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(1-1-98)

NOTICE – Your report to the Census Bmay be seen only by sworn Census em

Please recand purch

FROM (First day)

U.

S.

DEPARTMENT OF COMMERC

E

BUREAU OF THE CENSUS

THROUGH (Seventh day)

Field representative’s name 

I will return on _________If you have any question

Field representative supervisor’s 

RegionalOfficecode

OF

Control number

PSU code Segment

number

Segmenumbesuffix

1.2. Household number 3. C

Second dayThird dayFourth dayFifth daySixth day
FORM CE-801 (1-1-98)

INSTRUCTIONS

I. HOW IS THE CONSUMER EXPENDITURE DIARY USED?

The Consumer Expenditure Diary Survey is sponsored by the Bureau 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 the7-day period indicated on the front page. Beginning on page 11 there are7 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 TO RECORD

Most people find that keepipurchases as soon as they person who keeps this diary members to obtain their ex

V. WHAT TO REPORT

Please use this diary to recosmall or inexpensive they aINCLUDE items such as:• Food for Home Consumpt• Food Away from Home su

meals purchased at restau

• Non Food Items such as c

and services, medicines, a

• Food and nonfood items p

purchased for someone omembers

• Any items rented such as • Any items purchased by cDO NOT INCLUDE these ite• Expenses of CU members • Business or farm operatin• Sales tax in the cost of the CREDIT CARDS• If an item is purchased on 

full cost of the item on the made on billing statementcharge account.

©
FORM CE-801 (1-1-98)

VI. WHERE AND HOW TO RECORD EXPENSES

The diary is divided by day. Each day of the diary is divided into 5 parts. FoodAway From Home; Food For Home Consumption; Food and BeveragesPurchased as Gifts; 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 2 – FOOD FOR HOME CONSUMPTION

Record whether the item is fresh, frozen, bottled, canned, or some other typeof packaging.

• PART 3 – FOOD AND BEVERAGES PURCHASED AS GIFTS

Record whether the item is fresh, frozen, bottled, canned, or some other typeof packaging.

VIII. EXAMPLES

The following list shows exampPlease record similar types of d

FOOD FOR HOME CONSUMP

BEEF – Specify the cut and desPORK – Specify the cut and desbacon, etc.

• PART 1 – FOOD AWAY FROM HOME

Read through all the Food Away From Home categories. To select theappropriate category, it is helpful to think of the location where it waspurchased e.g. – popcorn at a movie concession stand, beer at the ballpark,lunch at my employer cafeteria, etc. Report the total bill, including tax andtip. Include any alcoholic drinks purchased. Record the alcohol cost. Do notitemize the bill for each person.

• PART 4 – CLOTHING, SHOES, AND JEWELRY

Specify whether it was purchased for someone outside your Consumer Unit.Also record the code for the age and sex of the person for whom the itemwas purchased.

In all cases, the item purchased and the cost of the item are needed.Additional information is required in the following Parts:• 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 VIII on this page, which show theamount of information we would like you to record. I will return to pick upyour completed diary on _______________. If you have any questions, pleasefeel to call me. THANK YOU FOR YOUR COOPERATION.

If there is not enough space to record all expenses for a particular day on thelines provided, enter the additional items on pages 60–66. Be sure to specifythe day on which the expenses occurred in the column headed "Enter Day ofthe Week."

VII. ADDITIONAL PAGES

CHICKEN – Specify if whole or SOFT DRINKS – Specify if cola COFFEE – Specify if instant or gOTHER FOOD – Give a completFOOD AWAY FROM HOMEMEALS, SNACKS, AND DRINKS and place in the appropriate caalcohol is included, specify the CLOTHING, SHOES, AND JECLOTHING – Specify type of cloALL OTHER PURCHASES ANDOCTOR BILLS – Specify type ointernist, etc.MEDICINE – Specify if prescriptcough syrup.TOOLS – Specify if power or haSHOES – If sports shoes, specifJEWELRY – Specify type of jewBREAD – Specify if white, wholLAUNDRY/DRY CLEANING – Sphousehold item (such as drape
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

To be completed by field representative only

Cents

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a 

Line

number

PROCESSING

USE

Part 1 – Food Awa

VENDING MACHINES anInclude vending machines amove from place to place.EMPLOYER and SCHOOL only food/drinks bought at cafeteria.

120121122123124125126127128129131134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN F

130136

List all meals, snacks, a

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

FIELD REPRESENTATIVE – Review the examples 

respondent for some typical expenditures and r

EXAMPLE
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption Cents

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 (Bacon, pork chops, ham

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111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, salami, lamb, game, organ meaFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©

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

respondent for some typical expenditure

EXAMPLE
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont. Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, powdered milk, cream, butter, margarine, cheese, ice cream, etc.)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.)

VEGETABLES and VEGETABLE juice, potatoes, beans, corn, and etc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

Describe item 

PROCESSING

USE

OTHER FOOD ITEMS (Soupgourmet or specialty items, ssauces, gravies, baby food, n

Part 2 – Food for Ho

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281

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

respondent for some typical expenditu

EXAMPLE
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont. Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, FOdress, shorts, pants, sweater, et

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, Sho

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and SLEEpajamas, lingerie, hosiery, etc.)OUTDOOR, WORK, SCHOOL, jacket, thermals, windbreaker, u

408

Describe item pur

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

respondent for some typical expenditure

EXAMPLE
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING SUsmoking accessories, etc.)

a

Line

number

PROCESSING

USE

Desc

Part 5 – All Othe

GASOLINE, OIL and ADDITIVbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SUPP(Prescription/nonprescription dreyeglasses, hearing aids, wheehealth insurance, doctor/dentist 

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2

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

respondent for some typical expenditure

EXAMPLE
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont. Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other Pu

HOME FURNISHINGS, DECOAPPLIANCES (Refrigerators, spicture frames, vases, indoor pltowels, etc.)HOME MAINTENANCE, HAR(Decorations, improvement and power and hand tools, nails, sc

Describe 

HOUSING EXPENSES (Rent, mhomeowner’s insurance, mainteremoval, heating and cooling eq

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

respondent for some typical expenditure

EXAMPLE
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont. Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other Pu

SCHOOL EXPENSES (High schother school supplies, day care, ALL OTHER EXPENSES (Pet supplinewspapers, magazines, film and phodues, legal and accounting fees, donaoperated dry cleaning, shoe repair, a

1 2 

568569

Des

566577

592

1 21 2

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

respondent for some typical expenditure

EXAMPLE
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

FIRST DAY

Cents

ENTER DAY OF 

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC 1 S 2 M 3 T 4 

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a b 

Line

number

PROCESSING

USE

Part 1 – Food Away 

VENDING MACHINES and MInclude vending machines and move from place to place.EMPLOYER and SCHOOL Conly food/drinks bought at a scafeteria.

120121122123124125126127128129131134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN FOO

130136

List all meals, snacks, and 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

FIRST DAY – Continued

Cents

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 (Bacon, pork chops, ham

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, salami, lamb, game, organ meaFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

FIRST DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLE JUjuice, potatoes, beans, corn, and otheetc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a b

Line

number

Describe item p

PROCESSING

USE

OTHER FOOD ITEMS (Soups, gourmet or specialty items, seasauces, gravies, baby food, non

Part 2 – Food for Home 

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

FIRST DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, FOdress, shorts, pants, sweater, et

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, Sho

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and SLEEpajamas, lingerie, hosiery, etc.)OUTDOOR, WORK, SCHOOL, jacket, thermals, windbreaker, u

408

Describe item pur
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

FIRST DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING SUsmoking accessories, etc.)

a

Line

number

PROCESSING

USE

Desc

Part 5 – All Othe

GASOLINE, OIL and ADDITIVbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SUPP(Prescription/nonprescription dreyeglasses, hearing aids, wheehealth insurance, doctor/dentist 

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

FIRST DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other Pu

HOME FURNISHINGS, DECOAPPLIANCES (Refrigerators, spicture frames, vases, indoor pltowels, etc.)HOME MAINTENANCE, HAR(Decorations, improvement and power and hand tools, nails, sc

Describe 

HOUSING EXPENSES (Rent, mhomeowner’s insurance, mainteremoval, heating and cooling eq
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

FIRST DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other Pu

SCHOOL EXPENSES (High schother school supplies, day care, ALL OTHER EXPENSES (Pet supplinewspapers, magazines, film and phodues, legal and accounting fees, donaoperated dry cleaning, shoe repair, a

1 2 

568569

Des

566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

SECOND DAY

Cents

ENTER DAY OF 

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a b 

Line

number

PROCESSING

USE

Part 1 – Food Away 

VENDING MACHINES and MInclude vending machines and move from place to place.EMPLOYER and SCHOOL Conly food/drinks bought at a scafeteria.

120121122123124125126127128129131134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN FOO

130136

List all meals, snacks, and 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

SECOND DAY – Continued

Cents

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 (Bacon, pork chops, ham

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, salami, lamb, game, organ meaFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

SECOND DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLE JUjuice, potatoes, beans, corn, and otheetc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a b

Line

number

Describe item p

PROCESSING

USE

OTHER FOOD ITEMS (Soups, gourmet or specialty items, seasauces, gravies, baby food, non

Part 2 – Food for Home 

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

SECOND DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, FOdress, shorts, pants, sweater, et

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, Sho

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and SLEEpajamas, lingerie, hosiery, etc.)OUTDOOR, WORK, SCHOOL, jacket, thermals, windbreaker, u

408

Describe item pur
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

SECOND DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING SUsmoking accessories, etc.)

a

Line

number

PROCESSING

USE

Desc

Part 5 – All Othe

GASOLINE, OIL and ADDITIVbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SUPP(Prescription/nonprescription dreyeglasses, hearing aids, wheehealth insurance, doctor/dentist 

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

SECOND DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other Pu

HOME FURNISHINGS, DECOAPPLIANCES (Refrigerators, spicture frames, vases, indoor pltowels, etc.)HOME MAINTENANCE, HAR(Decorations, improvement and power and hand tools, nails, sc

Describe 

HOUSING EXPENSES (Rent, mhomeowner’s insurance, mainteremoval, heating and cooling eq
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

SECOND DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other Pu

SCHOOL EXPENSES (High schother school supplies, day care, ALL OTHER EXPENSES (Pet supplinewspapers, magazines, film and phodues, legal and accounting fees, donaoperated dry cleaning, shoe repair, a

1 2 

568569

Des

566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

THIRD DAY

Cents

ENTER DAY OF 

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a b 

Line

number

PROCESSING

USE

Part 1 – Food Away 

VENDING MACHINES and MInclude vending machines and move from place to place.EMPLOYER and SCHOOL Conly food/drinks bought at a scafeteria.

120121122123124125126127128129131134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN FOO

130136

List all meals, snacks, and 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

THIRD DAY – Continued

Cents

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 (Bacon, pork chops, ham

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, salami, lamb, game, organ meaFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

THIRD DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLE JUjuice, potatoes, beans, corn, and otheetc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a b

Line

number

Describe item p

PROCESSING

USE

OTHER FOOD ITEMS (Soups, gourmet or specialty items, seasauces, gravies, baby food, non

Part 2 – Food for Home 

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

THIRD DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, FOdress, shorts, pants, sweater, et

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, Sho

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and SLEEpajamas, lingerie, hosiery, etc.)OUTDOOR, WORK, SCHOOL, jacket, thermals, windbreaker, u

408

Describe item pur
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

THIRD DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING SUsmoking accessories, etc.)

a

Line

number

PROCESSING

USE

Desc

Part 5 – All Othe

GASOLINE, OIL and ADDITIVbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SUPP(Prescription/nonprescription dreyeglasses, hearing aids, wheehealth insurance, doctor/dentist 

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

THIRD DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other Pu

HOME FURNISHINGS, DECOAPPLIANCES (Refrigerators, spicture frames, vases, indoor pltowels, etc.)HOME MAINTENANCE, HAR(Decorations, improvement and power and hand tools, nails, sc

Describe 

HOUSING EXPENSES (Rent, mhomeowner’s insurance, mainteremoval, heating and cooling eq
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

THIRD DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other Pu

SCHOOL EXPENSES (High schother school supplies, day care, ALL OTHER EXPENSES (Pet supplinewspapers, magazines, film and phodues, legal and accounting fees, donaoperated dry cleaning, shoe repair, a

1 2 

568569

Des

566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

FOURTH DAY

Cents

ENTER DAY OF 

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a b 

Line

number

PROCESSING

USE

Part 1 – Food Away 

VENDING MACHINES and MInclude vending machines and move from place to place.EMPLOYER and SCHOOL Conly food/drinks bought at a scafeteria.

120121122123124125126127128129131134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN FOO

130136

List all meals, snacks, and 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

FOURTH DAY – Continued

Cents

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 (Bacon, pork chops, ham

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, salami, lamb, game, organ meaFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

FOURTH DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLE JUjuice, potatoes, beans, corn, and otheetc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a b

Line

number

Describe item p

PROCESSING

USE

OTHER FOOD ITEMS (Soups, gourmet or specialty items, seasauces, gravies, baby food, non

Part 2 – Food for Home 

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

FOURTH DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, FORdress, shorts, pants, sweater, et

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, Sho

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and SLEEpajamas, lingerie, hosiery, etc.)OUTDOOR, WORK, SCHOOL, jacket, thermals, windbreaker, u

408

Describe item pur
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

FOURTH DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING SUsmoking accessories, etc.)

a

Line

number

PROCESSING

USE

Descr

Part 5 – All Othe

GASOLINE, OIL and ADDITIVbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SUPP(Prescription/nonprescription dreyeglasses, hearing aids, wheelhealth insurance, doctor/dentist 

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

FOURTH DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other Pu

HOME FURNISHINGS, DECORAPPLIANCES (Refrigerators, stpicture frames, vases, indoor platowels, etc.)HOME MAINTENANCE, HARD(Decorations, improvement and power and hand tools, nails, scr

Describe 

HOUSING EXPENSES (Rent, mhomeowner’s insurance, mainteremoval, heating and cooling eq
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

FOURTH DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other Pu

SCHOOL EXPENSES (High schother school supplies, day care, ALL OTHER EXPENSES (Pet supplienewspapers, magazines, film and phodues, legal and accounting fees, donaoperated dry cleaning, shoe repair, al

1 2 

568569

Des

566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

FIFTH DAY

Cents

ENTER DAY OF 

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a b 

Line

number

PROCESSING

USE

Part 1 – Food Away 

VENDING MACHINES and MInclude vending machines and move from place to place.EMPLOYER and SCHOOL CAonly food/drinks bought at a scafeteria.

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©

CATERED AFFAIRSBOARD or MEAL PLAN FOO

130136

List all meals, snacks, and 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

FIFTH DAY – Continued

Cents

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 (Bacon, pork chops, ham

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, bsalami, lamb, game, organ meatFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

FIFTH DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLE JUjuice, potatoes, beans, corn, and otheetc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a b

Line

number

Describe item p

PROCESSING

USE

OTHER FOOD ITEMS (Soups, fgourmet or specialty items, seassauces, gravies, baby food, non

Part 2 – Food for Home 

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

FIFTH DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, FORdress, shorts, pants, sweater, et

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, Sho

1 234

Part 3 – Food and Beverages Purchased

as Gifts

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401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and SLEEpajamas, lingerie, hosiery, etc.)OUTDOOR, WORK, SCHOOL, jacket, thermals, windbreaker, u

408

Describe item pur
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

FIFTH DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING SUsmoking accessories, etc.)

a

Line

number

PROCESSING

USE

Descr

Part 5 – All Othe

GASOLINE, OIL and ADDITIVbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SUPP(Prescription/nonprescription dreyeglasses, hearing aids, wheelhealth insurance, doctor/dentist 

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

FIFTH DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other Pu

HOME FURNISHINGS, DECORAPPLIANCES (Refrigerators, stpicture frames, vases, indoor platowels, etc.)HOME MAINTENANCE, HARD(Decorations, improvement and power and hand tools, nails, scr

Describe 

HOUSING EXPENSES (Rent, mhomeowner’s insurance, mainteremoval, heating and cooling eq
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

FIFTH DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other Pu

SCHOOL EXPENSES (High schother school supplies, day care, ALL OTHER EXPENSES (Pet supplienewspapers, magazines, film and phodues, legal and accounting fees, donaoperated dry cleaning, shoe repair, al

1 2 

568569

Des

566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

SIXTH DAY

Cents

ENTER DAY OF 

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a b 

Line

number

PROCESSING

USE

Part 1 – Food Away 

VENDING MACHINES and MInclude vending machines and move from place to place.EMPLOYER and SCHOOL CAonly food/drinks bought at a scafeteria.

120121122123124125126127128129131134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN FOO

130136

List all meals, snacks, and 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

SIXTH DAY – Continued

Cents

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 (Bacon, pork chops, ham

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a b 

Line

number

Describe item p

PROCESSING

USE

Part 2 – Food for Home 

FISH and SEAFOOD (Fish, shePOULTRY (Whole chicken, turkpoultry, etc.)OTHER MEATS (Frankfurters, bsalami, lamb, game, organ meatFATS, OILS and DRESSINGS salad dressings, shortening, etc

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

SIXTH DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLE JUjuice, potatoes, beans, corn, and otheetc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a b

Line

number

Describe item p

PROCESSING

USE

OTHER FOOD ITEMS (Soups, fgourmet or specialty items, seassauces, gravies, baby food, non

Part 2 – Food for Home 

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

SIXTH DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, dress, shorts, pants, sweate

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, S

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and Spajamas, lingerie, hosiery, eOUTDOOR, WORK, SCHOjacket, thermals, windbreake

408

Describe item 
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

SIXTH DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING smoking accessories, etc.)

a

Line

number

PROCESSING

USE

D

Part 5 – All O

GASOLINE, OIL and ADDIbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SU(Prescription/nonprescription eyeglasses, hearing aids, whhealth insurance, doctor/den

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

SIXTH DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other 

HOME FURNISHINGS, DEAPPLIANCES (Refrigeratorpicture frames, vases, indootowels, etc.)HOME MAINTENANCE, H(Decorations, improvement power and hand tools, nails

Desc

HOUSING EXPENSES (Renhomeowner’s insurance, maremoval, heating and coolin
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

SIXTH DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other 

SCHOOL EXPENSES (High other school supplies, day caALL OTHER EXPENSES (Pet sunewspapers, magazines, film and dues, legal and accounting fees, doperated dry cleaning, shoe repa

1 2 

568569566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

SEVENTH DAY

Cents

ENTER DAY O

FAST FOOD, TAKE-OUT, DELIVERY, CONCESSIONSTANDS, BUFFET and CAFETERIA – You payBEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS, DRINKS – Youpay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

None PROCESSING USE

1 2 TR 3 BD 4 VC

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a 

Line

number

PROCESSING

USE

Part 1 – Food Aw

VENDING MACHINES anInclude vending machines move from place to place.EMPLOYER and SCHOOonly food/drinks bought at cafeteria.

120121122123124125126127128129134135132133

©

CATERED AFFAIRSBOARD or MEAL PLAN F

130

List all meals, snacks, 

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

136131
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption

SEVENTH DAY – Continued

Cents

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 (Bacon, pork chops, h

201202203204205206207208209210211212213214215216217218219220221

111111111111111111111

222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

Describe ite

PROCESSING

USE

Part 2 – Food for Ho

FISH and SEAFOOD (Fish, POULTRY (Whole chicken, poultry, etc.)OTHER MEATS (Frankfurtesalami, lamb, game, organ mFATS, OILS and DRESSINsalad dressings, shortening, 

222223224225226227228229230231232233234235236237238239240

© ©
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

SEVENTH DAY – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, whole milk, skim milk, 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.)

VEGETABLES and VEGETABLjuice, potatoes, beans, corn, and etc.)

1111111111111111111

2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

Describe ite

PROCESSING

USE

OTHER FOOD ITEMS (Sougourmet or specialty items, sauces, gravies, baby food, 

Part 2 – Food for Ho

1 234

241242243244245246247248249250251252253254255256257258259260

261262263264265266267268269270271272273274275276277278279280281
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home Consumption – Cont.

SEVENTH DAY – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee, tea,fruit-flavored and other noncarbonated beverages,carbonated and noncarbonated waters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (for someoneoutside your CU) (Fruit baskets, cheese, candy, wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSWEAR, dress, shorts, pants, sweate

11111111111111111

22222222222222222

33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Clothing, S

1 234

Part 3 – Food and Beverages Purchased

as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS and Spajamas, lingerie, hosiery, eOUTDOOR, WORK, SCHOjacket, thermals, windbreake

408

Describe item 
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

SEVENTH DAY – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

11111111111111

22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOKING smoking accessories, etc.)

a

Line

number

PROCESSING

USE

D

Part 5 – All O

GASOLINE, OIL and ADDIbrake fluid, etc.)

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDICAL SU(Prescription/nonprescription eyeglasses, hearing aids, whhealth insurance, doctor/den

SPORTS-TEAM CLOTHES and SPORT SHOES(Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

SEVENTH DAY – Continued

Cents

HOUSEKEEPING SUPPLIES and SERVICES (Laundry and cleaningdetergents, cleansers, sponges, mops and brooms, bathroom tissue, papertowels, 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 care products, perfume, deodorants, men’s and women’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Pots andpans, dinnerware, glassware, knives, forks, spoons, pot holders, canisters,cooking utensils, can openers, blenders, mixers, food processors, coffeemakers, irons, telephones, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 – All Other 

HOME FURNISHINGS, DEAPPLIANCES (Refrigeratorpicture frames, vases, indootowels, etc.)HOME MAINTENANCE, H(Decorations, improvement power and hand tools, nails

Desc

HOUSING EXPENSES (Renhomeowner’s insurance, maremoval, heating and coolin
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and Expenses – Cont.

SEVENTH DAY – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events, records,tapes, CDs, radios, TVs, video/stereo equipment, purchase or rental ofvideos, toys, hunting, camping, sports/exercise equipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance and repair, taxis,buses, commuter fares, car rental, airline fares, train fares, parking fees, tolls, etc.)

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222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594595596597598

Yes No

571

1 21 2

Part 5 – All Other 

SCHOOL EXPENSES (High other school supplies, day caALL OTHER EXPENSES (Pet sunewspapers, magazines, film and dues, legal and accounting fees, doperated dry cleaning, shoe repa

1 2 

568569566577

592

1 21 2
FORM CE-801 (1-1-98) 

a b c

Line

number

List all meals, snacks, and beverages purchased Total cost Include tax and tip

Dollars

PROCESSING

USE

Part 1 – Food Away From Home

ADDITIONAL PAGE

Cents

FAST FOOD, TAKE-OUT, DELIVERY,CONCESSION STANDS, BUFFET and CAFETERIA – You pay BEFORE eating/drinking.FULL-SERVICE MEALS, SNACKS,DRINKS – You pay AFTER eating/drinking.

101102103104105106107108109110111112113114115116117118119

©

e

If "YES" – How much?

Dollars Cents

Werealcoholicbeveragesincludedin totalcost?

d

Mark (X) one

Yes No

a 

Line

number

PROCESSING

USE

Part 1 – Foo

VENDING MACHIVENDORS – Includcarts and trucks thaEMPLOYER and SInclude only food/demployer cafeteria.

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©

CATERED AFFAIRBOARD or MEAL 

130136

List all meals, sna

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

Use this page to record expenditures if you ru

the day of the week (Mon., Tues., etc.) for eac

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

Enter

day

of

the

week

Enter

day

of

the

week
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home 

Consumption

ADDITIONAL PAGE – Continued

Cents

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 (Bacon, pork croasts, etc.)

201202203204205206207208209210211212213214215216217218219220221

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222222222222222222222

333333333333333333333

444444444444444444444

a 

Line

number

Descri

PROCESSING

USE

Part 2 – F

C

FISH and SEAFOOD seafood)POULTRY (Whole chpoultry, etc.)OTHER MEATS (Frasalami, lamb, game, FATS, OILS and DRsalad dressings, shor

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© ©

Use this page to record expenditures if you ru

the day of the week (Mon., Tues., etc.) for eac

(1) (2)

Enter

day

of

the

week

(1) (2)

Enter

day

of

the

week
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home 

 Consumption – Cont.

ADDITIONAL PAGE – Continued

Cents

EGGS and DAIRY PRODUCTS (Eggs, wholemilk, skim milk, 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 fruitjuices, etc.)

VEGETABLES and VEGtomatoes, tomato juice, vegetables and vegetabl

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2222222222222222222

3333333333333333333

4444444444444444444

a 

Line

number

Descri

PROCESSING

USE

OTHER FOOD ITEMbutter, gourmet or spnuts, snack foods, sanondairy creamer, et

Part 2 – 

 

1 234

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261262263264265266267268269270271272273274275276277278279280281

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

Enter

day

of

the

week

Enter

day

of

the

week

Use this page to record expenditures if you ru

the day of the week (Mon., Tues., etc.) for each 
FORM CE-801 (1-1-98) 

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

Part 2 – Food for Home 

Consumption – Cont.

ADDITIONAL PAGE – Continued

Cents

NON-ALCOHOLIC BEVERAGES (Cola and othercarbonated beverages, instant and ground coffee,tea, fruit-flavored and other noncarbonatedbeverages, carbonated and noncarbonatedwaters, etc.)FOOD and BEVERAGES PURCHASED AS GIFTS (forsomeone outside your CU) (Fruit baskets, cheese, candy,wine, beer, liquor, etc.)ALCOHOLIC BEVERAGES (Beer, wine, whiskey,liqueurs, champagne, etc.)

CASUAL, SPORTSW(Suit, shirt, dress, sho

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33333333333333333

4444444444444444

a b 

Line

number

PROCESSING

USE

Part 4 – Cloth

 Jewe

1 234

Part 3 – Food and Beverages 

Purchased as Gifts

282283284285286287288289290291292293301302303304305306

401402403404405406407409410411412413414415416417418419420421

4

UNDERGARMENTS (Socks, pajamas, lingOUTDOOR, WORK, SCjacket, thermals, windb

408

Describe i

(1) (2)

Enter

day

of

the

week

(1) (2)

Enter

day

of

the

week

Use this page to record expenditures if you r

the day of the week (Mon., Tues., etc.) for ea
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

Part 4 – Clothing, Shoes, 

and Jewelry – Cont.

ADDITIONAL PAGE – Continued

SHOES (Boots, dress, work, sandals, sneakers, slippers, etc.)

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22222222222222

111

222

422423424425426427428429430431432433434435436437438439440

Total cost

Do not include

sales tax

Dollars Cents

e

Enter code

TOBACCO and SMOtobacco, smoking acc

a

Line

number

PROCESSING

USE

Part 

 

GASOLINE, OIL and ants, brake fluid, etc.

FORM CE-801 (1-1-98) 

501502503504505506507508509

MEDICINES, MEDIC(Prescription/nonpreseyeglasses, hearing aequipment, health in

SPORTS-TEAM CLOTHES and SPORT SHOES (Cleats, team uniform, ski boots, golf shoes, etc.)JEWELRY, ACCESSORIES, and SEWING ITEMS (Watch, ring, belt, hat, hairpiece, umbrella, thread, buttons, etc.)CLOTHING SERVICES (Tailoring, alterations, shoe repairs, cleaning, storage, etc.)

510511512513514515516517518519520

1 21 21 2

Use this page to record expenditures if you r

the day of the week (Mon., Tues., etc.) for eac

(1) (2)

Enter

day

of

the

week

Enter

day

of

the

week

(1) (2)
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and

Expenses – Cont.

ADDITIONAL PAGE – Continued

Cents

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, handsoap, cosmetics, skin care products, perfume, deodorants, men’s andwomen’s haircuts, etc.)HOUSEWARES and SMALL HOUSEHOLD APPLIANCES (Potsand pans, dinnerware, glassware, knives, forks, spoons, potholders, canisters, cooking utensils, can openers, blenders, mixers,food processors, coffee makers, irons, telephones, etc.)

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222222222222222

a 

Line

number

PROCESSING

USE

1 2

521522523524527525526528529530531532534535536537538

539540541542543544545546547548549550551552553554555556

Yes No

533

1 21 2

Part 5 

HOME FURNISHINGMAJOR APPLIANCrugs, curtains, art, pitablecloths, pillows, sHOME MAINTENANSERVICES (Decoratisupplies and serviceslawn/garden equipmHOUSING EXPENStelephone, homeowntaxes, garbage/snow TV service, etc.)

(1) (2)

Enter

day

of

the

week

Use this page to record expenditures if you ru

the day of the week (Mon., Tues., etc.) for eac

(1) (2)

Enter

day

of

the

week
FORM CE-801 (1-1-98) 

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

Part 5 – All Other Purchases and 

Expenses – Cont.

ADDITIONAL PAGE – Continued

Cents

ENTERTAINMENT/AMUSEMENTS and SPORTS/RECREATION(Admissions to movies, concerts, sporting and cultural events,records, tapes, CDs, radios, TVs, video/stereo equipment, purchaseor rental of videos, toys, hunting, camping, sports/exerciseequipment and fees, etc.)TRANSPORTATION EXPENSES (New and used cars, maintenance andrepair, taxis, buses, commuter fares, car rental, airline fares, train fares,parking fees, tolls, etc.)

111111111111111

222222222222222

a 

Line

number

PROCESSING

USE

1 2

557558559560563561562564565567570572573574575576

578579580581582583584585586587588589590591593594

Yes No

571

1 21 2

Part 

SCHOOL EXPENSEtextbooks and other sALL OTHER EXPENSES stationery, books, newspluggage, sewing goods, babysitting, diaper servicalteration and repair of h

1 2

568569566577

592

1 21 2

Use this page to record expenditures if you r

the day of the week (Mon., Tues., etc.) for eac

Enter

day

of

the

week

(1) (2)

Enter

day

of

the

week

(1) (2)

598597596595
FORM CE-801 (1-1-98) 

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 purchases 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.