Sales Tax Rate Refundable? YES N
Date of Exchange Rate Information
(effective the date of the survey):
Survey Exchange Rate:
Source of Exchange Rate:
(e.g., bank, USG facility, etc.):
Number of Employees
Number of LPQs
Percentage of Participation:
VAT Tax Rate Refundable? YES N
Other Tax Rate Refundable? YES N
rate available to Federal Government personnel (civilian
Living Pattern Questionnaire
List prevailing sales tax percentages
available to Federal Government personnel (civilian and
military) and indicate if tax is refundable:
List prevailing currency exchange
Interagency Report Control No. 1168-DOS-AN
UNITED STATES DEPARTMENT OF STATE
Retail Price Schedule
Part 1 - Outlet Report
Part 2 - Living Pattern Questionnaire Summary
Date of Survey:
(Date most data are collected (mm-dd-yyyy))
BEFORE BEGINNING THIS REPORT
a. Review the Retail Price Schedule Instructions (DS 2020I).
b. Reports prepared for Uniformed Service members must follow procedures outlined in Appendix M, Joint Federal Travel Regulations.
c. Use the previous Retail Price Schedule as a guide in preparing this report (if applicable).
d. Report prices in currency used for actual purchases by Americans. Explain any use of non-local currencies in local retail outlets.
e. Explain any "cash" or other special discounts in comments.
f. Use substitute retail outlets for items not available in the regular survey outlet.
g. Report any retail sales taxes not included in the prices listed. (Specify the tax rate on each type of goods or services.)
h. Provide explanation of changes in outlets in the cover memorandum.
DS-2020 Part 1 & Part 2
Page 1 of 9
All U.S. Government Agencies at post affected by this report
(including military component):
Agency Names of Representatives
List the individuals responsible for price collection:
Agency Names of Price Collectors
OFFICER WITH OVERALL RESPONSIBILITY FOR THIS SURVEY
I hereby certify that the retail outlets selected for this survey are based on current
employee living pattern survey information and that this report was prepared in
accordance with the guidelines in the U.S. Department of State Standardized
I also certify that the last Living Pattern Questionnaires were completed in full
compliance with the DSSR 074.43.
Signature of Certifying Official
Name (Printed or Typed)
Date Survey Began
Date Survey Completed
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