Your Daily Expenses

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

FORM CE-801 (1-2017)

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.

Field representative’s name:

U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration

U.S. CENSUS BUREAU

Acting as a collecting agent for

U.S. Department of Labor

Bureau of Labor Statistics

U.S. DEPARTMENT OF COMMERCE

BUREAU OF THE CENSUS

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 (40% and 100%); Pantone at 100% -- Red(199), Blue(281)

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

statistical purposes only.

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.

Pierre-Vending

Machine.jpg

Jeanette & LindaPastry Shop.jpg

Stephen - Writing

Checks.jpg

Nhien & Jenny - 

Flower Shop.jpg

George - Gas

Station.jpg

10/4/2016 REVISED

OMB No. 1220-0050

Measuring America

’s

Spending Since 1888
Fill out this diary for an entire week, writing

down EVERYTHING you and the people on

your list spend money on each day – the

products you buy, the services you use, the

household expenses you have during the

week – no matter how large or small they

are.

■

We recommend that you record your

expenses each day. Think about where you

went and what you’ve done.

■ Include payments by 

Expenses of people on your list while 

they were away from home overnight.

■

■ Business or farm operating expenses

Sales tax, except for Meals, Snacks, and 

Drinks Away from Home

■

FORM CE-801 (1-2017)

Black Ink (40% and 100%)

Talk to the people on your list every day

to find out how they spent their money.

■

Cash

Check

Food Stamps

Credit/Debit Card

Money Order

WIC Voucher

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

Bills

Pay Stubs

Bank Statements

Catalog/Internet Purchases

Credit Card Statements

Some record types include:

Include items that you bought for people

who are not on your list, such as gifts.

10/4/2016 REV

Do NOT record Do NOT record

General Instructions General Instructions

Automatic 

Withdrawal

Payroll 

Deduction

■■

Gift Certificate

Store Charge 

Card

FRONT OF FRONT FLAP-ATTACH TO COVER/TITLE PAGE, 

FOLD IN
Meals, Snacks, and Drinks Away from 

Home

Mark one of the four choices that best 

describes the type of meal and describe briefly.

■

2.

FORM CE-801 (1-2017)

Mark one of the four choices that best

describes where you made the purchase.

■

■ 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.

Black Ink (40% and 100%)

The diary is divided into 7 days and each

day is divided into 4 parts.

1.

■ Describe the item.

Mark whether the item was fresh, frozen,

bottled/canned, or other.

■

Enter the cost without tax and deduct any

discounts or coupons.

■

■ Mark the last column if the item was

purchased for someone not on your list

(e.g. gifts).

Clothing, Shoes, Jewelry, and Accessories

Describe the item and enter the cost without

tax.

■

3.

Mark the appropriate sex and age range of 

the person for whom the item was bought.

■

■ Mark the last column if the item was 

purchased for someone not on your list (e.g.

gifts).

All Other Products, Services, and 

Expenses

Describe the item and enter the total cost

without tax.

■

4.

Mark the last column if the item was 

purchased for someone not on your list (e.g.

gifts).

■

There is an Additional Pages section 

on pages 18–23 in case you run out of

lines on any particular day.

10-4-2016 REVISED

How to Fill Out 

Your Diary

How to Fill Out 

Your Diary

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. 

Food and Drinks for Home Consumption

See back flap for answers to 

Frequently Asked Questions

Enter each item in the appropriate part 

for each day.

BACK SIDE OF FRONT FLAP, ATTACH TO RECORD DAILY EXPENSES PAGE
CE-801V1 Black Ink (40% and 100%)

Record Your Daily Expenses Record Your Daily Expenses

The people on your list:

Record the purchases and expenses made by ALL of these people.

FORM CE-801 (1-2017)

Notes Notes

10-4-2016 REVISED
Questions?

Thank you for agreeing to fill out this diary.

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

We understand that this task takes time; however, your information is

very important to us and will be used for many purposes that affect all

Americans. Among the most important, it is used to help calculate the

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 (1-2017)

Thank you for agreeing to fill out this diary.

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%) 10-4-2016 REVISED
10-4-2016 REVISED

Food and Drinks for Home Consumption

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

§)"#¤

080102

2

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

bread

eggs 1 50

chicken wings

apples

beer

milk

orange juice

candy

vegetable oil

baby food

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 X 8 97

ketchup

soup

soda

pork chops

shrimp

cookies

apple pie

carbonated water

ground beef

coffee

bagels

wine

dog food

X 1 59

X 42 00

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

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

1 4 3

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

3 4

Mark (X) one

X

CE-801, Pantone Blue 313 (20%, 40%, 70, & 100%) Pantone Yellow 101 (70%), Black (30% and 100%)

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

12 4 3

12 4 3

12 4 3

12 4 3

1 4 3

Use the pocket on the inside of the back 

cover to store your receipts until you’re 

ready to record your purchases.

1

1

1

1

1

1

1

1

1

1

Examples Examples

2

1

Level of detail needed

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.

OTHER FOOD – Give a complete

description, such as scalloped

potatoes.

1

2

2
10-4-2016 REVISED

Examples Examples

X

Mark (X) one that

best describes 

the type of meal

Meals, Snacks, and Drinks Away from Home breakfast lunch dinner snack/other

Fast Food

Take-out

Delivery

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

3

Description

coffee

X school lunch - month

soda

dinner

drinks at bar

X

X

X

X

X

X

35

X X

X

45

62

15

65

00

23

00

1

12 00

X 15 00

X

X lunch 25

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

301

302

303

304

305

306

307

308

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

dress shirts

running shoes

non-prescription sunglasses

baseball cap

bib

child’s costume (returned for refund)

wallet

necklace

Level of detail needed

SHOES – If sports shoes,

specify sport, such as football

cleats, etc.

JEWELRY – Specify type of 

jewelry, such as watches, etc.

EYEWEAR – Specify prescription

or non-prescription.

X

X

X

X

X

X

X

X

X

75 00

69 00

59 00

14 99

3 50

15 00

29 00

250 00

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

cold medicine (non-prescription) X 6 95

gasoline

highway tolls

Music CD

cigarettes

dry cleaning (clothes)

lottery tickets

bus fare

piano lessons

electric drill

Netflix subscription

X

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.

12 86

2 00

10

8

99

99

15

1

1

00

50

50

150 00

65 00

9 99

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over

1 23

1 23

§)"$¤

080103

412 veterinarian fees 85 00

413 Donation 50 00

CE-801, Pantone Blue 313 (20%, 40%, 70% & 100%), Pantone Yellow 101 (70%), Black (30% & 100%)

X

7
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)"%¤

080104

4

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40%, and 100%)

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

DAY 1 ENTER 

DAY AND

DATE

Food and Drinks for Home Consumption
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

5

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)"&¤

080105

10-4-2016 REVISED

DAY 1

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20% 40%, and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

301

302

303

304

305

306

307

308

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)"’¤

080106

6

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

Food and Drinks for Home Consumption

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40% and 100%)

DAY 2 ENTER 

DAY AND

DATE
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

7

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

301

302

303

304

305

306

307

308

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)"(¤

080107

10-4-2016 REVISED

DAY 2

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)")¤

080108

8

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

Food and Drinks for Home Consumption

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40% and 100%)

DAY 3 ENTER 

DAY AND

DATE
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

9

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

301

302

303

304

305

306

307

308

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)"*¤

080109

10-4-2016 REVISED

DAY 3

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)"+¤

080110

10

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

Food and Drinks for Home Consumption

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40%, and 100%)

DAY 4 ENTER 

DAY AND

DATE
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

11

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

301

302

303

304

305

306

307

308

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)",¤

080111

10-4-2016 REVISED

DAY 4

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)"-¤

080112

12

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

Food and Drinks for Home Consumption

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20%, 40% and 100%)

DAY 5 ENTER 

DAY AND

DATE
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

13

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

301

302

303

304

305

306

307

308

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)".¤

080113

10-4-2016 REVISED

DAY 5

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)"/¤

080114

14

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

Food and Drinks for Home Consumption

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20%, 40% and 100%)

DAY 6 ENTER 

DAY AND

DATE
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

15

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

301

302

303

304

305

306

307

308

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)"0¤

080115

10-4-2016 REVISED

DAY 6

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

bottled/

canned

Cost

without tax

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

Mark (X) If 

purchased for

someone not

on your list

119

120

FORM CE-801 (1-2017)

See pages 2-3 for examples. If you need additional space, use pages 18–23.

§)"1¤

080116

16

What did you buy or pay for?

Is this item:

fresh frozen other

121

122

123

124

125

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 4 3

2 3 4

2 3 4

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

Mark (X) one

126

127

128

129

130

131

132

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

12 4 3

133

134

135

136

2 4 3

2 4 3

2 4 3

2 4 3

12 4 3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

Food and Drinks for Home Consumption

Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20%, 40% and 100%)

DAY 7 ENTER 

DAY AND

DATE
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

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

201

202

203

204

205

206

FORM CE-801 (1-2017)

wine

beer

other

17

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

301

302

303

304

305

306

307

308

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

1 23

1 23

412

§)"2¤

080117

10-4-2016 REVISED

DAY 7

FR USE:

VC

413

Meals, Snacks, and Drinks Away from Home

None

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

Food and Drinks for Home Consumption

Cost

without tax

Mark (X) if

purchased for

someone not 

on your list

FORM CE-801 (1-2017)

§)"3¤

080118

18

127

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

Additional Pages

What did you buy or pay for? bottled/

canned

Is this item:

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

101

128

129

130

131

132

133

134

135

136

137

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

Black Ink (100%), Pantone Blue 313 (20%, 40% and 70%)
FORM CE-801 (1-2017)

§)"4¤

080119

19

Additional Pages

Mark (X) one that

best describes 

the type of meal

Meals, Snacks, and Drinks Away from Home

breakfastlunchdinnersnack/other

Fast Food

Take-out

Delivery

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

201

202

203

204

205

206

wine

beer

other

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

All Other Products, Services, and Expenses

Cost

without tax

401

402

403

404

405

406

407

408

409

410

411

412

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

301

302

303

304

305

306

307

308

10-4-2016 REVISED

1 23

1 23

413

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40%, 70% and 100%)

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

Food and Drinks for Home Consumption

Cost

without tax

Mark (X) if

purchased for

someone not 

on your list

FORM CE-801 (1-2017)

§)"5¤

080120

20

164

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

Additional Pages

What did you buy or pay for? bottled/

canned

Is this item:

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

138

165

166

167

168

169

170

171

172

173

174

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

Black Ink (100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
FORM CE-801 (1-2017)

§)"6¤

080121

21

Additional Pages

Mark (X) one that

best describes 

the type of meal

Meals, Snacks, and Drinks Away from Home

breakfastlunchdinnersnack/other

Fast Food

Take-out

Delivery

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

207

208

209

210

211

212

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

All Other Products, Services, and Expenses

Cost

without tax

414

415

416

417

418

419

420

421

422

423

424

425

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

309

310

311

312

313

314

315

316

10-4-2016 REVISED

1 23

1 23

426

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40%, 70% and 100%)

wine

beer

other

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over
10-4-2016 REVISED

Food and Drinks for Home Consumption

Cost

without tax

Mark (X) if

purchased for

someone not 

on your list

FORM CE-801 (1-2017)

§)"7¤

080122

22

176

177

178

179

180

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

Additional Pages

What did you buy or pay for? bottled/

canned

Is this item:

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

Mark (X) one

175

Black Ink (100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
FORM CE-801 (1-2017)

§)"8¤

080123

23

Additional Pages

Mark (X) one that

best describes 

the type of meal

Meals, Snacks, and Drinks Away from Home

breakfastlunchdinnersnack/other

Fast Food

Take-out

Delivery

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

213

214

215

216

217

218

Description

1234

1234

1 234

1234

1234

1234

1 23

1 23

1 23

1 23

1 23

1 23

1 234

4

4

1 234

1 234

1234

All Other Products, Services, and Expenses

Cost

without tax

427

428

429

430

431

432

433

434

435

436

437

438

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for?

317

318

319

320

321

322

323

324

10-4-2016 REVISED

1 23

1 23

439

Black Ink (40% & 100%), Pantone Blue 313 (20%, 40%, 70% and 100%)

wine

beer

other

Clothing, Shoes, Jewelry, and Accessories

Cost

without tax

Mark (X) If 

purchased for

someone not

on your list

What did you buy or pay for? Was the item for:

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

1 2 34 5

Child

Under 2

Boy

2-15

Girl

2-15

Man

16 &

over

Woman

16 &

over

Keep your records in this pocket.

(These records are only for your reference; we will not keep them.)

FORM CE-801 (1-2017)

Receipts

Bills

Pay Stubs

Bank Statements

Catalog/Internet Purchases

Credit Card Statements

■

■

■

■

■

■

10-4-2016 REVISED
FORM CE-801 (1-2017)

ATTACH THIS FLAP TO POCKET PAGE (FOLD IN, BACK OF FAQ 1-10)

FFrequently requently AAsked sked QQuestions uestions

What about gift certificates or gift

cards?

If you buy a gift certificate to give to someone,

write down the cost of it under the appropriate

section (e.g., a certificate to a clothing store

would go under Clothing, Shoes, Jewelry, and

Accessories and a certificate to a department

store would go under All Other Products,

Services, and Expenses. If you use a gift card,

write down the full amount for your purchase

as if paid with cash.

If an item is bought and returned during the

diary week, it can be erased or crossed out. If 

it was bought outside the week and returned

during the week, do not make an entry. If an

item is exchanged during the week, erase or

cross out the item that was returned and enter

the new item and its cost on the day the

exchange was made.

12. What do I do about returns & exchanges?

Yes, but if someone not on your list pays for 

or helps pay for an expense or if you will be

reimbursed for an expense, only record the

amount that you or someone on your list has 

to pay.

13. Should I record subsidized/reimbursed

expenses?

Include the shipping & handling cost in the total

price of the item. If the shipping & handling

covered multiple items, include the shipping &

handling in the total price of one item from the

order.

14. What should I do about shipping &

handling costs?

A concession stand has to stay in a permanent

location and a mobile vendor does not. Some

mobile vendors may seem permanent because

they are usually in the same location, but they

are still considered mobile vendors because

they have the option to change locations.

15. What’s the difference between a

concession stand and a mobile vendor?

(continued on other side)

11.

Fast food, Take-out, Delivery, Concession

You pay BEFORE you eat/drink

16. How do I categorize the establishment 

for Meals, Snacks, and Drinks Away from 

Home?

10-4-2016 REVISED

■

■

■ Full Services Places

You pay after you eat/drink

Employer and School Cafeterias

Includes school meal pre-payments

Vending Machines or Mobile Vendors

Include vending machines, carts, and 

trucks that move from place to place

■

Black Ink (30% and 100%), Pantone Blue 313 (20% and 100%)
FFrequently requently AAsked sked QQuestions uestions

1. How detailed should my descriptions be?

Refer to pages 2–3 for examples of the level of

detail needed in each part. Do not rely solely 

on brand names.

(continued on other side)

2. How should I record multiple quantities?

You may group identical items on the same line

and enter a total cost of all the items, or you 

may write each item on a separate line with the

individual cost.

3.

Record the expense when you pay for it, not

when you use it.

How should I record pre-payments such

as a subway fare card?

Record the purchase on the day that you use

your credit card to pay for it, not on the day you

receive or pay your credit card bill.

4. How should I record credit card

purchases?

5.

Yes, record automatic deductions (such as

health insurance premiums taken out of your

account or paycheck) only if they are deducted

that week. Write them in the section called All

Other Products, Services, and Expenses.

Should I record automatic deductions

taken from my paycheck or bank

account?

6. Should I record typical monthly bills?

Yes, record typical monthly bills only if you pay

them during the week that you have the diary.

Write them in the section called All Other

Products, Services, and Expenses.

7.

Subtract the discount from the original price 

and write the amount that you paid.

What should I do when I use coupons,

discount cards, or loyalty cards?

8.

No, we need you to write the information in the

diary. We encourage you to save your receipts

to review them with your field representative 

at the end of the week. You can use the pocket

on the inside of the back cover to store your

receipts until you’re ready to record your

purchases.

Can I just give you receipts instead of

writing the information down?

9.

Write down the amount paid.

How should I record items if I don’t 

know whether it includes tax?

FORM CE-801 (1-2017)

Black Ink (30% and 100%), Pantone Blue 313 (20% and 100%)

(continued on other side)

10-4-2016 REVISED

Record money contributions or donations in 

the section called All Other Products, Services, 

and Expenses.

10. What if I make a contribution or

charitable donation?

FINAL FLAP - ATTACH TO BACK COVER (SEE DUMMY)
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 day.

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 (1-2017)

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?

vending machines, concession stands, etc.?

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

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

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■

Coffee.jpg Car Dashboard-

& CD.jpg Gifts.jpg Money.jpg Haircut.jpg Pizza.jpg

Vegetables.jpg Hand Swiping Credit

Card.jpg

Kid with Toys

.jpg

Clothing.jpg Hammer and Nail

 .jpg

Newspaper.jpb

10-4-2016 REVISED

RO 

code

Spinoff 

Indicator

Control Number Week

Survey

code

PSU

state

Frame Sequence

#1

HH

No.

CU 

No. 1 2

PSU

county

Sample

Designation

Sequence

#2