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
and military):
SALES TAXES:
EXCHANGE RATE:
Living Pattern Questionnaire
(LPQ) Summary
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
Post:
U.S. Agency:
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
01-2008
Page 1 of 9
CONCURRENCE:
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
Regulations. (DSSR).
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)
Title
Date Survey Began
(mm-dd-yyyy)
(mm-dd-yyyy)
Date Survey Completed
click to sign
signature
click to edit
RETAIL PRICE SCHEDULE
This is form DS-2020
PART 1 -
These forms MUST be submitted together:
DS-2020, Parts 1-3
DS-2021 (if applicable)
Outlet Report
DS-2020 Part 1 & Part 2 Page 2 of 9
Retail Price Schedule, Part 1
Page 3 of 9
DS-2020 Part 1 & Part 2
CONSUMER GOODS AND SERVICES
PRIMARY LOCAL
OUTLET
SECONDARY LOCAL
OUTLET
MEATS (beef, pork, lamb, poultry)
FISH, FRESH
FISH, CANNED
DAIRY PRODUCTS (eggs, ice cream, cheese)
GROCERIES
GROCERIES
(milk, bread, cereal, rice, pasta,
soda, baby food, other)
FRUIT AND VEGETABLES
FRESH FRUIT & VEGETABLES
CANNED FRUIT & VEGETABLES
FROZEN VEGETABLES
ALCOHOL AND TOBACCO
CURRENCY
MEAT AND DAIRY PRODUCTS
WINE
WHISKEY (if different from wine)
BEER (if different from wine or whiskey)
CLOTHING
MEN'S
WOMEN'S
CHILDREN'S
CIGARETTES
TOILETRIES (e.g., toothpaste and shampoo)
LAUNDRY AND DRY CLEANING
HAIR SERVICES, MEN'S
HAIR SERVICES, WOMEN'S
HAIR SERVICES, CHILD'S
PERSONAL CARE
Use individual Living Pattern Questionnaires to summarize the two outlets for price collecting for the following
subcategories. It must be completed before any data is entered into the other tabs in this survey.
OUTLET REPORT
Page 4 of 9DS-2020 Part 1 & Part 2
PRIMARY LOCAL
OUTLET
SECONDARY LOCAL
OUTLET
CURRENCY
PUBLIC TRANSPORTATION
TAXI
PERSONALLY OWNED VEHICLES
GASOLINE
AUTO MAINTENANCE (oil change; tune-up)
AUTO PARTS (e.g., tires)
HOUSEHOLD HELP
DAY CARE (outside the home)
BREAKFAST
FOOD AWAY
LUNCH
DINNER
HOUSEHOLD FURNISHINGS
APPLIANCES (e.g., microwave and toaster)
COMPUTER ACCESSORIES
(e.g., detergent and
paper products)
MEDICAL
HOUSEHOLD CONSUMABLES
MEDICINE (e.g., non-prescription)
DOCTOR (e.g., General Practitioner and Pediatrician)
DENTIST
HOSPITAL FACILITIES
RECREATION
AUDIO/VISUAL (music CDs, DVD movies)
PHOTOGRAPHY SUPPLIES
READING MATERIAL (books, magazines)
RECREATIONAL EQUIPMENT (e.g., Bicycle)
MOVIE THEATER
(film and developing
photos/digital photos)
PERFORMING ARTS
SPORTS EVENTS
GYM MEMBERSHIP
PET FOOD
CONSUMER GOODS AND SERVICES
RETAIL PRICE SCHEDULE
This is form DS-2020
PART 2 -
Living Pattern Questionnaire Summary
These forms MUST be submitted together:
DS-2020, Parts 1-3
DS-2021 (if applicable)
Page 5 of 9
DS-2020 Part 1 & Part 2
Page 6 of 9
SUBCATEGORY
SPECIAL FACILITIES
SUPPLY
BROUGHT
TO
CURRENT
LOCATION
(%)
LOCAL
MARKET
(%)
EMBASSY
COMMISSARY
(%)
MILITARY
COMMISSARY
EXCHANGE
(%)
SPECIAL
PURCHASES
U.S. (incl.
internet/
mail
order
(%)
OTHER
FOREIGN
LOCATION
(%)
TOTAL
(%)
Meat
(beef, pork, lamb, poultry)
Seafood, fresh fish
Seafood, canned fish
Dairy Products
(eggs, cheese and ice Cream)
Groceries (milk, cereal, other)
Fresh Fruits and Vegetables
Frozen Vegetables
Alcoholic Beverages
Tobacco
Toiletries
Laundry and Dry Cleaning
Hair Services
Small Appliances
Computer Accessories
100%
100%
100%
100%
100%
100%
100%
100%
Household Consumables
100%
Non-Prescription Medicine
100%
Doctor
100%
Dentist
100%
Audio and Visual Supplies
100%
Photographic Supplies
100%
Reading Material
100%
Recreational Equipment
100%
100%
100%
100%
100%
100%
100%
Retail Price Schedule, Part 2
Living Pattern Questionnaire (LPQ) Summary
Relative Importance of Various Sources of Supply
Canned Fruits and Vegetables
100%
DS-2020 Part 1 & Part 2
Page 7 of 9
Relative Importance of Various Sources of Supply
SUBCATEGORY
SPECIAL FACILITIES
SUPPLY
BROUGHT
TO
CURRENT
LOCATION
(%)
LOCAL
MARKET
(%)
EMBASSY
COMMISSARY
(%)
MILITARY
COMMISSARY
EXCHANGE
(%)
SPECIAL
PURCHASES
U.S. (incl.
internet/
mail
order
(%)
OTHER
FOREIGN
LOCATION
(%)
TOTAL
(%)
Auto Parts (e.g., tires)
Retail Price Schedule, Part 2
Living Pattern Questionnaire (LPQ) Summary
Movies
Performing Arts
100%
100%
Sports Events
Gym Membership
Pet Food
Gasoline
Auto Maintenance
100%
100%
100%
100%
100%
100%
100%
LPQ Summary
Relative Use of Commodities and Services
1. As determined by the most recent LPQ's, approximate the proportion of each specified type of food used by
Americans at the post, based on volume only, for meals eaten at home.
FRUITS
MEATS/SEAFOOD
Beef %
Pork %
Lamb %
Poultry %
Seafood %
100%TOTAL
VEGETABLES
Fresh %
Canned %
Frozen %
Fruit %
Canned
%
TOTAL 100% TOTAL 100%
2. Transportation: Average usage of the methods of
transportation as determined by the most recent LPQs:
3. Dining: As determined by the most recent LPQs, to
what extent are the following metal facilities used based on
family use:
Privately Owned Vehicle (POV)
%
Government Owned Vehicle (GOV) %
Taxi %
Municipal Bus %
Subway/Commuter Train %
100%
TOTAL
Local Restaurants %
%
%
%
Post Restaurant
Military Restaurant
Home
TOTAL 100%
Breakfast Lunch Dinner
%
%
%
%
%
%
%
%
100% 100%
Number of USG employees at post
Number of USG employees provided major household furniture by landlord or USG
4. Post Employees:
Number of USG employees provided major appliances by landlord or USG
Uniformed MilitaryCivilians
5. Special Facilities: If any commissary and exchange facilities are listed under "Special Facilities", describe the type
of facility, its distance from the post, and the typical expenses incurred in using that facility (i.e., the means of obtaining
goods and services, road mileage, road and bridge tolls, etc.)
Name of Commissary/Exchange
One way distance from post of assignment
One way road tolls (note currency used)
DS-2020 Part 1 & Part 2
Page 8 of 9
Name of Other Foreign Location:
Comments:
LPQ SUMMARY NOTES:
If living patterns for civilians and Uniformed Service members differ substantially, prepare separate summaries for each
group and submit both pages with the Retail Price Survey.
For WebPASS locations: enter only the civilian living pattern summary into eAllowances.
DS-2020 Part 1 & Part 2
Page 9 of 9
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