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