U.S. Department of Commerce

Bureau of the Census

Acting as a collecting agent for

U.S. Department of Labor

Bureau of Labor Statistics

Record of

Your Daily

Expenses

FORM CE-801(11-1-96)

NOTICE – Your remay be seen only 

FROM (First da

U.

S.

DEPARTMENT OF COMMERC

E

BUREAU OF THE CENSUS

THROUGH (Se

Field representa

I will return If you have a

Field representa

PGM 7

RegionalOfficecode

Control 

PSU co

1.2. Household numb

Second dayThird dayFourth dayFifth daySixth day
FORM CE-801 (11-1-96)

INSTRUCTIONS

I. HOW IS THE CONSUMER EXPENDITURE DIARY USED?

The Consumer Expenditure Diary Survey is sponsored by the Bureau ofLabor Statistics and is used to collect information on householdexpenditures. Data collected from the Diary enable government agenciesand private corporations to:• Calculate the Consumer Price Index (inflation rate) by identifying 

current American buying habits

• Help to develop economic policies such as: school programs and

retirement benefits

II. GENERAL INSTRUCTIONS

Use this form to record all your consumer unit’s expenses for the

7-day period indicated on the front page. Beginning on page 10 there are6 pages for each day. Record each day’s expenses on the appropriatepages under the most appropriate heading. The day should be entered atthe top of the page as shown in the example below:

ENTER DAYOF THE WEEK

III. WHO TO INCLUDE (CONSUMER UNIT)

Record ALL purchases and expenses for the following persons:

All members of this household

OR

The following persons

The persons listed above are the members of your Consumer Unit (CU).

IV. BEST TIME T

Most people fpurchases as who keeps thobtain their e

V. WHAT TO RE

Please use thsmall or inexpINCLUDE item• Food for Ho• Food Away 

meals purch

• Non Food It

items and se

• Food and no

purchased fmembers

• Any items re• Any items pDO NOT INCL• Expenses of • Business or • Sales tax in CREDIT CARD • If an item is 

full cost of tmade on bilcharge acco

©
FORM CE-801 (11-1-96)

VI. WHERE AND HOW TO RECORD EXPENSES

The diary is divided by day. Each day of the diary is divided into 5 parts: FoodFor Home Consumption; Food and Beverages Purchased as Gifts; Food AwayFrom Home; Clothing, Shoes, and Jewelry; and All Other Purchases andExpenses. Within each of these parts there are category headings withexamples to help you determine where an item should be recorded. Enter allpurchases and other expenses in the most appropriate part on the correctdiary day.• Part 1 – Food for Home Consumption. Record whether the item is fresh,

frozen, bottled, canned, or some other type of packaging.

• Part 2 – Food and Beverages Purchased as Gifts. Record whether the

item is fresh, frozen, bottled, canned, or some other type of packaging.

VIII. PICK UP

Thank you for your cooperation. I will return to pick up your completed diaryon _____________. If you have any questions during the week, please feel freeto call me.

IX. EXAMPLES

The following Please record Food for Ho

MILK – SpeBEEF – Spe

ground be

PORK – Spe

bacon, etc

• Part 3 – Food Away From Home. Record whether alcoholic beverages are

included in the total cost. Also include tax and tips in the total cost.

• Part 4 – Clothing, Shoes, and Jewelry. Specify whether it was purchased

for someone outside your Consumer Unit. Also record the code for the ageand sex of the person for whom the item was purchased.

In all cases, the item purchased and the cost of the item are needed.Additional information is required in the following categories:• Part 5 – All Other Purchases and Expenses. Specify if the item was

purchased for someone outside your Consumer Unit.

It is important that you record complete descriptions of each item purchased.Please refer to the examples in part IX on this page which show the amount ofinformation we would like you to record. If you are undecided where to recorda purchase, contact your Census Bureau Field Representative.If there is not enough space to record all expenses for a particular day on thelines provided, enter the additional items on pages 52–57. Be sure to specifythe day on which the expenses occurred in the column headed "Enter Day ofthe Week."

VII. ADDITIONAL PAGES

CHICKEN – 

chicken qu

SOFT DRIN

noncarbon

COFFEE – SOTHER FOO

Food Away 

MEALS – Sp

specify typ

Clothing, Sh

CLOTHING 

All Other Pu

DOCTOR BI

internist, e

MEDICINE – 

cough syr

LAUNDRY/D

specify wh

TOOLS – SpSHOES – If JEWELRY – BREAD – Sp
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

To be completed by field representative only

Cents

FIELD REPRESENTATIVE – Revie

respondent for some typical exp

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

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USE

PGM 10 Par

Fish anPoultry Other Mlamb, gFats, Oshorten

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©

EXAMPLE

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FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

To be completed by field representative only – Continued

Cents

FIELD REPRESENTATIVE – Revie

respondent for some typical exp

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

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2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 234

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181

EXAMPLE
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

To be completed by field representative only – Continued

Cents

FIELD REPRESENTATIVE – Revie

respondent for some typical exp

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, SCarry-ousnacks, 

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22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 234

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

EXAMPLE 4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 year

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

To be completed by field representative only – Continued FIELD REPRESENTATIVE – Review 

respondent for some typical expe

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other Sslippers

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelry and watclasps, 

PGM 14

Tobacco accesso

a

Line

number

PROCESSING

USE

Gasolinfluid, et

FORM CE-801 (11-1-96) 

EXAMPLE

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b cd

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

To be completed by field representative only – Continued

Cents

FIELD REPRESENTATIVE – Review 

respondent for some typical expe

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewaknives, fomixers, fo

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222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

EXAMPLE

YES NO

522

1 21 2

PGM 14 P

Home Fustoves, soclocks, taHome Maand repailawn/gard
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

To be completed by field representative only – Continued

Cents

FIELD REPRESENTATIVE – Review 

respondent for some typical expe

Housing Expenses (Rent, mortgage payments, electricity, telephone, home owner’sinsurance, maintenance fees, property taxes, garbage/snow removal, heating andcooling equipment, cable TV service, etc.)Entertainment/Amusements and Sports/Recreation (Admissions to movies,concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,video/stereo equipment, purchase or rental of videos, toys, hunting, camping, sports/exercise equipment and fees, etc.)

Transporcommute

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

EXAMPLE

YES NO

560

1 21 2

PGM 14 P

School Esupplies, All Other newspapdues, legoperated 

1 21 2

557558
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

FIRST DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

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111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 1 None PROCESSING USE

1 2 TR 3 BD 4 VC 1 S 2 M 
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

FIRST DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 234

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

FIRST DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 234

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

FIRST DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

FIRST DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

FIRST DAY – Continued

Cents

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.)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.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School supplieAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

SECOND DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

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111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 2 None PROCESSING USE

1 2 TR 3 BD 4 VC
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

SECOND DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 234

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

SECOND DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 234

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

SECOND DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

SECOND DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b cd

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

SECOND DAY – Continued

Cents

Housing Expenses (Rent, mortgage payments, electricity, telephone, home owner’sinsurance, maintenance fees, property taxes, garbage/snow removal, heating andcooling equipment, cable TV service, etc.)Entertainment/Amusements and Sports/Recreation (Admissions to movies,concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,video/stereo equipment, purchase or rental of videos, toys, hunting, camping, sports/exercise equipment and fees, etc.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School supplieAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

THIRD DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

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111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 3 None PROCESSING USE

1 2 TR 3 BD 4 VC
FORM CE-801 (11-1-96) 

a bc d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

THIRD DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 234

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

THIRD DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 234

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

THIRD DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

THIRD DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

THIRD DAY – Continued

Cents

Housing Expenses (Rent, mortgage payments, electricity, telephone, home owner’sinsurance, maintenance fees, property taxes, garbage/snow removal, heating andcooling equipment, cable TV service, etc.)Entertainment/Amusements and Sports/Recreation (Admissions to movies,concerts, sporting and cultural events, records, tapes, CDs, radios, TVs,video/stereo equipment, purchase or rental of videos, toys, hunting, camping, sports/exercise equipment and fees, etc.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School supplieAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

FOURTH DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

101102103104105106107108109110111112113114115116117118119120121

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 4 None PROCESSING USE

1 2 TR 3 BD 4 VC
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

FOURTH DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 234

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

FOURTH DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 2 3 4

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

FOURTH DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

FOURTH DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

FOURTH DAY – Continued

Cents

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.)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.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School other scAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

FIFTH DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

101102103104105106107108109110111112113114115116117118119120121

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 5 None PROCESSING USE

1 2 TR 3 BD 4 VC
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

FIFTH DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 2 3 4

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

FIFTH DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 2 3 4

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

FIFTH DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

FIFTH DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

FIFTH DAY – Continued

Cents

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.)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.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School other scAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

SIXTH DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

101102103104105106107108109110111112113114115116117118119120121

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 6 None PROCESSING USE

1 2 TR 3 BD 4 VC
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

SIXTH DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 2 3 4

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

SIXTH DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 2 3 4

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

SIXTH DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

SIXTH DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

SIXTH DAY – Continued

Cents

Housing Expenses (Rent, mortgage payments, electricity, telephone, home,owner’s insurance, maintenance fees, property taxes, garbage/snow removal,heating and cooling equipment, cable TV service, etc.)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.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School other scAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption

SEVENTH DAY

Cents

E

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

Pork (B

101102103104105106107108109110111112113114115116117118119120121

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 Par

Fish anPoultry Other lamb, Fats, Oshorte

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 7 None PROCESSING USE

1 2 TR 3 BD 4 VC
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

SEVENTH DAY – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skim milk,powdered milk, cream, butter, margarine, cheese, icecream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificialsweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vegetabpotatoe

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 10 

Other gourmsauces

Pa

1 2 3 4

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 10 Part 1 – Food for Home Consumption – Cont.

SEVENTH DAY – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonatedbeverages, instant and ground coffee, tea, fruit-flavoredand other noncarbonated beverages, carbonated andnoncarbonated waters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

Meals, Carry-osnacks, 

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 12 

1 2 3 4

Part 2 – Food and Beverages Purchased

as Gifts PGM 11

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 13 Part 4 – Clothing, Shoes, and Jewelry

SEVENTH DAY – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts, shorts,underwear, nightwear, uniforms, diapers/infantwear,socks, stockings, lingerie, clothing rental, etc.)Shoes for Sports (Specify type of sport such as footballcleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

Other slipper

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

Jewelrand wclasps

PGM 14

Tobaccaccess

a

Line

number

PROCESSING

USE

Gasolifluid, e

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 13
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

SEVENTH DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs and othermedical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue,paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

Housewknives, mixers, 

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

PGM 14 P

Home Fstoves, clocks, Home Mand replawn/ga
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 14 Part 5 – All Other Purchases and Expenses – Cont.

SEVENTH DAY – Continued

Cents

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.)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.)

Transpocommu

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 14 P

School other scAll Othenewspadues, leoperate

1 21 2

557558
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 15 Part 1 – Food for Home Consumption

ADDITIONAL PAGE

Cents

Use this page to 

Enter the day of 

Flour, Cereal and Other Grain Products (Flour, cake mixes,cereal, rice, cornmeal, spaghetti, and other pasta, etc.)Bakery Products (White bread, other bread, cakes,cookies, pies, frozen waffles, etc.)Beef (Ground beef, round and other roasts, sirloin,round and other steaks, briskets, etc.)

101102103104105106107108109110111112113114115116117118119120121

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

PROCESSING

USE

PGM 15

Os

122123124125126127128129130131132133134135136137138139140

© ©

PGM 8 8

(1) (2)

Enter

Day

of

the

Week

(1) (2)

Enter

Day

of

the

Week
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 15 Part 1 – Food for Home Consumption – Cont.

ADDITIONAL PAGE – Continued

Cents

Eggs and Dairy Products (Eggs, whole milk, skimmilk, powdered milk, cream, butter, margarine, cheese, ice cream, etc.)Sugar, Sugar Substitutes and Sweets (Sugar, artificial sweeteners, candy, gum, jams, jellies, etc.)Fruits and Fruit Juices (Apples, bananas, oranges,orange juice, and other fruits and fruit juices, etc.)

Vjj

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

PROCESSING

USE

PGM 15

Oog

1 2 3 4

141142143144145146147148149150151152153154155156157158159160

161162163164165166167168169170171172173174175176177178179180181

Use this page to reco

the day of the week (

(1) (2)

Enter

Day

of

the

Week

(1) (2)

Enter

Day

of

the

Week 
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Is this item –

Mark (X) one Total cost

Do not include

sales tax

Fresh Frozen

Bottled

or

canned

Other

Dollars

PROCESSING

USE

PGM 15 Part 1 – Food for Home Consumption – Cont.

ADDITIONAL PAGE – Continued

Cents

Non-Alcoholic Beverages (Cola and other carbonated beverages,instant and ground coffee, tea, fruit-flavored and othernoncarbonated beverages, carbonated and noncarbonatedwaters, etc.)Food and Beverages Purchased as Gifts (for someone outsideyour CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)Alcoholic Beverages (Beer, wine, whiskey, liqueurs,champagne, etc.)

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a 

Line

number

PROCESSING

USE

PGM 17

1 2 3 4

Part 2 – Food and Beverages

Purchased as Gifts PGM 16

182183184185186187188189190191192193201202203204205206

301302303304305306307308309310311312313314315316317318319320321322

4

Use this page to reco

the day of the week 

Enter

Day

of

the

Week

(1) (2)(1) (2)

Enter

Day

of

the

Week

Enter

Day

of

the

Week

(1) (2)
a b c d

Line

number

Describe item purchased

Was this boughtfor someoneoutside yourconsumer unit?Mark (X) one

For whom was thisitem purchased?1 – Male 16 or over2 – Female 16 or over3 – Male 2 through 154 – Female 2 through 155 – Under 2 years

YES NO

PROCESSING

USE

PGM 18 Part 4 – Clothing, Shoes, and Jewelry

ADDITIONAL PAGE – Continued

Clothing (Suits, coats, dresses, skirts, pants, shirts,shorts, underwear, nightwear, uniforms,diapers/infantwear, socks, stockings, lingerie,clothing rental, etc.)Shoes for Sports (Specify type of sport such asfootball cleats, golf shoes, ski boots, etc.)Accessories (Hats, belts, scarfs, purses, wallets, ties,gloves, handkerchiefs, key chains, umbrellas, etc.)

11111111111111111

22222222222222222

a

Line

number

PROCESSING

USE

1 2111

222

401402403404405406407408409410411412413414415416417418419420

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

PGM 19

a

Line

number

PROCESSING

USE

FORM CE-801 (11-1-96) 

421422423424425426501502503504505506507508509

PGM 18

Use this page to rec

Enter the day of the 

Enter

Day

of

the

Week

(1) (2)

Enter

Day

of

the

Week

(1) (2)

Enter

Day

of

the

Week

(1) (2)
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought for someoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 19 Part 5 – All Other Purchases and Expenses – Cont.

ADDITIONAL DAY – Continued

Cents

Medicines, Medical Supplies and Services (Prescription/nonprescription drugs,ointments and dressings, eyeglasses, hearing aids, canes, wheelchairs andother medical equipment, health insurance, doctor/dentist services, etc.)Housekeeping Supplies and Services (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, paper towels, light bulbs, maid service, etc.)Personal Care Products and Services (Hair care products, combs, hair brushes,wigs, dental products, shaving products, hand soap, cosmetics, skin careproducts, perfume, deodorants, men’s and women’s haircuts, etc.)

111111111111111

222222222222222

a 

Line

number

1 2

510511512513516514515517518519520521523524525526527

528529530531532533534535536537538539540541542543544545

YES NO

522

1 21 2

Use this page to recor

Enter the day of the w

(1) (2)

Enter

Day

of

the

Week

PROCESSING

USE

PGM 19 

(1) (2)

Enter

Day

of

the

Week
FORM CE-801 (11-1-96) 

a b c d

Line

number

Describe item purchased

Was thisbought forsomeoneoutside yourconsumer unit?Mark (X) one

Total cost

Do not include

sales tax

Dollars

PROCESSING

USE

PGM 19 Part 5 – All Other Purchases and Expenses – Cont.

ADDITIONAL PAGE – Continued 

Cents

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.)Entertainment/Amusements and Sports/Recreation (Admissions tomovies, 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.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

546547548549552550551553554555556559561562563564565

566567568569570571572573574575576577578579580581582583584585

YES NO

560

1 21 2

PGM 19 

1 21 2

557558

Use this page to re

Enter the day of th

(1) (2) (1) (2)

Enter

Day

of

the

Week

Enter

Day

of

the

Week
FORM CE-801 (11-1-96) 

DAILY REMINDER LIST

Please review the list of expenses below with other members of yourhousehold at the end of each day. If you have forgotten to record any expense,please do so on the appropriate page.EXPENSES FOR – 

Flour, sugar, cereal, salt, shortening, cake mixes, etc.Canned soup, tomato paste, chili mix, salad dressing, etc.Food items purchased as gifts

a.

b.

c.

d. Food and beverages purchased at a restaurant or carry-out (including school

lunches and vending machine purchases)

e.

f.

g.h.

i.j.

Snack foods (potato chips, pretzels, cookies, etc.)Beer, wine, whiskey, and other alcoholic beveragesCigarettes, tobacco, or other smoking suppliesClothing, shoes, and jewelryHousekeeping supplies and paper productsLumber, nails, sandpaper, paint brushes, etc.Gasoline, turnpike or bridge tolls, parking fees, car pool expenses, publictransportation, etc.

k.

Newspaper, postage stamps, greeting cards, etc.Vitamins, medicine, and other medical or sanitary supplies

l.

m.

Laundry and dry cleaning (including coin-operated machines used at alaundromat)

n.

Cosmetics, soap, and other personal care itemsHair cuts and sets (including purchased and care of wigs and hair pieces)Toys, hobbies, games, etc.Bank charges for checking accounts, safe-deposit boxes, etc.Furniture and appliancesFees for lessons or instructions

o.p.q.

r.

s.

t.