Your Daily Expenses Your Daily Expenses

Help us learn about the buying habits of people in the United States

FORM CE-801 (1-1-2013)

When you write down how you spend your money in this diary, you will help us understand

more about the products and services that are bought by the people in the United States.

By law (title 13, U.S. Code), we must keep your information confidential; we use it for statistical purposes only.

Field representative’s name:

Acting as a collecting agent for

U.S. Department of Labor

Bureau of Labor Statistics

EAU OF THE CEN

OMB No. 1220-0050

I will return on: _______________________________________

Field representative supervisor’s name:

Telephone:

Telephone:

If you have any questions, please call:

Please record your expenses and purchases

for the following period

1

2

3

4

5

6

7

Day Date

Black Ink (40% and 100%)

If you have comments regarding this survey, please send them to the Division of Consumer Expenditure Surveys,

2 Massachusetts Avenue N.E., Room 3985, Washington, DC 20212.
(contin

2. Food and Drink

3. Clothing, Shoe

Employer and Scho

Includes elementar

■

Grain Products (ca

pasta, rice, spaghe

■

Bakery Products (c

white bread, other 

■

Beef (briskets, grou

sirloin, etc.)

■

■ Pork (bacon, ham, 

■ Poultry (chicken pa

Other meats (bolog

organ meats, salam

■

■ Fish & Seafood (fis

Oils, Fats & Dressin

vinegar, etc.)

■

Eggs & Dairy Produ

cream, skim milk, p

■

Fruits & Fruit Juice

juice, oranges, oran

■

Sugar, Sugar Subs

sweeteners, candy, 

■

Vegetables & Vege

potatoes, tomatoes

■

Other Food Items (

gourmet/specialty 

etc.)

■

Non-Alcoholic Beve

non-carbonated wa

beverages, fruit-fla

coffee, tea, etc.)

■

Alcoholic Beverage

whiskey, wine, etc.

■

Food & Beverages 

not on your list (ca

■

Casual, Sportswear

suit, sweater, etc.)

■

Undergarments & 

pajamas, socks, etc

■

Outdoor, Work, Sc

thermals, uniform, 

■

■ Shoes (boots, dres

Sports-team Clothe

shoes, ski boots, te

■

Jewelry, Accessori

hairpiece, hat, ring

■

FORM CE-801 (1-1-2013)

Black Ink (40% and 100%)
(contin

FORM CE-801 (1-1-2013)

)

Tobacco & Smokin

smoking accessorie

■

Gasoline, Oil, & Ad

gasoline, motor oil, 

■

■ Personal Care Prod

products, deodoran

men’s & women’s h

skin care products, 

Housekeeping Sup

brooms, laundry & 

maid service, mops

■

Housewares & Sma

(blenders, coffee m

dinnerware, glassw

telephones, & toast

■

Home Furnishings, 

Appliances (art wor

frames, pillows, pla

sofas, stoves, table 

■

Home Maintenance

Services (hand tool

equipment, lawn/ga

tools, screws, supp

■

Housing Expenses 

removal, heating/co

fees, mortgage pay

telephone, etc.)

■

Entertainment/Am

(admissions to mov

events, camping, C

& exercise equipme

equipment, video p

■

Transportation Exp

rental, commuter fa

maintenance and re

fares, etc.)

■

School Expenses (d

tuition, room & boa

■

All Other Expenses 

household furnishi

books, club dues, d

accounting fees, m

& veterinary service

sewing goods, ship

■

Black Ink (40% and 100%) 
FORM CE-801 (1-1-2013)

Notes Notes

Black Ink (40% and 100%)
Questions?

Here are some of the uses of the Consumer Price Index:

Consumer Price Index, or CPI, which is a basic measure of the rate of

inflation.

♦ Provide cost-of-living wage adjustments for millions of American workers

♦ Adjust Social Security payments

♦ Determine the cost of school lunches

♦ Adjust Federal income-tax brackets

Some Frequently Asked Questions are answered on the flap attached to the back cover.

If you still have questions after reviewing these, please call your field representative.

FORM CE-801 (1-1-2013)

Questions?

Office Use: Place the barcode label here

1

For more information about the survey, visit: http://www.bls.gov/cex and http://www.census.gov

§)""¤

080101

Black Ink (40% and 100%)
Refer to the flap

attached to the

front cover for

Examples of Expenses.

Do NOT record:

Refer to the flap

attached to the

back cover for answers to

Frequently Asked Questions.

♦ Expenses of people on your list while they were away from home overnight.

■ We recommend that you record your expenses each day.

Think about where you went and what you’ve done.

■ Talk to the people on your list every day to find out how they spent their money.

■ Include payments by:

Cash

Check

Food Stamps

Credit/Debit Card

Money Order

WIC Voucher

Automatic Withdrawal/Payroll Deduction

Store Charge Card

Grocery Certificate

■ Keep receipts and other records so that you will remember to record what you

bought or paid for. Use the pocket at the back of the diary to store them.

Receipts

Utility Bills

Pay Stubs

Some record types include:

Include items that you bought for people who are not on your list, such as gifts.

♦ Business or farm operating expenses

♦ Sales tax for:

Part 2. Food and Drinks for Home Consumption

Part 3. Clothing, Shoes, Jewelry, and Accessories

Part 4. All Other Products, Services, and Expenses

Bank Statements

Telephone Bills

Catalog/Internet Order Invoices

Credit Card Statements

2

FORM CE-801 (1-1-2005)

CE-801, Page 2, Pantone Blue 313 (20%, 40%, and 

1 §)"#¤

080102

Black Ink

FORM CE-801 (1-1-2013)
Look on the next 4 pages for examples and tips

on how to record your purchases.

1. Food and Drinks Away from Home

■

■

■ Enter the total cost with tax and tip.

If alcohol was part of the purchase, check whether it was wine, beer, and/or other

alcohol and enter the total cost of the alcohol.

■

Mark one of the four choices that best describes where you made the purchase.

2. Food and Drinks for Home Consumption

■

■ Mark whether the item was fresh, frozen, bottled/canned, or other.

■ Enter the cost without tax and deduct any discounts or coupons.

Describe the item.

■ Mark the last column if the item was purchased for someone not on your list (e.g. gifts).

3. Clothing, Shoes, Jewelry, and Accessories

■

■ Mark the appropriate sex and age range of the person for whom the item was bought.

Describe the item and enter the cost without tax.

■ Mark the last column if the item was purchased for someone not on your list (e.g. gifts).

4. All Other Products, Services, and Expenses

■

■ Mark the last column if the item was purchased for someone not on your list (e.g. gifts).

Describe the item and enter the total cost without tax.

There is an "Additional Pages" section on pages 36–44 in case you

run out of lines on any particular day.

*Please Note: If you are unsure about whether to include an item or

where to record an item, write it down wherever it seems best or

make a note and ask your field representative.

Mark one of the four choices that best describes the type of meal and describe briefly.

3

FORM CE-801 (1-1-2013)

CE-801, Page 3, Pantone Blue 313 (20%, 40%, and 100%)

3

§)"$¤

080103

Black Ink
3

1 23

X X

Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

FR USE: None TR VC FORM CE-801 (1-1-2013)

§)"%¤

080104

wine

beer

other

4

Description

CE-801, Page 4, Pantone Blue 313 (20%, 40%, & 100%)

bagel, juice

X

pizza

coffee

sandwich, soda

chips

elem.school lunch - month

soda

buffet

drinks from cash bar

X

X

X

X

X

X

X

X

X

X

X

X

X

79

XX

X

45

62

15

57

35

15

70

00

65

23

00

2

5

1

5

12 00

15 00

☛ Level of detail needed: 

briefly describe the meal.

Include tax & tip

for part 1 only.

☛

X

X

X

X

CE-801, Page 4, Pantone Yellow 101 (7

117

118

119

120

121

122

X caterer - Family Reunion 350 00 X X 95 00

1234

1234

1 234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

1 23

☛ If alcohol was included

in the purchase, mark

whether it was wine, beer,

and/or other and enter the

total cost of the alcohol.

☛ Use the pocket on the inside of the back

cover to store your receipts until you’re ready 

to record your purchases.

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

2

1 234

4

4

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

1 234

(See examples above

and on the flap)

EXAMPLE

1 2

1234

Black Ink (10%, 50%, & 100%)
bottled/

canned

Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)"&¤

080105

5

What did you buy or pay for?

fresh frozen other

221

222

223

224

225

wheat bread

eggs 1 50

chicken wings

apples

beer

skim milk

orange juice

candy

vegetable oil

baby food (5 jars)

potato chips

1 49

6 78

2 80

4 29

2 99

3 99

2 50

2 99

4 95

2 79

X

X

X

X

X

X

X

X

X

X

frozen meals (3 boxes) X 8 97

ketchup

soup (4 cans)

soda (2 bottles)

pork chops

shrimp

cookies

apple pie

carbonated water

ground beef

ground coffee

bagels

wine

dog food

X 1 59

X 0042

X 5 85

X 1 98

X 4 96

X 89

X 6 36

X 11 20

X 3 50

X 4 99

5 25

2 79

5 87

X

X

X

X

X

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

1 2 3 4

1 2 3 2

1 2 3 4

1 2 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

EXAMPLE

☛ Level of detail needed:

BREAD – Specify if white, wheat, rye, etc.

BEEF – Specify the cut and describe, such as

round roast, ground beef, etc.

PORK – Specify the cut and describe, such as

whole ham, bacon, spareribs, etc.

CHICKEN – Specify if whole or parts, such as

chicken legs, chicken wings, etc.

SOFT DRINKS – Specify if soda or other

type: if not cola, specify if carbonated or non.

COFFEE – Specify if ground or instant.

OTHER FOOD – Give a complete description,

such as scalloped potatoes.

☛List food & drinks from 

specialty food stores in this part

(i.e. bakery, liquor store, farmers’

market, convenience store, etc.)

(see examples above and on the flap)

Mark (X) one

X

Black Ink (10%, 50%, & 100%) CE-801, Page 5, Pantone Blue 313 (20%, 40%, & 100%) CE-801, Page 5, Pantone Yellow 101 (
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"’¤

080106

6

What did you buy or pay for? Age

Under

2 2–15 16 &

Over

321

322

323

324

325

Was the 

item for:

male female

3 dress-shirts ($25 each) X

1 dress-shirt

running shoes

non-prescription sunglasses

baseball cap

bib

child’s costume (returned for refund)

wallet

necklace

scarf

trouser socks

☛ Level of detail needed: 

CLOTHING – Specify type of clothing

and give a description of the item.

SHOES – If sports shoes, specify 

sport, such as football cleats, etc.

JEWELRY – Specify type of jewelry,

such as watches, etc.

ACCESSORIES – If eyewear, specify

prescription or non-prescription.

X

X X

X X

X X

X

X

X

X

X XX

X

X X

X X

X X

X

0075

0030

0069

0059

9914

3 50

0015

4 99

0029

250 00

3 99 EXAMPLE

☛ If you run out of space in any

section, continue listing the items

under that section on the Additional

Pages in the back (p. 36–44)

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)

X

Black Ink (10%, 50%, & 100%) CE-801, Page 6, Pantone Blue 313 (20%, 40%, & 100%) CE-801, Page 6, Pantone Yellow 101 
00

00

00

00

Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"(¤

080107

7

What did you buy or pay for?

421

422

423

424

425

cold medicine (non-prescription) 6 95 X

EXAMPLE

gasoline

highway tolls

Music CD

cigarettes

dry cleaning

lottery tickets

bus fare

piano lessons

electric drill

postage stamps

video rental

car speakers

car oil change

board game

area rug (exchanged for a different area rug)

concert tickets

dog leash dog toy (exchange)

ATM service fee

Health insurance

Mortgage payment

Telephone bill

veterinarian fees

Shipping and Handling for internet purchase

Donation

X

X

X

6 99

39 99

2

250

875

120

☛ Level of detail needed:

DOCTOR BILLS – Specify type of doctor visited, such

as an internist, orthodontist, etc.

MEDICINE – Specify if prescription or non-prescription.

TOOLS – Specify if power or hand tool.

DRY-CLEANING – Specify whether household item

(such as drapes) or apparel.

☛Mark the

last column of

parts 2, 3, & 4

if a purchase

was made for

someone not

on your list.

00

95

00

50

85

6

100 00

12 86

2 00

10

8

99

99

15

1

1

00

50

50

150 00

65 00

6

4 00

80

140 00

48

8

50

97

3 99

20 99

(see examples above and on the flap)

Black Ink (10%, 50%, & 100%) CE-801, Page 7, Pantone Blue 313 (20%, 40%, & 100%) CE-801, Page 7, Pantone Yellow 101 
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)")¤

080108

wine

beerother

8

CE-801, Page 8, Pantone Blue 313 (20%, 40%, and 10

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

1 2

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)"*¤

080109

9

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 9, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"+¤

080110

10

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 10, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)",¤

080111

11

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 11, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)"-¤

080112

wine

beerother

12

CE-801, Page 12, Pantone Blue - PMS-313

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)".¤

080113

13

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 13, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"/¤

080114

14

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 14, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"0¤

080115

15

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 15, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)"1¤

080116

wine

beerother

16

CE-801, Page 16, Pantone Blue - PMS-313

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)"2¤

080117

17

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 17, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"3¤

080118

18

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 18, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"4¤

080119

19

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 19, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)"5¤

080120

wine

beerother

20

CE-801, Page 20, Pantone Blue - PMS-313

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)"6¤

080121

21

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 21, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"7¤

080122

22

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 22, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"8¤

080123

23

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 23, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)"9¤

080124

wine

beerother

24

CE-801, Page 24, Pantone Blue - PMS-313

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)":¤

080125

25

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 25, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)";¤

080126

26

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 26, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"<¤

080127

27

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 27, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)"=¤

080128

wine

beerother

28

CE-801, Page 28, Pantone Blue - PMS-313

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)">¤

080129

29

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 29, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"?¤

080130

30

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 30, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"@¤

080131

31

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 31, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Total Cost

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

122

FR USE: None TR VC

FORM CE-801 (1-1-2013)

§)"A¤

080132

wine

beerother

32

CE-801, Page 32, Pantone Blue - PMS-313

117

118

119

120

121

If there are not enough lines in this part, please continue recording your expenses on pages 36–37.

1 2 34

1234

1 2 3

1 234

1234

1

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1234

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

1 2 34

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

123

1234

1

Description

(see examples above

and on the flap)

4

234
Total Cost

without tax

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

a() 

purchased for

someone not

on your list

219

220

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 38–41.

§)"B¤

080133

33

What did you buy or pay for?

221

222

223

224

225

CE-801, Page 33, Pantone Blue - PMS 313

bottled/

canned

fresh frozen other

12 4 3

Mark (X) one

12 4 3

2 4 3

12 4 3

1

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

(see examples above and on the flap)
Total Cost

without tax

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

a() 

purchased for

someone not

on your list

319

320

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 41–42.

§)"C¤

080134

34

What did you buy or pay for? Age

Under

2 2–15

16 & 

Over

321

322

323

324

325

Was the 

item for:

male female

CE-801, Page 34, Pantone Blue- PMS-313

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples above and on the flap)
Total Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

a() 

purchased for

someone not

on your list

419

420

FORM CE-801 (1-1-2013)

If there are not enough lines in this part, please continue recording your expenses on pages 43–44.

§)"D¤

080135

35

What did you buy or pay for?

421

422

423

424

425

CE-801, Page 35, Pantone Blue - PMS-313

(see examples above and on the flap)
Mark (X) one that

best describes 

the type of meal

breakfastlunchdinnersnack/other

Fast-Food

Take-out

Delivery

Concession

Full 

Service

Places

Description

with tax & tip

If alcoholic

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

FORM CE-801 (1-1-2013)

§)"E¤

080136

wine

beer

other

36

117

118

119

120

121

122

123

CE-801, Page 36, Pantone Blue - PMS-313

Total Cost

(see examples on the flap)
Mark (X) one that

best describes 

the type of meal

breakfast lunch dinner snack/other

Fast-Food

Take-out

Delivery

Full 

Service

Places

Total Cost

with tax & tip

beverages

included,

mark (X) all 

that apply

Enter the

total cost of

the alcohol

Vending

Machines

or Mobile

Vendors

Employer 

or School

Cafeteria

Mark (X) one that best describes

where you made this purchase

124

125

126

127

128

129

130

131

132

133

134

135

FORM CE-801 (1-1-2013)

§)"F¤

080137

wine

beerother

37

142

143

144

145

146

136

CE-801, Page 37, Pantone Blue - PMS-313

137

138

139

140

141

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

1234 1 2 3 4 123

Description

(see examples on the flap)

Concession
Total Cost

without tax

purchased for

someone not 

on your list

FORM CE-801 (1-1-2013)

§)"G¤

080138

38

What did you buy or pay for?

227

CE-801, Page 38, Pantone Blue - PMS-313

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

219

220

221

222

223

224

225

226

bottled/

canned

fresh frozen other

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

1 34 2

1 34 2

(see examples on the flap)

Mark (X) one
Total Cost

without tax

Mark (X) if

purchased for

someone not 

on your list

FORM CE-801 (1-1-2013)

§)"H¤

080139

39

What did you buy or pay for?

254

CE-801, Page 39, Pantone Blue - PMS-313

228

229

230

231

232

233

234

235

236

237

238

239

240

241

242

243

244

245

246

247

248

249

250

251

252

253

bottled/

canned

fresh frozen other

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

1 34 2

1 34 2

Mark (X) one

(see examples on the flap)
Total Cost

without tax

Mark (X) if

purchased for

someone not 

on your list

FORM CE-801 (1-1-2013)

§)"I¤

080140

40

281

CE-801, Page 40, Pantone Blue - PMS-313

256

257

258

259

260

261

262

263

264

265

266

267

268

269

270

271

272

273

274

275

276

277

278

279

280

What did you buy or pay for?

bottled/

canned

s ts te

fresh frozen other

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

1 34 2

1 34 2

Mark (X) one

(see examples on the flap)

255
3. Clothing, Shoes, Jewelry, and Accessories

Total Cost

without tax

Mark (X) if

purchased for

someone not 

on your list

FORM CE-801 (1-1-2013)

§)"J¤

080141

41

What did you buy or pay for?

309

CE-801, Page 41, Pantone Blue - PMS-313

282

283

284

285

286

287

288

289

290

291

292

293

294

295

301

302

303

304

305

306

307

308

Mark (X) if

purchased for

someone not 

on your list

Total Cost

without tax

Was the

item for: Under

2

16 & 

Over male female 2–15

What did you buy or pay for? Age:

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

bottled/

canned

s ts te

fresh frozen other

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

Mark (X) one

(see examples on the flap)

(see examples on the flap)
FORM CE-801 (1-1-2013)

§)"K¤

080142

42

336

CE-801, Page 42, Pantone Blue - PMS-313

310

311

312

313

314

315

316

317

() 

purchased for

someone not 

on your list

Total Cost

without tax

Was the

item for: Under

2

16 & 

Over

2–15 male female

What did you buy or pay for?

318

319

320

321

322

323

324

325

326

327

328

329

330

331

332

333

334

335

Age:

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

1 2 123

(see examples on the flap)
FORM CE-801 (1-1-2013)

§)"L¤

080143

43

427

CE-801, Page 43, Pantone Blue - PMS-313

401

402

403

404

405

406

407

408

() 

purchased for

someone not 

on your list

Total Cost

without tax

409

410

411

412

413

414

415

416

417

418

419

420

421

422

423

424

425

426

What did you buy or pay for?

(see examples on the flap)
FORM CE-801 (1-1-2013)

§)"M¤

080144

44

454

CE-801, Page 44, Pantone Blue - PMS-313

428

429

430

431

432

433

434

435

purchased for

someone not 

on your list

Total Cost

without tax

436

437

438

439

440

441

442

443

444

445

446

447

448

449

450

451

452

453

What did you buy or pay for?

(see examples on the flap)
(contin

on the same line 

the items. See ex

3.

Record the expe

when you use it.

How should I r

as a subway fa

Record the indiv

you use your cre

not on the day y

bill.

4. How should I r

purchases?

5.

Yes, record auto

health insurance 

account or paych

that week. Write 

Other Products, 

Should I recor

taken from my 

account?

6. Should I recor

Yes, record typic

them during the 

Write them in th

Products, Servic

7.

Subtract the disc

write the amoun

What should I 

discount cards

8.

No, we need you 

information in th

save your receip

field representat

can use the pock

cover to store yo

record your purc

Can I just give 

writing the inf

9.

Write down the a

How should I r

know whether 

FORM CE-801 (1-1-2013)

Black Ink (40% and 100%)
(contin

What about g

cards?

If you buy a gif

write down the 

section (e.g. a c

would go unde

Accessories (Pa

department sto

Products, Servi

you buy somet

down the full a

ignoring the gif

If an item is bo

diary week, it c

was bought ou

during the wee

item is exchang

entry. If the new 

old cost and wr

examples on pa

12. What do I do 

Yes, but if som

helps pay for a

reimbursed for 

extra amount t

has to pay.

13. Should I reco

expenses?

Include the ship

price of the item

covered multip

handling in the 

order.

14. What should 

handling cost

A concession s

location and a 

mobile vendors 

they are usually 

are still conside

they have the o

15. What’s the di

concession s

FORM CE-801 (1-1-2013)

11.

Black Ink (40% and 100%)
FORM CE-801 (1-1-2013)

Bank Statements

Credit Card Statements

Pay Stubs

Catalog/Internet Order Invoices

Utility Bills

Telephone bills

■

■

■

■

■

■
Daily Reminder List

Did you or anyone on your list pay for . . .

Please review the list of expenses below with the people on your list at the end of each da

If you have forgotten to record any expense, please do so on the appropriate page.

■

catered events or meal plans?

food & drinks from a grocery store or other speciality food store

FORM CE-801 (1-1-2013)

clothing, shoes, jewelry, accessories or clothing services such as dry cleaning?

personal care items or services such as cosmetics, soaps, haircuts, etc.?

housekeeping supplies or services for home decoration/maintenance?

toys, books, electronics, hobby supplies, etc.?

cigarettes, tobacco, or other smoking supplies?

commuting costs such as public transportation, parking fees, gasoline, or tolls?

medicine or medical/dental services?

entertainment or recreational activities?

typical bills such as utility bills, cable bills, telephone bills, etc.?

automatic deductions from a paycheck such as insurance premiums?

bank/ATM service fees?

credit card interest or finance charges?

internet or catalog orders?

fees for lessons or instructions?

gifts, contributions, donations?

For more specific examples of expenses, please refer to the flap attached to the front cover.

vending machines, concession stands, etc.?

such as a bakery, candy shop, or liquor store?

meals, drinks, or snacks from restaurants, fast food, cafeterias,

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■

RO 

code

Spinoff 

Indicator

Control Number Week

PSU code Segment No. Segment No.

Suffix

Sample

Designation

Serial No. Serial No.

Suffix

HH No. CU No.

1 2