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
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
(1-1-98)
2
Page 2
FORM CE-801 (1-1-98)
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 11 there are
7 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 home from the store. Each day, the
person who keeps this diary should check with their 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 Away from Home such as costs for all snacks, beverages, and
meals purchased at restaurants, carry-outs, vending machines, etc.
• Food for Home Consumption
• Non Food Items such as clothing, shoes, jewelry, personal care items
and services, medicines, and appliances
• Food and nonfood 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 CARDS
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
Away From Home; Food For Home Consumption; Food and Beverages
Purchased as Gifts; 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.
In all cases, the item purchased and the cost of the item are needed.
Additional information is required in the following Parts:
VIII. EXAMPLES
The following list shows examples of the type of detailed information needed.
Please record similar types of detail for all expenditures.
FOOD AWAY FROM HOME
MEALS, SNACKS, AND DRINKS – Specify the type (breakfast, lunch, dinner, snack)
and place in the appropriate category based on the type of establishment used. If
alcohol is included, specify the type and the alcohol cost.
• PART 1 – FOOD AWAY FROM HOME
Read through all the Food Away From Home categories. To select the
appropriate category, it is helpful to think of the location where it was
purchased e.g. – popcorn at a movie concession stand, beer at the ballpark,
lunch at my employer cafeteria, etc. Report the total bill, including tax and
tip. Include any alcoholic drinks purchased. Record the alcohol cost. Do not
itemize the bill for each person.
FOOD FOR HOME CONSUMPTION
• PART 2 – FOOD FOR HOME CONSUMPTION
Record whether the item is fresh, frozen, bottled, canned, or some other type
of packaging.
CHICKEN – Specify if whole or parts, such as chicken parts, chicken legs, etc.
• PART 3 – FOOD AND BEVERAGES PURCHASED AS GIFTS
Record whether the item is fresh, frozen, bottled, canned, or some other type
of packaging.
COFFEE – Specify if instant or ground.
• 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.
BREAD – Specify if white, whole-wheat, rye, pumpernickel, etc.
BEEF – Specify the cut and describe, such as round roast, ground beef, etc.
PORK – Specify the cut and describe, such as loin roast, whole ham, spareribs,
bacon, etc.
SOFT DRINKS – Specify if cola or other type: if not cola, specify if carbonated or non.
OTHER FOOD – Give a complete description, such as boxed scalloped potatoes.
CLOTHING, SHOES, AND JEWELRY
CLOTHING – Specify type of clothing and give a description of item purchased.
• PART 5 – ALL OTHER PURCHASES AND EXPENSES
Specify if the item was purchased for someone outside your Consumer Unit.
SHOES – If sports shoes, specify sport, such as football cleats, etc.
It is important that you record complete descriptions of each item purchased.
Please refer to the examples in PART VIII on this page, which show the
amount of information we would like you to record. I will return to pick up
your completed diary on _______________. If you have any questions, please
feel to call me. THANK YOU FOR YOUR COOPERATION.
LAUNDRY/DRY CLEANING – Specify if coin operated or not; specify whether
household item (such as drapes) or apparel.
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 60–66. Be sure to specify
the day on which the expenses occurred in the column headed "Enter Day of
the Week."
FORM CE-801 (1-1-98)
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.
TOOLS – Specify if power or hand tool.
Page 3
Page 4
FORM CE-801 (1-1-98)
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
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
a
If "YES" –
How much?
b
Line
number
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
1
2
1
110
Dollars
Cents
Yes
No
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
109
Part 1 – Food Away From Home
M
A
X
E
2
E
L
P
126
127
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
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
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
FORM CE-801 (1-1-98)
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
© Part 2 – Food for Home Consumption – Cont.
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
Cents
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
E
L
P
M
A
EX
228
229
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
230
231
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Page 5
FORM CE-801 (1-1-98)
Page 6
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
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
Is this item –
Mark (X) one
PROCESSING
USE
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
E
L
P
M
A
X
E
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
or
Other
canned
VEGETABLES and VEGETABLE JUICES (Lettuce, tomatoes, tomato
juice, potatoes, beans, corn, and other vegetables and vegetable juices,
etc.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
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
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Total cost
Do not include
sales tax
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
Dollars
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
FORM CE-801 (1-1-98)
PROCESSING
USE
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
E
L
P
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
E
M
A
X
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Line
number
401
Part 3 – Food and Beverages Purchased
as Gifts
301
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
Page 7
Page 8
FORM CE-801 (1-1-98)
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
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
b
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
1
2
1
2
1
2
AM
508
EX
509
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
E
L
P
507
510
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
Total cost
Do not include
sales tax
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
Describe item purchased
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
PROCESSING
USE
c
516
517
518
519
520
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
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
Line
number
b
PROCESSING
USE
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
a
Yes
b
Line
number
522
523
524
Part 5 – All Other Purchases and Expenses – Cont.
1
2
1
2
1
2
1
2
1
1
529
530
531
2
2
2
1
2
1
2
1
2
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.)
532
533
534
535
536
537
538
FORM CE-801 (1-1-98)
541
542
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
E
L
P
544
545
546
547
548
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
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
HOME MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
AM
EX
528
540
2
1
527
539
543
1
526
d
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
Describe item purchased
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
c
550
551
552
553
554
555
556
Page 9
Page 10
FORM CE-801 (1-1-98)
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
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
563
564
565
566
567
568
569
570
573
574
575
576
577
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
572
Describe item purchased
579
580
581
582
583
584
585
586
587
588
589
590
591
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
1
2
1
2
1
2
1
2
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.)
E
L
P
M
A
X
E
562
571
PROCESSING
USE
No
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.)
557
Line
number
b
592
593
594
595
596
597
598
FIRST DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
©
ENTER DAY OF THE WEEK
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
VC
4
e
1
S
M
2
3
T
a
If "YES" –
How much?
Line
number
W
4
5
Th
6
F
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
Sa
7
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Dollars
Cents
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
FORM CE-801 (1-1-98)
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Page 11
Page 12
FORM CE-801 (1-1-98)
FIRST DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
or
Other
canned
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Total cost
Do not include
sales tax
Dollars
Cents
FIRST DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
FORM CE-801 (1-1-98)
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
or
Other
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.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Page 13
Page 14
FORM CE-801 (1-1-98)
FIRST DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
PROCESSING
USE
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
FIRST DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
FORM CE-801 (1-1-98)
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
Page 15
Page 16
FORM CE-801 (1-1-98)
FIRST DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
FIRST DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
FORM CE-801 (1-1-98)
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
Page 17
Page 18
FORM CE-801 (1-1-98)
SECOND DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
ENTER DAY OF THE WEEK
List all meals, snacks, and beverages purchased
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
©
VC
4
e
a
If "YES" –
How much?
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Dollars
Cents
SECOND DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
Other
or
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
FORM CE-801 (1-1-98)
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
Other
or
canned
Total cost
Do not include
sales tax
Dollars
Cents
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Page 19
FORM CE-801 (1-1-98)
Page 20
SECOND DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
Other
or
canned
VEGETABLES and VEGETABLE JUICES (Lettuce, tomatoes, tomato
juice, potatoes, beans, corn, and other vegetables and vegetable juices,
etc.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Total cost
Do not include
sales tax
Dollars
Cents
SECOND DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
FORM CE-801 (1-1-98)
PROCESSING
USE
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
Page 21
Page 22
FORM CE-801 (1-1-98)
SECOND DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
SECOND DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
FORM CE-801 (1-1-98)
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
Page 23
Page 24
FORM CE-801 (1-1-98)
SECOND DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
THIRD DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
ENTER DAY OF THE WEEK
List all meals, snacks, and beverages purchased
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
©
VC
4
e
a
If "YES" –
How much?
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Dollars
Cents
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
FORM CE-801 (1-1-98)
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Page 25
FORM CE-801 (1-1-98)
Page 26
THIRD DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
or
Other
canned
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Total cost
Do not include
sales tax
Dollars
Cents
THIRD DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
FORM CE-801 (1-1-98)
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
or
Other
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.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Page 27
Page 28
FORM CE-801 (1-1-98)
THIRD DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
PROCESSING
USE
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
THIRD DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
FORM CE-801 (1-1-98)
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
Page 29
Page 30
FORM CE-801 (1-1-98)
THIRD DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
THIRD DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
FORM CE-801 (1-1-98)
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
Page 31
Page 32
FORM CE-801 (1-1-98)
FOURTH DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
ENTER DAY OF THE WEEK
List all meals, snacks, and beverages purchased
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
©
VC
4
e
a
If "YES" –
How much?
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Dollars
Cents
FOURTH DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
FORM CE-801 (1-1-98)
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
Cents
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Page 33
FORM CE-801 (1-1-98)
Page 34
FOURTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
Other
or
canned
VEGETABLES and VEGETABLE JUICES (Lettuce, tomatoes, tomato
juice, potatoes, beans, corn, and other vegetables and vegetable juices,
etc.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Total cost
Do not include
sales tax
Dollars
Cents
FOURTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
FORM CE-801 (1-1-98)
PROCESSING
USE
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
c
d
Total cost
Do not include
sales tax
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
Dollars
Cents
e
Yes
For whom was this
item purchased?
1 – Male 16 or over
5 – Under 2 years
2 – Female 16 or over
Enter code
3 – Male 2 through 15
4 – Female 2 though 15
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
Page 35
Page 36
FORM CE-801 (1-1-98)
FOURTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
FOURTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
FORM CE-801 (1-1-98)
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
Page 37
Page 38
FORM CE-801 (1-1-98)
FOURTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
FIFTH DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
ENTER DAY OF THE WEEK
List all meals, snacks, and beverages purchased
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
©
VC
4
e
a
If "YES" –
How much?
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Dollars
Cents
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
FORM CE-801 (1-1-98)
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Page 39
FORM CE-801 (1-1-98)
Page 40
FIFTH DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
or
Other
canned
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Total cost
Do not include
sales tax
Dollars
Cents
FIFTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
FORM CE-801 (1-1-98)
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
or
Other
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.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Page 41
Page 42
FORM CE-801 (1-1-98)
FIFTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
PROCESSING
USE
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
FIFTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
FORM CE-801 (1-1-98)
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
Page 43
Page 44
FORM CE-801 (1-1-98)
FIFTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
FIFTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
FORM CE-801 (1-1-98)
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
Page 45
Page 46
FORM CE-801 (1-1-98)
SIXTH DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
ENTER DAY OF THE WEEK
List all meals, snacks, and beverages purchased
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
©
VC
4
e
a
If "YES" –
How much?
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Dollars
Cents
SIXTH DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
FORM CE-801 (1-1-98)
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
Cents
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Page 47
FORM CE-801 (1-1-98)
Page 48
SIXTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
Other
or
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
Other
or
canned
VEGETABLES and VEGETABLE JUICES (Lettuce, tomatoes, tomato
juice, potatoes, beans, corn, and other vegetables and vegetable juices,
etc.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Total cost
Do not include
sales tax
Dollars
Cents
SIXTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
FORM CE-801 (1-1-98)
PROCESSING
USE
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
Page 49
Page 50
FORM CE-801 (1-1-98)
SIXTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
SIXTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
FORM CE-801 (1-1-98)
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
Page 51
Page 52
FORM CE-801 (1-1-98)
SIXTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
SEVENTH DAY
1
a
Line
number
None
2
TR
PROCESSING USE
b
PROCESSING
USE
ENTER DAY OF THE WEEK
List all meals, snacks, and beverages purchased
3
c
d
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
BD
©
VC
4
e
a
If "YES" –
How much?
Line
number
b
PROCESSING
USE
List all meals, snacks, and beverages purchased
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Mark (X) one
Dollars
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY, CONCESSION
STANDS, BUFFET and CAFETERIA – You pay
BEFORE eating/drinking.
101
102
103
104
105
106
107
108
109
110
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Dollars
Cents
VENDING MACHINES and MOBILE VENDORS –
Include vending machines and carts and trucks that
move from place to place.
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
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
EMPLOYER and SCHOOL CAFETERIAS – Include
only food/drinks bought at a school or employer
cafeteria.
128
FULL-SERVICE MEALS, SNACKS, DRINKS – You
pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
FORM CE-801 (1-1-98)
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Page 53
FORM CE-801 (1-1-98)
Page 54
SEVENTH DAY – Continued
a
Line
number
PROCESSING
USE
©
b
c
Describe item purchased
Is this item –
Mark (X) one
Part 2 – Food for Home Consumption
Fresh Frozen
Bottled
Other
or
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti, and
other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
a
Total cost
Do not include
sales tax
Line
number
Dollars
216
217
218
219
220
221
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
d
Is this item –
Mark (X) one
Describe item purchased
©
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
Fresh Frozen
Bottled
Other
or
canned
1
2
3
4
226
1
2
3
4
227
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other seafood)
BEEF (Ground beef, round and other roasts, sirloin,
round and other steaks, briskets, etc.)
215
b
PORK (Bacon, pork chops, ham, sausage, pork roasts, etc.)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
d
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Total cost
Do not include
sales tax
Dollars
Cents
SEVENTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
a
Total cost
Do not include
sales tax
Dollars
Line
number
242
243
244
245
246
247
248
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
258
259
260
FORM CE-801 (1-1-98)
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
261
262
263
264
265
266
267
268
269
1
2
3
4
1
2
3
4
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.)
257
d
Bottled
or
Other
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.)
FRUITS and FRUIT JUICES (Apples, bananas, oranges,
orange juice, and other fruits and fruit juices, etc.)
249
PROCESSING
USE
c
Part 2 – Food for Home Consumption – Cont.
Cents
EGGS and DAIRY PRODUCTS (Eggs, whole milk,
skim milk, powdered milk, cream, butter, margarine,
cheese, ice cream, etc.)
241
b
270
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.)
271
272
273
274
275
276
277
1
1
278
279
280
281
Page 55
Page 56
FORM CE-801 (1-1-98)
SEVENTH DAY – Continued
a
Line
number
b
PROCESSING
USE
c
d
Is this item –
Mark (X) one
Describe item purchased
Fresh Frozen
Part 2 – Food for Home Consumption – Cont.
Bottled
or
Other
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee, tea,
fruit-flavored and other noncarbonated beverages,
carbonated and noncarbonated waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
303
304
305
306
Describe item purchased
Part 4 – Clothing, Shoes, and Jewelry
Cents
402
403
404
405
406
407
408
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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
UNDERGARMENTS and SLEEPCLOTHES (Socks,
pajamas, lingerie, hosiery, etc.)
409
410
411
412
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for someone
outside your CU) (Fruit baskets, cheese, candy, wine, beer,
liquor, etc.)
302
Dollars
Line
number
PROCESSING
USE
401
Part 3 – Food and Beverages Purchased
as Gifts
301
Total cost
Do not include
sales tax
b
CASUAL, SPORTSWEAR, FORMAL (Suit, shirt,
dress, shorts, pants, sweater, etc.)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
SEVENTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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 years
Enter code
Dollars
Cents
Yes
No
a
Line
number
423
424
425
426
427
429
430
431
1
2
433
434
435
437
438
439
440
FORM CE-801 (1-1-98)
Total cost
Do not include
sales tax
Dollars
Cents
Yes
No
1
1
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil, coolants,
brake fluid, etc.)
1
2
507
1
2
508
1
2
509
1
2
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical equipment,
health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations,
shoe repairs, cleaning, storage, etc.)
436
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
501
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece, umbrella,
thread, buttons, etc.)
432
Describe item purchased
c
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars, tobacco,
smoking accessories, etc.)
SPORTS-TEAM CLOTHES and SPORT SHOES
(Cleats, team uniform, ski boots, golf shoes, etc.)
428
PROCESSING
USE
Part 5 – All Other Purchases and Expenses
SHOES (Boots, dress, work, sandals, sneakers,
slippers, etc.)
422
b
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
Page 57
Page 58
FORM CE-801 (1-1-98)
SEVENTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
Line
number
522
523
524
526
527
528
529
530
531
1
2
1
2
1
2
1
2
533
534
535
536
537
538
539
540
541
542
543
1
2
1
2
1
2
1
2
1
2
1
2
1
2
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.)
532
Describe item purchased
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
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.)
HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaning
detergents, cleansers, sponges, mops and brooms, bathroom tissue, paper
towels, light bulbs, maid service, etc.)
525
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and SERVICES
(Decorations, improvement and repair equipment, supplies and services,
power and hand tools, nails, screws, lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity, telephone,
homeowner’s insurance, maintenance fees, property taxes, garbage/snow
removal, heating and cooling equipment, cable TV service, etc.)
549
1
1
550
551
552
553
554
555
556
SEVENTH DAY – Continued
a
Line
number
b
PROCESSING
USE
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
a
Yes
558
559
560
561
562
563
564
565
566
567
568
569
570
572
573
574
575
576
577
FORM CE-801 (1-1-98)
Describe item purchased
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
SCHOOL EXPENSES (High school and college tuition, board, textbooks and
other school supplies, day care, etc.)
578
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
TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,
buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)
571
PROCESSING
USE
Part 5 – All Other Purchases and Expenses – Cont.
No
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.)
557
Line
number
b
579
580
581
582
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
1
2
1
2
1
2
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.)
583
584
585
586
587
588
589
590
591
1
1
592
593
594
595
596
597
598
Page 59
Page 60
FORM CE-801 (1-1-98)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter day of the week" column.
ADDITIONAL PAGE
a
Line
number
b
PROCESSING Enter
day
USE
of
the
week
List all meals, snacks, and beverages purchased
(2)
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
a
If "YES" –
How much?
Line
number
Mark (X) one
©
(1)
c
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
Dollars
102
103
104
105
106
107
108
109
110
PROCESSING Enter
day
USE
of
the
week
List all meals, snacks, and beverages purchased
(1)
1
2
120
1
2
121
1
2
122
1
2
123
1
2
124
1
2
125
1
2
126
1
2
127
1
2
1
2
(2)
c
d
e
Total cost
Include tax and tip
Were
alcoholic
beverages
included
in total
cost?
If "YES" –
How much?
Mark (X) one
©
Cents
FAST FOOD, TAKE-OUT, DELIVERY,
CONCESSION STANDS, BUFFET and
CAFETERIA – You pay BEFORE eating/drinking.
101
b
Part 1 – Food Away From Home
Dollars
Cents
Yes
No
VENDING MACHINES and MOBILE
VENDORS – Include vending machines and
carts and trucks that move from place to place.
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
EMPLOYER and SCHOOL CAFETERIAS –
Include only food/drinks bought at a school or
employer cafeteria.
128
FULL-SERVICE MEALS, SNACKS,
DRINKS – You pay AFTER eating/drinking.
111
112
113
114
115
116
117
118
119
129
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
130
131
BOARD or MEAL PLAN FOOD
132
133
CATERED AFFAIRS
134
135
136
Dollars
Cents
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter day of the week" column.
ADDITIONAL PAGE – Continued
a
Line
number
b
PROCESSING Enter
day
USE
of
the
week
(1)
(2)
c
Describe item purchased
©
Part 2 – Food for Home
Consumption
d
Is this item –
Mark (X) one
Fresh Frozen
Bottled
or
Other
canned
FLOUR, CEREAL and OTHER GRAIN PRODUCTS
(Flour, cake mixes, cereal, rice, cornmeal, spaghetti,
and other pasta, etc.)
201
202
203
204
205
206
207
209
210
211
212
213
214
Line
number
Cents
1
2
3
4
222
1
2
3
4
223
1
2
3
4
224
1
2
3
4
225
1
2
3
4
1
2
3
4
226
1
2
3
4
227
216
217
218
219
220
221
FORM CE-801 (1-1-98)
(2)
c
Describe item purchased
©
Part 2 – Food for Home
Consumption – Cont.
d
Is this item –
Mark (X) one
Fresh Frozen
Bottled
or
Other
canned
Total cost
Do not include
sales tax
Dollars
Cents
PORK (Bacon, pork chops, ham, sausage, pork
roasts, etc.)
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
228
229
1
2
3
4
1
2
3
4
1
2
3
4
230
1
2
3
4
231
1
2
3
4
232
1
2
3
4
233
1
2
3
4
234
OTHER MEATS (Frankfurters, bologna, liverwurst,
salami, lamb, game, organ meats, etc.)
FISH and SEAFOOD (Fish, shellfish, and other
seafood)
BEEF (Ground beef, round and other roasts,
sirloin, round and other steaks, briskets, etc.)
215
PROCESSING Enter
day
USE
of
the
week
(1)
BAKERY PRODUCTS (White bread, other bread,
cakes, cookies, pies, frozen waffles, etc.)
208
Total cost
Do not include
sales tax
Dollars
b
a
1
2
3
4
235
1
2
3
4
236
1
2
3
4
237
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
FATS, OILS and DRESSINGS (Vinegar, oils,
salad dressings, shortening, etc.)
238
239
240
Page 61
Page 62
FORM CE-801 (1-1-98)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). 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
Line
USE
number
(1)
(2)
Enter
day
of
the
week
c
Is this item –
Mark (X) one
Describe item purchased
Part 2 – Food for Home
Consumption – Cont.
Fresh Frozen
Bottled
Other
or
canned
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
260
Line
number
Dollars
PROCESSING
USE
Cents
(2)
Enter
day
of
the
week
Describe item purchased
Part 2 – Food for Home
Consumption – Cont.
261
262
263
264
265
266
267
268
270
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
271
1
2
3
4
272
1
2
3
4
273
1
2
3
4
274
1
2
3
4
275
277
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
d
Is this item –
Mark (X) one
Total cost
Do not include
sales tax
Fresh Frozen
Bottled
Other
or
canned
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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.)
276
1
c
VEGETABLES and VEGETABLE JUICES (Lettuce,
tomatoes, tomato juice, potatoes, beans, corn, and other
vegetables and vegetable juices, etc.)
269
SUGAR, SUGAR SUBSTITUTES and SWEETS
(Sugar, artificial sweeteners, candy, gum, jams,
jellies, etc.)
259
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.)
258
a
EGGS and DAIRY PRODUCTS (Eggs, whole
milk, skim milk, powdered milk, cream, butter,
margarine, cheese, ice cream, etc.)
241
257
d
278
279
280
281
Dollars
Cents
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter day of the week" column.
ADDITIONAL PAGE – Continued
a
Line
number
b
Enter
PROCESSING day
of
USE
the
week
(1)
(2)
c
Is this item –
Mark (X) one
Describe item purchased
Part 2 – Food for Home
Consumption – Cont.
d
Total cost
Do not include
sales tax
Bottled
Other
Fresh Frozen or
canned
NON-ALCOHOLIC BEVERAGES (Cola and other
carbonated beverages, instant and ground coffee,
tea, fruit-flavored and other noncarbonated
beverages, carbonated and noncarbonated
waters, etc.)
282
283
284
285
286
287
288
289
291
292
293
303
304
305
306
FORM CE-801 (1-1-98)
Cents
1
2
3
4
402
1
2
3
4
403
1
2
3
4
404
1
2
3
4
405
1
2
3
4
406
1
2
3
4
407
1
2
3
4
408
1
2
3
4
(2)
Enter
day
of
the
week
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 though 15
5 – Under 2 years
Enter code
Dollars
Cents
Yes
No
CASUAL, SPORTSWEAR, FORMAL
(Suit, shirt, dress, shorts, pants, sweater, 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
UNDERGARMENTS and SLEEPCLOTHES
(Socks, pajamas, lingerie, hosiery, etc.)
409
1
2
3
4
410
1
2
3
4
411
1
2
3
4
412
1
2
3
4
413
414
OUTDOOR, WORK, SCHOOL, COSTUMES (Coat,
jacket, thermals, windbreaker, uniform, etc.)
FOOD and BEVERAGES PURCHASED AS GIFTS (for
someone outside your CU) (Fruit baskets, cheese, candy,
wine, beer, liquor, etc.)
302
PROCESSING
USE
401
Part 3 – Food and Beverages
Purchased as Gifts
301
Dollars
Line
number
b
(1)
ALCOHOLIC BEVERAGES (Beer, wine, whiskey,
liqueurs, champagne, etc.)
290
a
415
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
416
417
418
419
420
421
Page 63
Page 64
FORM CE-801 (1-1-98)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter day of the week" column.
ADDITIONAL PAGE – Continued
a
Line
number
b
PROCESSING Enter
day
USE
of
the
week
(1)
(2)
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 years
Enter code
Dollars
Cents
Yes
No
423
424
425
426
427
1
2
1
433
434
435
Dollars
Cents
Yes
No
2
2
502
1
2
1
2
503
1
2
1
2
504
1
2
1
2
1
2
505
1
2
506
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
GASOLINE, OIL and ADDITIVES (Gasoline, diesel fuel, motor oil,
ants, brake fluid, etc.)
507
2
2
1
2
1
2
JEWELRY, ACCESSORIES, and SEWING
ITEMS (Watch, ring, belt, hat, hairpiece,
umbrella, thread, buttons, etc.)
432
Total cost
Do not include
sales tax
TOBACCO and SMOKING SUPPLIES (Cigarettes, pipes, cigars,
tobacco, smoking accessories, etc.)
509
431
MEDICINES, MEDICAL SUPPLIES and SERVICES
(Prescription/nonprescription drugs, vitamins, ointments, dressings,
eyeglasses, hearing aids, wheelchairs, canes and other medical
equipment, health insurance, doctor/dentist services etc.)
510
1
2
1
2
1
2
1
2
CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)
440
Part 5 – All Other Purchases and
Expenses
d
Was this bought
for someone
outside your
consumer unit?
Mark (X) one
1
1
430
439
(2)
Describe item purchased
508
429
438
PROCESSING Enter
day
USE
of
the
week
c
501
1
428
b
(1)
SPORTS-TEAM CLOTHES and SPORT
SHOES (Cleats, team uniform, ski boots,
golf shoes, etc.)
437
Line
number
SHOES (Boots, dress, work, sandals,
sneakers, slippers, etc.)
422
436
a
511
512
513
514
515
1
2
1
2
1
2
1
2
1
2
516
517
518
519
520
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter day of the week" column.
ADDITIONAL PAGE – Continued
a
Line
number
b
PROCESSING Enter
day
USE
of
the
week
(1)
(2)
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
a
Yes
522
523
524
(1)
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.)
525
526
527
528
529
530
531
534
535
536
537
538
FORM CE-801 (1-1-98)
(2)
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
539
540
541
542
2
1
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
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 MAINTENANCE, HARDWARE, LAWN SUPPLIES and
SERVICES (Decorations, improvement and repair equipment,
supplies and services, power and hand tools, nails, screws,
lawn/garden equipment, etc.)
544
545
546
547
548
HOUSING EXPENSES (Rent, mortgage payments, electricity,
telephone, homeowner’s insurance, maintenance fees, property
taxes, garbage/snow removal, heating and cooling equipment, cable
TV service, etc.)
549
1
c
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.)
543
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.)
533
PROCESSING Enter
day
USE
of
the
week
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
532
Line
number
b
550
551
552
553
554
555
556
Page 65
Page 66
FORM CE-801 (1-1-98)
Use this page to record expenditures if you run out of space on any of the Diary day(s) (pages 11-59). Enter
the day of the week (Mon., Tues., etc.) for each expenditure in the "Enter day of the week" column.
ADDITIONAL PAGE – Continued
a
Line
number
b
PROCESSING Enter
day
USE
of
the
week
(1)
(2)
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
a
Yes
Line
number
b
PROCESSING
USE
No
(1)
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.)
(2)
Enter
day
of
the
week
Describe item purchased
Part 5 – All Other Purchases and
Expenses – Cont.
557
558
1
2
1
2
560
1
2
561
1
2
562
1
2
563
1
2
564
1
2
565
1
2
566
1
2
567
1
2
1
2
569
1
2
570
1
2
568
TRANSPORTATION EXPENSES (New and used cars, maintenance and
repair, taxis, buses, commuter fares, car rental, airline fares, train fares,
parking fees, tolls, etc.)
Dollars
Cents
Yes
No
2
1
2
1
2
1
2
1
2
583
1
2
584
1
2
585
1
2
586
1
2
587
1
2
588
1
2
589
1
2
590
1
2
591
1
2
580
559
Total cost
Do not include
sales tax
1
579
2
d
Was this
bought for
someone
outside your
consumer unit?
Mark (X) one
SCHOOL EXPENSES (High school and college tuition, board,
textbooks and other school supplies, day care, etc.)
578
1
c
581
582
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
592
1
2
1
2
593
1
2
573
1
2
594
1
2
574
1
2
595
1
2
1
2
596
1
2
1
2
597
1
2
1
2
598
1
2
571
572
575
576
577
DAILY REMINDER LIST
Notes
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 purchases 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
FORM CE-801 (1-1-98)
Page 67