Fillable Form DS-2020 part 3 RETAIL PRICE SCHEDULE

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Form DS-2020 part 3 RETAIL PRICE SCHEDULE

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RETAIL PRICE SCHEDULE
This is form DS-2020, PART 3
Retail Prices
These forms MUST be submitted together:
DS-2020, Parts 1-3
DS-2021, Part 4 (if applicable)
DS-2020 Part 3 Retail Prices
02-2008
Page 1 of 37
Page 2 of 37
MOST FREQUENTLY USED OUTLET:
NAME:
Beef Steak
Beef Roast
Beef Hamburger
SECOND MOST USED OUTLET:
NAME:
Beef Steak
Beef Roast
Beef Hamburger
MOST FREQUENTLY USED OUTLET:
NAME:
SECOND MOST USED OUTLET:
NAME:
Pork Chops
Loin Roast
Pork Chops
Loin Roast
SUBCATEGORY: BEEF
YES NO N/A
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
TAX: RATE
INCLUDED IN REPORTED PRICE?
(by weight)
SUBCATEGORY: PORK
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO N/A
TAX: RATE
INCLUDED IN REPORTED PRICE?
(by weight)
RETAIL PRICE SCHEDULE, PART 3
CATEGORY: MEAT AND DAIRY PRODUCTS
DS-2020 Part 3 Retail Prices
Page 3 of 37
MOST FREQUENTLY USED OUTLET:
NAME:
Lamb Chops
Lamb, Leg of
SUBCATEGORY: LAMB
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
(by weight)
YES NO N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
SECOND MOST USED OUTLET:
NAME:
Lamb Chops
Lamb, Leg of
MOST FREQUENTLY USED OUTLET:
NAME:
Chicken - Whole
Chicken - Breast
Chicken - Leg
SECOND MOST USED OUTLET:
NAME:
Chicken - Whole
Chicken - Breast
Chicken - Leg
SUBCATEGORY: POULTRY
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
(by weight)
DS-2020 Part 3 Retail Prices
QUANTITY
UNIT
PRICE DESCRIPTION COMMENTS
MOST FREQUENTLY USED OUTLET:
MOST FREQUENTLY USED OUTLET:
Eggs
(each or dozen)
Typical
Substitute
NAME:
Page 4 of 37
SECOND MOST USED OUTLET:
Fish, Canned
(specify type)
Typical
Substitute
Fish, Canned
(specify type)
Typical
Substitute
NAME:
SECOND MOST USED OUTLET:
NAME:
MOST FREQUENTLY USED OUTLET:
NAME:
Fish, Fresh
(uncooked filet, specify type)
Typical
Substitute
SUBCATEGORY: SEAFOOD
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES
NO
N/A
(by weight)
TAX: RATE
INCLUDED IN REPORTED PRICE?
Fish, Fresh
(uncooked filet, specify type)
Typical
Substitute
NAME:
SUBCATEGORY: DAIRY PRODUCTS
YES
NO
N/A
TAX: RATE
INCLUDED IN REPORTED PRICE?
(by weight)
Ice Cream
Typical
Substitute
DS-2020 Part 3 Retail Prices
Cheese
(natural, firm to hard)
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Ice Cream
Cheese
(natural, firm to hard)
Typical
Substitute
Typical
Substitute
CATEGORY: GROCERIES
MOST FREQUENTLY USED OUTLET:
NAME:
Typical
Substitute
Milk, Fresh
Typical
Substitute
SECOND MOST USED OUTLET:
Milk, Fresh
SUBCATEGORY: MILK
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
NAME:
NO
Eggs
(each or dozen)
Typical
Substitute
Page 5 of 37
QUANTITY UNIT
(by weight)
PRICE DESCRIPTION COMMENTS
DS-2020 Part 3 Retail Prices
SUBCATEGORY: DAIRY PRODUCTS
MOST FREQUENTLY USED OUTLET:
NAME:
Bread, White or Wheat
(sliced)
Typical
Substitute
SUBCATEGORY: BREAD, FLOUR
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES
NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
Page 6 of 37
Flour
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Bread, White or Wheat
(sliced)
Flour
Typical
Substitute
Typical
Substitute
MOST FREQUENTLY USED OUTLET:
NAME:
Cereal
(ready-to-eat)
Typical
Substitute
SUBCATEGORY: CEREAL
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
NAMES(S):
Cereal
(ready-to-eat)
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
DS-2020 Part 3 Retail Prices
MOST FREQUENTLY USED OUTLET:
NAME:
Rice, Regular
Typical
Substitute
Pasta
(uncooked)
Typical
Substitute
SECOND MOST FREQUENTLY USED OUTLET:
NAME:
Rice, Regular
Pasta
(uncooked)
Typical
Substitute
Typical
Substitute
SUBCATEGORY: RICE/PASTA
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
MOST FREQUENTLY USED OUTLET:
NAME:
Tea, Bags
(specify # bags)
Typical
Substitute
Coffee, instant
Typical
Substitute
Coffee, ground
Typical
Substitute
SUBCATEGORY: TEA/COFFEE
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES
NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
Page 7 of 37
DS-2020 Part 3 Retail Prices
SECOND MOST USED OUTLET:
NAME:
Tea, Bags
(specify # bags)
Typical
Substitute
Coffee, instant
Typical
Substitute
Coffee, ground
Typical
Substitute
MOST FREQUENTLY USED OUTLET:
NAME:
Soft Drink, Carbonated
Typical
Substitute
Bottled, Drinking Water
Substitute
SECOND MOST USED OUTLET:
NAME:
Soft Drink, Carbonated
Bottled, Drinking Water
Typical
Substitute
Typical
Substitute
SUBCATEGORY: SOFT DRINKS
/BOTTLED WATER
QUANTITY
UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
Typical
Page 8 of 37
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
(by weight)
DS-2020 Part 3 Retail Prices
SUBCATEGORY: TEA/COFFEE
MOST FREQUENTLY USED OUTLET:
NAME:
Candy, Chocolate Bar
(plain)
Typical
Substitute
Sugar, Granulated
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Candy, Chocolate Bar
(plain)
Sugar, Granulated
Typical
Substitute
Typical
Substitute
SUBCATEGORY: CANDY/SUGAR
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
MOST FREQUENTLY USED OUTLET:
NAME:
Baby Food
(exclude meat)
Typical
Substitute
SUBCATEGORY: BABY FOOD
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
Page 9 of 37
SECOND MOST USED OUTLET:
NAME:
Baby Food
(exclude meat)
Typical
Substitute
DS-2020 Part 3 Retail Prices
SUBCATEGORY: FRUITS, FRESH
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
MOST FREQUENTLY USED OUTLET:
NAME:
Cooking Oil
Typical
Substitute
Peanut Butter
Typical
Substitute
SECOND MOST USED OUTLET:
NAMES:
Cooking Oil
Peanut Butter
Typical
Substitute
Typical
Substitute
SUBCATEGORY: FATS, OTHER
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by volume)
TAX: RATE
MOST FREQUENTLY USED OUTLET:
NAME:
Oranges
Apples
Bananas
Page 10 of 37
CATEGORY: FRUITS AND VEGETABLES
DS-2020 Part 3 Retail Prices
SECOND MOST USED OUTLET:
Page 11 of 37
Oranges
Apples
Bananas
MOST FREQUENTLY USED OUTLET:
NAME:
SUBCATEGORY: VEGETABLES, FRESH
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
INCLUDED IN REPORTED PRICE?
TAX: RATE
(by weight)
N/A
Potatoes
Beans, Green
Carrots
Lettuce
Onions
Tomatoes
Lettuce
Onions
Tomatoes
Potatoes
Beans, Green
Carrots
SECOND MOST USED OUTLET:
NAME:
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
(by weight)
NAME:
DS-2020 Part 3 Retail Prices
SUBCATEGORY: FRUITS, FRESH
SUBCATEGORY: FRUITS, CANNED
MOST FREQUENTLY USED OUTLET:
NAME:
Peaches
(822-879gr/29-31oz.)
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
(by weight)
TAX: RATE
Pineapples
(822-879gr/29-31oz.)
Pears
(822-879gr/29-310z.)
Peaches
(822-879gr/29-31oz.)
SECOND MOST USED OUTLET:
NAME:
Pineapples
(822-879gr/29-31oz.)
Pears
(822-879gr/29-31oz.)
SUBCATEGORY: FRUIT JUICES,
CANNED
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
MOST FREQUENTLY USED OUTLET:
NAME:
Apple Juice
(1304gr/46oz.)
Orange Juice
(1304gr/46oz.)
Apple Juice
(1304gr/46oz.)
Orange Juice
(1304gr/46oz.)
SECOND MOST USED OUTLET:
NAME:
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
(by weight)
Page 12 of 37
DS-2020 Part 3 Retail Prices
SUBCATEGORY: VEGETABLES,
CANNED
QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS
MOST FREQUENTLY USED OUTLET:
NAME:
Peas, Green
(425-482gr./15-17oz.)
Corn
(425-482gr./15-17oz.)
Tomatoes
(425-482gr./15-17oz.)
Peas, Green
(425-482gr./15-17oz.)
SECOND MOST USED OUTLET:
NAME:
Corn
(425-482gr./15-17oz.)
Tomatoes
(425-482gr./15-17oz.)
SUBCATEGORY: VEGETABLES,
FROZEN
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
MOST FREQUENTLY USED OUTLET:
NAME:
Peas, Green
(284gr./10oz.)
French Fries
(284gr./10oz.)
Peas, Green
(284gr./10oz.)
SECOND MOST USED OUTLET:
NAME:
French Fries
(284gr./10oz.)
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
(by weight)
(by weight)
Page 13 of 37
DS-2020 Part 3 Retail Prices
UNIT
MOST FREQUENTLY USED OUTLET:
NAME:
Wine, Table, non-vintage
(1 bottle)
Typical
Substitute
MOST SECOND USED OUTLET:
NAME:
Wine, Table, non-vintage
(1 bottle)
Typical
Substitute
MOST FREQUENTLY USED OUTLET:
NAME:
Whiskey, non-premium
(bourbon, scotch, rye,etc.)
Typical
Substitute
MOST SECOND USED OUTLET:
NAME:
Whiskey, non-premium
(bourbon, scotch, rye,etc.)
Typical
Substitute
SUBCATEGORY: WHISKEY
QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS
YES NO
N/A
TAX: RATE
INCLUDED IN REPORTED PRICE?
(by volume
Page 14 of 37
SUBCATEGORY: BEER
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
QUANTITY
(by volume
MOST FREQUENTLY USED OUTLET:
NAME:
Beer
(e.g. 12oz.)
Typical
Substitute
PRICE BRAND/DESCRIPTION COMMENTS
SUBCATEGORY: WINE, TABLE
QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS
YES NO
N/A
TAX: RATE
INCLUDED IN REPORTED PRICE?
(by volume)
CATEGORY: TOBACCO AND ALCOHOL
DS-2020 Part 3 Retail Prices
QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS
(by weight)
MOST SECOND USED OUTLET:
NAME:
Beer
(e.g. 12oz.)
Typical
Substitute
MOST FREQUENTLY USED OUTLET:
NAME:
Cigarettes
(carton of 200)
Typical
Substitute
SUBCATEGORY: CIGARETTES
QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
MOST SECOND USED OUTLET:
NAME:
Cigarettes
(carton of 200)
Typical
Substitute
Page 15 of 37
CATEGORY: CLOTHING
SUBCATEGORY: MEN'S CLOTHING
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Slacks, Man's Dress
Shirt, Man's Dress
Typical
Substitute
Typical
Substitute
DS-2020 Part 3 Retail Prices
SUBCATEGORY: BEER
PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION
MOST FREQUENTLY USED OUTLET:
Shoes, Man's Dress
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Slacks, Man's Dress
Typical
Substitute
Shirt, Man's Dress
Typical
Substitute
Shoes, Man's Dress
Typical
Substitute
Page 16 of 37
MOST FREQUENTLY USED OUTLET:
NAME:
Blouse, Woman's
Typical
Substitute
Skirt, Woman's
Typical
Substitute
Slacks, Woman's Dress
Typical
Substitute
SUBCATEGORY: WOMEN'S CLOTHING
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION
DS-2020 Part 3 Retail Prices
SUBCATEGORY: MEN'S CLOTHING
PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION
SECOND MOST USED OUTLET:
NAME:
Blouse, Woman's
Typical
Substitute
Skirt, Woman's
Typical
Substitute
Slacks, Woman's Dress
Typical
Substitute
Page 17 of 37
SUBCATEGORY: CHILDREN'S
CLOTHING
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Jeans, Child's
Typical
Substitute
Shoes, Child's Athletic
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Jeans Child's
Typical
Substitute
Shoes, Child's Athletic
Typical
Substitute
DS-2020 Part 3 Retail Prices
SUBCATEGORY: WOMEN'S CLOTHING
Page 18 of 37
MOST FREQUENTLY USED OUTLET:
NAME:
Toothpaste
(198g/7oz.)
Typical
Substitute
Razor Blades
(pkg. of 15-10 twin blades.)
Typical
Substitute
SUBCATEGORY: TOILETRIES
QUANTITY UNIT PRICE DESCRIPTION
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
CATEGORY: PERSONAL CARE
SECOND MOST USED OUTLET:
NAME:
Sanitary Napkins
(box of 24)
Typical
Substitute
Typical
Substitute
Typical
Substitute
Typical
Substitute
Typical
Substitute
Typical
Substitute
Shampoo
(450ml/16 fluid oz.)
Toothpaste
(198g/7oz.)
Razor Blades
(pkg. of 15-10 twin blades.)
Sanitary Napkins
(box of 24)
Shampoo
(450ml/16 fluid oz.)
DS-2020 Part 3 Retail Prices
MOST FREQUENTLY USED OUTLET:
SUBCATEGORY: LAUNDRY AND DRY
CLEANING
INCLUDED IN REPORTED PRICE?
YES NO
N/A
TAX: RATE
PRICE DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME
Launder Man's Shirt
Dry Cleaning, Man's Slacks
SECOND MOST USED OUTLET:
NAME:
Launder Man's Shirt
Dry Cleaning, Man's Slacks
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
Launder Man's Shirt
Dry Cleaning, Man's Slacks
SUBCATEGORY: HAIR SERVICES
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE TIP DESCRIPTION
NAME:
Haircut, Man's Regular
Shampoo, Haircut, & Blow Dry, Woman's
Permanent, Woman's
Haircut, Child's
SECOND MOST USED OUTLET:
Haircut, Man's Regular
Shampoo, Haircut, & Blow Dry, Woman's
Permanent, Woman's
Haircut, Child's
NAME:
Page 19 of 37
DS-2020 Part 3 Retail Prices
PRICE DESCRIPTIONTIP
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
Haircut, Man's Regular
Shampoo, Haircut, & Blow Dry, Woman's
Permanent, Woman's
Haircut, Child's
Page 20 of 37
SUBCATEGORY: APPLIANCES
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE BRAND AND DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Microwave, Portable, mid-size
(800-1000 watt)
Typical
Substitute
Typical
Substitute
Typical
Substitute
Typical
Substitute
Toaster, Two Slice
Coffee Maker, drip
(10-12 cup)
SECOND MOST USED OUTLET:
NAME:
Microwave, Portable, mid-size
(800-1000 watt)
CATEGORY: HOUSEHOLD FURNISHINGS
DS-2020 Part 3 Retail Prices
SUBCATEGORY: HAIR SERVICES
PRICE BRAND AND DESCRIPTION
SECOND MOST USED OUTLET:
Typical
Substitute
Typical
Substitute
Toaster, Two Slice
Coffee Maker, drip
(10-12 cup)
Page 21 of 37
SECOND MOST USED OUTLET:
NAME:
Washing Machine
(specify capacity)
Typical
Substitute
SUBCATEGORY: COMPUTER
ACCESSORIES
YES NO N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
MOST FREQUENTLY USED OUTLET:
NAME:
Cartridge, Black Ink
(single)
Typical
Substitute
SUBCATEGORY: WASHING MACHINE
PRICE BRAND AND DESCRIPTION
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
MOST FREQUENTLY USED OUTLET:
NAME:
Washing Machine
(specify capacity)
Typical
Substitute
QUANTITY UNIT PRICE BRAND AND DESCRIPTION
DS-2020 Part 3 Retail Prices
SUBCATEGORY: APPLIANCES
MOST FREQUENTLY USED OUTLET:
Paper, package
(500 sheets)
Typical
Substitute
Blank data CD's R/W
(5pk, 650 or 700MB)
Typical
Substitute
Page 22 of 37
MOST FREQUENTLY USED OUTLET:
NAME:
Diapers, Disposable
(package of 48)
Typical
Substitute
Laundry Detergent Liquid
(gr./oz.)
Typical
Substitute
DESCRIPTION
SUBCATEGORY: HOUSEHOLD
CONSUMABLES
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO N/A
QUANTITY UNIT PRICE
SECOND MOST USED OUTLET:
NAME:
Cartridge, Black Ink
(single)
Paper, package
(500 sheets)
Blank data CD's R/W
(5pk, 650 or 700MB)
Typical
Substitute
Typical
Substitute
Typical
Substitute
QUANTITY UNIT PRICE BRAND AND DESCRIPTION
DS-2020 Part 3 Retail Prices
SUBCATEGORY: COMPUTER
ACCESSORIES
SECOND MOST USED OUTLET:
NAME:
Diapers, Disposable
(package of 48)
Typical
Substitute
Laundry Detergent Liquid
(gr./oz.)
Typical
Substitute
DESCRIPTIONQUANTITY UNIT PRICE
Page 23 of 37
MOST FREQUENTLY USED OUTLET:
NAME:
Pain Reliever Compound
(100 Tabs, 325 mg strength)
Typical
Substitute
Adult Multi-Vitamins
(100 tablets)
Typical
Substitute
Children's Vitamins
(100 tablets)
Typical
Substitute
CATEGORY: MEDICAL
SUBCATEGORY: MEDICINE
QUANTITY UNIT PRICE DESCRIPTION
YES
NO
N/A
TAX: RATE
INCLUDED IN REPORTED PRICE?
ITEM
3 Minutes Long Distance Call to the U.S.
COST PROVIDER
Internet Service, Monthly
Dial Up
DSL
SUBCATEGORY: TELEPHONE SERVICE
(International Long Distance & Internet Service)
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES
NO N/A
DS-2020 Part 3 Retail Prices
SUBCATEGORY: HOUSEHOLD
CONSUMABLES
SECOND MOST USED OUTLET:
NAME:
QUANTITY UNIT PRICE DESCRIPTION
Page 24 of 37
Pain Reliever Compound
(100 tabs, 325 mg strength)
Typical
Substitute
Adult Multi-Vitamins
(100 tablets)
Typical
Substitute
Children's Vitamins
(100 tablets)
Typical
Substitute
MOST FREQUENTLY USED OUTLET:
NAME:
General Practitioner, General Visit
Pediatrician, General Visit
SECOND MOST USED OUTLET:
NAME:
General Practitioner, General Visit
Pediatrician, General Visit
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
General Practitioner, General Visit
Pediatrician, General Visit
NAME:
SUBCATEGORY: DOCTOR
PRICE DESCRIPTION
YES NO
N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
Number of visits by State Department Regional Medical Officer (RMO) to post in the past twelve months:
Is there a State Department Nurse Practitioner at post?
YES
NO
.
DS-2020 Part 3 Retail Prices
SUBCATEGORY: MEDICINE
MOST FREQUENTLY USED OUTLET:
Page 25 of 37
Filling, Simple One Surface
SECOND MOST USED OUTLET:
Extraction, Simple
Prophylaxis
Bitewing
NAME:
Filling, Simple One Surface
Extraction, Simple
Prophylaxis
Bitewing
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
NAME:
Filling, Simple One Surface
Extraction, Simple
Prophylaxis
Bitewing
SUBCATEGORY: HOSPITAL FACILITIES
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE DESCRIPTION
MOST FREQUENTLY USED OUTLET:
Private Room
Semi-Private Room
NAME:
SUBCATEGORY: DENTIST
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES
NO
N/A
PRICE DESCRIPTION
NAME:
DS-2020 Part 3 Retail Prices
Page 26 of 37
SUBCATEGORY: AUDIO/VISUAL
SUPPLIES
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE BRAND AND DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Music CD, in store
(single, no sets)
DVD Movie
(single, no sets)
Typical
Substitute
Typical
Substitute
DVD Player
(no combo player)
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Music CD, in store
(single album)
DVD Movie
(single, no sets)
Typical
Substitute
Typical
Substitute
DVD Player
(no combo player)
Typical
Substitute
CATEGORY: RECREATION
DS-2020 Part 3 Retail Prices
SUBCATEGORY: PHOTOGRAPHIC
SUPPLIES
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME
Film Processing,
24 exposure
Typical
Substitute
Camera Film
24 exposure
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Film Processing
24 exposure
Camera Film
24 exposure
Typical
Substitute
Typical
Substitute
SUBCATEGORY: READING MATERIAL
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
PRICE DESCRIPTION
MOST FREQUENTLY USED OUTLET:
Book, Paperback
Typical
Substitute
Newspaper, Daily
Local
News Magazine, Weekly
Typical
Substitute
Page 27 of 37
DS-2020 Part 3 Retail Prices
SECOND MOST USED OUTLET:
Page 28 of 37
SECOND MOST USED OUTLET:
NAME:
Book, Paperback
Typical
Substitute
Newspaper, Daily
News Magazine, Weekly
Typical
Substitute
Local
SUBCATEGORY: RECREATIONAL
EQUIPMENT
PRICE DESCRIPTION
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
MOST FREQUENTLY USED OUTLET:
Bicycle
Typical
Substitute
Bicycle
Typical
Substitute
NAME:
NAME:
PRICE DESCRIPTION
DS-2020 Part 3 Retail Prices
SUBCATEGORY: READING MATERIAL
Movie Theater
Evening
Performing Arts
Typical
Substitute
Sports Events
Typical
Substitute
Matinee
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
NAME:
Movie Theater
Evening
Matinee
Performing Arts
Typical
Substitute
MOST FREQUENTLY USED OUTLET:
NAME:
Gym Membership
Typical
Substitute
Sport Events
Evening
Matinee
Gym Membership
Typical
Substitute
Page 29 of 37
SUBCATEGORY: RECREATIONAL
ACTIVITIES
TAX: RATE
PRICE DESCRIPTION
INCLUDED IN REPORTED PRICE?
YES NO
N/A
DS-2020 Part 3 Retail Prices
SUBCATEGORY: PET FOOD
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO
N/A
QUANTITY DESCRIPTION
MOST FREQUENTLY USED OUTLET:
Dry Cat Food
Dry Dog Food
Typical
Substitute
Typical
Substitute
SECOND MOST USED OUTLET:
Dry Cat Food
Dry Dog Food
Typical
Substitute
Typical
Substitute
Page 30 of 37
CATEGORY: PUBLIC TRANSPORTATION
SUBCATEGORY: TAXI
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES
NO
N/A
DISTANCE UNIT
(miles/km)
PRICE
(%)
TIP DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Taxi
(approx. 1 1/4 miles/2km or 15 minutes)
Comments:
UNIT PRICE
DS-2020 Part 3 Retail Prices
SUBCATEGORY: MUNICIPAL BUS
INCLUDED IN REPORTED PRICE?
YES
NO
N/A
DISTANCE UNIT PRICE DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
(miles/km)
TAX: RATE
Bus
(3-4 miles/5-6 km at commuter rush hour)
Comments:
SUBCATEGORY: SUBWAY
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES
NO
N/A
DISTANCE UNIT PRICE DESCRIPTION
MOST FREQUENTLY USED OUTLET:
Subway
(5-6 miles/8-10 km at commuter rush hour)
Comments:
(miles/km)
Page 31 of 37
SUBCATEGORY: AIRFARE
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO N/A
DISTANCE UNIT
(Round trip)
PRICE DESCRIPTION
(Round trip)
(miles/km)
MOST FREQUENTLY USED OUTLET:
(round trip full Fare Coach Class, no
restrictions, to destination at least 1,000
miles from post)
Comments:
NAME:
DS-2020 Part 3 Retail Prices
SUBCATEGORY: AUTO FUEL
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO N/A
UNIT COMMENT
NAMES(S):
MOST FREQUENTLY USED OUTLET:
Gasoline
Regular Octane
Medium Octane
High Octane
(gallon/liter)
PRICE
DUTY-FREE/SPECIAL ARRANGEMENTS:
NAME:
Gasoline
Regular Octane
Medium Octane
High Octane
- Report price of gasoline obtained duty-free -- either at the duty location, with coupons, or a tax refund program at a local station or any other special
arrangement
- Percentage of post/duty station personnel eligible to purchase duty-free gasoline, through any means: %
CATEGORY: PERSONALLY OWNED VEHICLE
Page 32 of 37
SUBCATEGORY: AUTO MAINTENANCE
TAX: RATE
YES NO
N/A
PRICE DESCRIPTION
INCLUDED IN REPORTED PRICE?
MOST FREQUENTLY USED OUTLET:
Oil Change
(labor, 5 quarts of oil, and oil filter)
Motor Tune Up
Labor Charge Per Hour
NAME:
DS-2020 Part 3 Retail Prices
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
SECOND MOST USED OUTLET:
Tire, Radial
Typical
Substitute
SECOND MOST USED OUTLET:
NAME:
Oil Change
(labor, 5 quarts of oil, and oil filter)
Motor Tune Up
Labor Charge Per Hour
SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:
NAME:
Oil Change
(labor, 5 quarts of oil, and oil filter)
Motor Tune Up
Labor Change Per Hour
SUBCATEGORY: AUTO PARTS
QUANTITY PRICE BRAND AND DESCRIPTION
YES
NO N/A
INCLUDED IN REPORTED PRICE?
TAX: RATE
UNIT
MOST FREQUENTLY USED OUTLET:
NAME:
Tire, Radial
Typical
Substitute
NAME:
PRICE DESCRIPTION
Page 33 of 37
Tire, Radial
Typical
Substitute
NAME:
DS-2020 Part 3 Retail Prices
SUBCATEGORY: AUTO MAINTENANCE
SUBCATEGORY: AUTO INSURANCE
COST FOR A TWO
YEAR OLD VEHICLE
CURRENCY COMPANY/ DESCRIPTION
YES NO N/A
TAX: RATE
INCLUDED IN REPORTED PRICE?
(Typical cost for a 25 year old male driver).
MOST FREQUENTLY USED OUTLET:
NAME:
1. All inclusive/All Risk
(total of 2, 3, and 4)
2. Liability
3. Comprehensive
4. Collision
Is locally purchased liability insurance required by host-country law?
YES NO
Is there a Tax on Insurance? If Yes, provide Tax Rate:
YES
NO
If employees typically purchase additional insurance from a U.S. based or off-shore company, identify the company, explain and report the price below in the
comments section.
Additional required insurance not reported above:
Comments:
Number of years of safe driving needed to qualify for the discount:
SUBCATEGORY: CHILDCARE
YES
NO N/A
HOURLY
RATE
FIVE DAY
COST
DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Childcare, Outside the Home
Childcare, In the Home of the Parent
CATEGORY: HOUSEHOLD HELP
TAX: RATE
INCLUDED IN REPORTED PRICE?
Page 34 of 37
DS-2020 Part 3 Retail Prices
Page 35 of 37
SUBCATEGORY: HOUSEHOLD
HELP
TAX: RATE
INCLUDED IN REPORTED PRICE?
YES NO N/A
HOURLY
WAGES
SOCIAL
SECURITY
TAX
DESCRIPTION
MOST FREQUENTLY USED OUTLET:
NAME:
Maid
Cook
Day Worker
According to the data in the most recent LPQs completed by post/duty station personnel:
Maid
Cook
Day Worker
Average number of
hours worked per week
Security
Language Difficulties
Other (Please specify in comments section)
Extra cleaning/laundry due to climate
Household Help Necessary for:
Shopping/Food Preparation
Justification for Household Help:
Explain fully why each type of domestic help listed above is needed at the post. Use additional pages as necessary.
FIVE DAY
COST
DS-2020 Part 3 Retail Prices
1. Most Frequently Used Restaurant
Name:
Prices in local currency:
(If not included
in prices)
Page 36 of 37
CATEGORY: FOOD AWAY
This part of the form collects information pertaining to the restaurants typically frequented by post employees when eating
out. It differs from the Per Diem form which collects similar information for individuals visiting post on TDY.
BREAKFAST Restaurant Prices
Restaurant Information
Report Combined Price of
Bacon, 2 Eggs, Juice
Toast, and Coffee or Tea
i.e., the price of a typical
American breakfast
(If bacon is not available,
please incorporate the price
of another meat)
Tax Rates
% Flat
Service Charge or Tip Rates
(If customary and
not included in prices)
% Flat
(If not included
in prices)
YES NO
2. Second Most Used Restaurant
Name:
Prices in local currency:
YES
NO
Comments:
Restaurant Information
LUNCH Restaurant Prices
Main Course
Chicken entree
List prices for the following
a la carte items not included
in main entree
One
Side
Order
Dessert
Coffee,
Tea, or
Soda
(If customary and
not included in prices)
%
Flat % Flat
1. Most Frequently Used Restaurant
Name:
Prices in local currency:
YES NO
2. Second Most Used Restaurant
Name:
Prices in local currency:
YES
NO
Comments:
Tax Rates Service Charge or Tip Rates
DS-2020 Part 3 Retail Prices
1. Most Frequently Used Restaurant
Name:
Prices in local currency:
YES
NO
1. Most Frequently Used Restaurant
Name:
Prices in local currency:
YES
NO
2. Second Most Used Restaurant
Name:
Prices in local currency:
YES
NO
Hamburger
(Large)
French Fries
(Large)
% Flat
(If not included in prices)
Tax Rates
Coffee, Tea,
Soda (Medium)
Restaurant Information
FAST FOOD Restaurant Prices
Comments:
2. Second Most Used Restaurant
Name:
Prices in local currency:
YES NO
Chicken entree % Flat % Flat
(If not included
in prices)
List prices for the following a la carte
items not included in main entree.
Two
Side
Orders
(If customary and
not included in prices)
Restaurant Information
Main Course
Tax Rates Service Charge or Tip Rates
Dessert
Soup Salad
Coffee,
Tea, or
Soda
DINNER Restaurant Prices
Comments:
Page 37 of 37
DS-2020 Part 3 Retail Prices
N/A
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Form DS-2020 part 3 RETAIL PRICE SCHEDULE

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Completed 22 February 2020

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