
121
d
Is this item –
Mark (X) one
Describe item purchased
© Part 1 – Food for Home Consumption – Cont.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
122
123
124
125
Fresh Frozen
Bottled
or
Other
canned
126
127
128
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
c
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
b
PROCESSING
USE
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
©
VC
a
d
Describe item purchased
©
BD
c
Is this item –
Mark (X) one
PROCESSING
USE
Line
number
ENTER DAY OF THE WEEK
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
SEVENTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
Part 1 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
142
143
144
145
146
147
148
150
151
152
153
154
155
156
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
158
159
160
FORM CE-801 (11-1-96)
Fresh Frozen
PGM 10
d
Describe item purchased
Line
number
Cents
c
Is this item –
Mark (X) one
Part 1 – Food for Home Consumption – Cont.
162
163
164
165
166
167
168
169
170
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Sugar, Sugar Substitutes and Sweets (Sugar, artificial
sweeteners, candy, gum, jams, jellies, etc.)
157
Dollars
PROCESSING
USE
161
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
Total cost
Do not include
sales tax
b
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato juice,
potatoes, beans, corn, and other vegetables and vegetable juices, etc.)
Eggs and Dairy Products (Eggs, whole milk, skim milk,
powdered milk, cream, butter, margarine, cheese, ice
cream, etc.)
141
a
d
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter,
gourmet or specialty items, seasonings, nuts, snack foods,
sauces, gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
1
178
179
180
181
Page 47
Page 48
FORM CE-801 (11-1-96)
SEVENTH DAY – Continued
a
b
PROCESSING
USE
c
Is this item –
Mark (X) one
Describe item purchased
Line
number
Fresh Frozen
PGM 10
d
Part 1 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
PROCESSING
USE
183
184
185
186
187
188
189
PGM 12
Cents
191
192
193
PGM 11
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
202
203
204
205
206
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 2 – Food and Beverages Purchased
as Gifts
310
311
312
313
314
315
Food and Beverages Purchased as Gifts (for someone outside
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
201
Part 3 – Food Away From Home
c
d
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and wine, etc.)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
190
List all meals, snacks, and
beverages purchased
Line
number
Non-Alcoholic Beverages (Cola and other carbonated
beverages, instant and ground coffee, tea, fruit-flavored
and other noncarbonated beverages, carbonated and
noncarbonated waters, etc.)
182
b
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
SEVENTH DAY – Continued
a
b
PROCESSING
USE
Line
number
PGM 13
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,
underwear, nightwear, uniforms, diapers/infantwear,
socks, stockings, lingerie, clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 13
410
411
412
413
414
416
417
418
419
420
FORM CE-801 (11-1-96)
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
421
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
422
423
YES
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
b
PROCESSING
USE
Describe item purchased
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses
2
1
2
1
2
1
2
1
2
1
2
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
501
1
2
502
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
504
1
c
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco smoking
accessories, etc.)
503
Shoes for Sports (Specify type of sport such as football
cleats, golf shoes, ski boots, etc.)
415
Describe item purchased
c
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants, brake
fluid, etc.)
505
506
507
508
509
Page 49
Page 50
FORM CE-801 (11-1-96)
SEVENTH DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
PROCESSING
USE
511
512
513
PGM 14
NO
515
516
517
518
519
520
1
2
1
2
1
2
1
2
522
523
524
525
526
527
528
529
530
531
532
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue,
paper towels, light bulbs, maid service, etc.)
521
Part 5 – All Other Purchases and Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware, glassware,
knives, forks, spoons, pot holders, canisters, cooking utensils, can openers, blenders,
mixers, food processors, coffee makers, irons, telephones, etc.
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
514
Describe item purchased
Line
number
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and other
medical equipment, health insurance, doctor/dentist services, etc.)
510
b
2
1
2
1
2
1
2
1
2
1
2
1
2
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor plants,
clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations, improvement
and repair equipment, supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, supplies and services, etc.)
538
1
1
539
540
541
542
543
544
545
SEVENTH DAY – Continued
a
PROCESSING
USE
b
c
d
Describe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Line
number
PGM 14
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
a
547
548
549
550
551
552
553
PROCESSING
USE
PGM 14
555
556
557
566
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
Part 5 – All Other Purchases and Expenses – Cont.
c
Transportation Expenses (New and used cars, maintenance and repair, taxis, buses,
commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
Entertainment/Amusements and Sports/Recreation (Admissions to movies,
concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,
video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
Describe item purchased
Line
number
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home
owner’s insurance, maintenance fees, property taxes, garbage/snow removal,
heating and cooling equipment, cable TV service, etc.)
546
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 51
Page 52
FORM CE-801 (11-1-96)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 10–51).
Enter the day of the week (Mon. Tues. etc.) for each expenditure in the "Enter Day of the Week" column.
ADDITIONAL PAGE
PGM 8
8
a
b
PROCESSING
USE
Line
number
PGM 15
(1)
(2)
Enter
Day
of
the
Week
c
Is this item –
Mark (X) one
Describe item purchased
©
Part 1 – Food for Home
Consumption
d
Fresh Frozen
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
PGM 15
Cents
Flour, Cereal and Other Grain Products (Flour, cake mixes,
cereal, rice, cornmeal, spaghetti, and other pasta, etc.)
101
102
103
104
105
106
107
(1)
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Bakery Products (White bread, other bread, cakes,
cookies, pies, frozen waffles, etc.)
108
109
110
111
112
113
114
116
117
118
119
120
121
(2)
Enter
Day
of
the
Week
©
Part 1 – Food for Home
Consumption – Cont.
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
d
Is this item –
Mark (X) one
Fresh Frozen
Bottled
or
Other
canned
Pork (Bacon, pork chops, ham, sausage, pork roasts, etc.)
123
124
125
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Poultry (Whole chicken, turkey parts, other poultry, etc.)
126
127
128
1
c
Describe item purchased
122
129
Other Meats (Frankfurters, bologna, liverwurst, salami,
lamb, game, organ meats, etc.)
130
131
132
133
134
Fish and Seafood (Fish, shellfish, and other seafood)
Beef (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
115
b
PROCESSING
USE
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
135
136
137
Fats, Oils and Dressings (Vinegar, oils, salad dressings,
shortening, etc.)
138
139
140
Total cost
Do not include
sales tax
Dollars
Cents
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 10–51). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter Day of the Week" column.
ADDITIONAL PAGE – Continued
a
PROCESSING
USE
Enter
Line
number
PGM 15
(1)
(2)
Day
of
the
Week
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 1 – Food for Home
Consumption – Cont.
Fresh Frozen
d
Bottled
Other
or
canned
Eggs and Dairy Products (Eggs, whole milk, skim
milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
141
142
143
144
145
146
147
148
150
151
152
153
154
155
156
158
159
160
FORM CE-801 (11-1-96)
Dollars
PROCESSING
USE
Enter
Line
number
PGM 15
Cents
161
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
(2)
Day
of
the
Week
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Part 1 – Food for Home
Consumption – Cont.
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
d
Is this item –
Mark (X) one
Fresh Frozen
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
Vegetables and Vegetable Juices (Lettuce, tomatoes, tomato
juice, potatoes, beans, corn, and other vegetables and vegetable
juices, etc.)
162
163
164
165
166
167
168
169
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Other Food Items (Soups, frozen foods, peanut butter, gourmet
or specialty items, seasonings, nuts, snack foods, sauces,
gravies, baby food, nondairy creamer, etc.)
171
172
173
174
175
176
177
1
c
Describe item purchased
170
Sugar, Sugar Substitutes and Sweets (Sugar,
artificial sweeteners, candy, gum, jams, jellies, etc.)
157
Total cost
Do not include
sales tax
b
(1)
Fruits and Fruit Juices (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
149
a
178
179
180
181
Page 53
Page 54
FORM CE-801 (11-1-96)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 10–51). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter Day of the Week" column.
ADDITIONAL PAGE – Continued
a
b
PROCESSING
USE
Line
number
PGM 15
(1)
(2)
Enter
Day
of
the
Week
c
Is this item –
Mark (X) one
Describe item purchased
Part 1 – Food for Home
Consumption – Cont.
d
Fresh Frozen
Bottled
or
Other
canned
183
184
185
186
187
188
189
190
191
192
193
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
203
204
205
206
PROCESSING
USE
Line
number
PGM 17
Cents
301
302
303
304
305
306
307
308
309
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Enter
Part 2 – Food and Beverages
Day
Purchased as Gifts
of
the
(2) Week Food and Beverages Purchased as Gifts (for someone outside
310
311
312
313
314
PGM 16
202
Dollars
b
(1)
Alcoholic Beverages (Beer, wine, whiskey, liqueurs,
champagne, etc.)
201
Total cost
Do not include
sales tax
Non-Alcoholic Beverages (Cola and other carbonated beverages,
instant and ground coffee, tea, fruit-flavored and other
noncarbonated beverages, carbonated and noncarbonated
waters, etc.)
182
(1)
a
315
your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)
316
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
317
318
319
320
321
322
(2)
Enter
Day
of
the
Week
List all meals, snacks, and
beverages purchased
Part 3 – Food Away From Home
c
d
Total cost
Include tax & tip
Dollars
e
Were
alcoholic
beverages
included in
total cost?
Mark (X) one
Cents
YES
NO
Meals, Snacks, and Beverages Purchased at a Restaurant,
Carry-out, etc. (Breakfast, lunch (including school), dinner
snacks, vending machine purchases, soda, beer, and
wine, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
If "YES," –
How much?
Dollars
Cents
ADDITIONAL PAGE – Continued
a
Line
number
b
PROCESSING
Enter
USE
Day
of
the
Week
PGM 18
(1)
(2)
Describe item purchased
Part 4 – Clothing, Shoes,
and Jewelry
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 10–51).
Enter the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter Day of the Week" column.
c
d
e
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
Dollars
Cents
YES
NO
Clothing (Suits, coats, dresses, skirts, pants, shirts,
shorts, underwear, nightwear, uniforms,
diapers/infantwear, socks, stockings, lingerie,
clothing rental, etc.)
401
402
403
404
405
406
407
408
a
Line
number
PGM 18
(1)
410
411
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
418
419
420
FORM CE-801 (11-1-96)
Dollars
Cents
YES
423
1
2
1
2
1
2
1
2
1
2
1
2
Jewelry (Costume jewelry, dress jewelry, watches
and watchbands, earrings, charms, bracelets, tie
clasps, rings, necklaces, brooches, cuff links, etc.)
424
425
426
a
Line
number
b
PROCESSING
Enter
USE
Day
of
the
Week
PGM 19
(2)
Describe item purchased
Part 5 – All Other Purchases and Expenses
2
1
2
1
2
1
2
1
2
1
2
c
d
Total cost
Do not include
sales tax
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Tobacco and Smoking Supplies (Cigarettes, pipes, cigars, tobacco
smoking accessories, etc.)
504
1
NO
Other Shoes (Dress shoes, boots, work shoes,
slippers, sneakers, baby shoes, etc.)
503
Shoes for Sports (Specify type of sport such as
football cleats, golf shoes, ski boots, etc.)
417
Total cost
Do not include
sales tax
502
414
416
Part 4 – Clothing, Shoes,
and Jewelry – Cont.
e
For whom was this
item purchased?
1 – Male 16 or over
2 – Female 16 or over
3 – Male 2 through 15
4 – Female 2 through 15
5 – Under 2 years
Enter code
501
413
415
(2)
Describe item purchased
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
422
(1)
412
Enter
Day
of
the
Week
c
421
Accessories (Hats, belts, scarfs, purses, wallets, ties,
gloves, handkerchiefs, key chains, umbrellas, etc.)
409
b
PROCESSING
USE
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Gasoline, Oil and Additives (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
505
506
507
508
509
Page 55
Page 56
FORM CE-801 (11-1-96)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 10–51).
Enter the day of the week (Mon. Tues. etc.) for each expenditure in the "Enter Day of the Week" column.
ADDITIONAL DAY – Continued
a
b
PROCESSING
USE
Enter
Line
number
PGM 19
(1)
(2)
Day
of
the
Week
Describe item purchased
Part 5 – All Other Purchases and
Expenses – Cont.
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
a
511
512
513
514
515
516
517
518
519
520
523
524
525
526
527
PGM 19
(1)
1
2
1
2
1
2
1
2
(2)
Day
of
the
Week
Describe item purchased
Part 5 – All Other Purchases and
Expenses – Cont.
1
2
1
2
1
2
1
2
1
2
1
2
1
2
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
NO
Housewares and Small Household Appliances (Pots and pans, dinnerware,
glassware, knives, forks, spoons, pot holders, canisters, cooking utensils, can
openers, blenders, mixers, food processors, coffee makers, irons, telephones, etc.
528
529
530
531
532
Housekeeping Supplies and Services (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom
tissue, paper towels, light bulbs, maid service, etc.)
522
Line
number
NO
Personal Care Products and Services (Hair care products, combs, hair brushes,
wigs, dental products, shaving products, hand soap, cosmetics, skin care
products, perfume, deodorants, men’s and women’s haircuts, etc.)
521
PROCESSING
USE
Enter
Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,
ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and
other medical equipment, health insurance, doctor/dentist services, etc.)
510
b
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Home Furnishings, Decorative items, Linens, and Major Appliances (Refrigerators,
stoves, sofas, tables, lamps, rugs, curtains, art, picture frames, vases, indoor
plants, clocks, tablecloths, pillows, sheets, towels, etc.)
533
534
535
536
537
Home Maintenance, Hardware, Lawn Supplies and Services (Decorations,
improvement and repair equipment, supplies and services, power and hand tools,
nails, screws, lawn/garden equipment, supplies and services, etc.)
538
1
2
1
2
1
2
1
2
1
2
1
2
1
2
539
540
541
542
543
544
545
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 10–51).
Enter the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter Day of the Week" column.
ADDITIONAL PAGE – Continued
a
b
PROCESSING
USE
Enter
Line
number
PGM 19
(1)
(2)
Day
of
the
Week
Describe item purchased
Part 5 – All Other Purchases and
Expenses – Cont.
a
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
YES
547
548
549
550
551
552
553
Line
number
PGM 19
NO
Housing Expenses (Rent, mortgage payments, electricity, telephone, home
owner’s insurance, maintenance fees, property taxes, garbage/snow removal,
heating and cooling equipment, cable TV service, etc.)
546
PROCESSING
Enter
USE
(1)
555
556
557
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
560
561
562
563
564
565
FORM CE-801 (11-1-96)
d
Decribe item purchased
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Part 5 – All Other Purchases and Expenses – Cont.
Dollars
Cents
YES
NO
Transportation Expenses (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
567
568
569
570
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
School Expenses (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
571
572
573
All Other Expenses (Pet supplies and veterinary services, postage, stationery, books,
newspapers, magazines, film and photographic supplies, luggage, sewing goods, club
dues, legal and accounting fees, donations, babysitting, diaper services, coin and non-coin
operated dry cleaning, shoe repair, alteration and repair of household furnishings, etc.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
558
559
c
566
Entertainment/Amusements and Sports/Recreation (Admissions to
movies, concerts, sporting and cultural events, records, tapes, CDs,
radios, TVs, video/stereo equipment, purchase or rental of videos, toys,
hunting, camping, sports/exercise equipment and fees, etc.)
554
(2)
Day
of
the
Week
b
574
575
576
577
578
579
580
581
582
583
584
585
Page 57
Page 58
FORM CE-801 (11-1-96)
Notes
DAILY REMINDER LIST
Please review the list of expenses below with other members of your
household at the end of each day. If you have forgotten to record any expense,
please do so on the appropriate page.
EXPENSES FOR –
a. Flour, sugar, cereal, salt, shortening, cake mixes, etc.
b. Canned soup, tomato paste, chili mix, salad dressing, etc.
c. Food items purchased as gifts
d. Food and beverages purchased at a restaurant or carry-out (including school
lunches and vending machine purchases)
e. Snack foods (potato chips, pretzels, cookies, etc.)
f. Beer, wine, whiskey, and other alcoholic beverages
g. Cigarettes, tobacco, or other smoking supplies
h. Clothing, shoes, and jewelry
i. Housekeeping supplies and paper products
j. Lumber, nails, sandpaper, paint brushes, etc.
k. Gasoline, turnpike or bridge tolls, parking fees, car pool expenses, public
transportation, etc.
l. Newspaper, postage stamps, greeting cards, etc.
m. Vitamins, medicine, and other medical or sanitary supplies
n. Laundry and dry cleaning (including coin-operated machines used at a
laundromat)
o. Cosmetics, soap, and other personal care items
p. Hair cuts and sets (including purchased and care of wigs and hair pieces)
q. Toys, hobbies, games, etc.
r. Bank charges for checking accounts, safe-deposit boxes, etc.
s. Furniture and appliances
t. Fees for lessons or instructions