RETAIL PRICE SCHEDULE
This is form DS-2021
Part 4 - Embassy or Consulate Store Survey
These forms MUST be submitted together:
DS-2020, Parts 1-3
DS-2021 (if applicable)
DS-2021
08-2007
Page 1 of 9
DS-2021
Page 2 of 9
Beef (by weight)
Steak
Roast
Hamburger
Loin Roast
Chops
Pork (by weight)
Lamb (by weight)
Lamp Chops
Leg of Lamb
Chicken (by weight)
Whole
Breast
Leg
Fish, Fresh Filet (by weight)
(uncooked, specify type)
Typical
Substitute
Fish, Canned (by weight)
(specify type)
Typical
Substitute
Eggs
(each or dozen)
Typical
Substitute
QUANTITY UNIT PRICE
MEAT AND DAIRY PRODUCTS
DESCRIPTION COMMENTS
CATEGORY: MEAT AND DAIRY PRODUCTS
Name of Embassy or Consulate Facility
Survey Date
(mm-dd-yyyy)
Typical
Substitute
Typical
Substitute
Milk, Fresh
(per liter or quart)
Typical
Substitute
Bread, White or Wheat
(sliced)
Typical
Substitute
Flour
(general purpose)
Typical
Substitute
Cereal, Breakfast
(ready-to-eat)
Typical
Substitute
Rice, Regular
Pasta
(uncooked)
Typical
Substitute
Typical
Substitute
QUANTITY UNIT PRICE
GROCERIES
DESCRIPTION COMMENTS
CATEGORY: GROCERIES
DS-2021
Page 3 of 9
CATEGORY: MEAT AND DAIRY PRODUCTS
QUANTITY UNIT PRICE
MEAT AND DAIRY PRODUCTS
DESCRIPTION COMMENTS
Ice Cream
(per liter or quart)
Cheese
(natural - firm to hard)
CATEGORY: GROCERIES
Coffee, Ground
Typical
Substitute
Coffee, Instant
Typical
Substitute
Soft Drink, Carbonated
Typical
Substitute
Bottled
Drinking Water
Typical
Substitute
Candy, Chocolate Bar
(plain)
Typical
Substitute
Sugar, Granulated
Typical
Substitute
Baby Food
(exclude meat)
Typical
Substitute
Cooking Oil
Typical
Substitute
Peanut Butter
Typical
Substitute
DS-2021
Page 4 of 9
Tea, Bags
(specify number of bags)
Typical
Substitute
GROCERIES
QUANTITY UNIT PRICE DESCRIPTION COMMENTS
DS-2021 Page 5 of 9
Wine, Table
(1 bottle)
Typical
Substitute
Whiskey
(bourbon, scotch, rye, etc.)
Typical
Substitute
Beer
Typical
Substitute
Cigarettes
(carton of 200)
Typical
Substitute
QUANTITY UNIT
PRICE
SUBCATEGORY: CIGARETTES &
ALCOHOL
BRAND AND DESCRIPTION
COMMENTS
CATEGORY: FRUITS AND VEGETABLES
QUANTITY UNIT PRICE
SUBCATEGORY: FRUITS, FRESH
(by weight)
BRAND AND DESCRIPTION COMMENTS
(ml/fluid oz.)
Oranges
Bananas
Apples
Beans, Green
Potatoes
Carrots
QUANTITY UNIT PRICE
SUBCATEGORY: VEGETABLES, FRESH
(by weight)
BRAND AND DESCRIPTION COMMENTS
CATEGORY: ALCOHOL AND TOBACCO
Lettuce
Onions
Tomatoes
QUANTITY
UNIT PRICE
SUBCATEGORY: FRUITS, CANNED
BRAND AND DESCRIPTION COMMENTS
Peaches (822-879gr/29-31oz.)
Pineapples (822-879gr/29-31oz.)
Pears (822-879gr/29-31oz.)
QUANTITY UNIT PRICE
SUBCATEGORY: FRUIT JUICES, CANNED
BRAND AND DESCRIPTION COMMENTS
Apple Juice (1304 gr/46 oz.)
Orange Juice (1304 gr/46 oz.)
SUBCATEGORY: VEGETABLES, CANNED
QUANTITY UNIT PRICE BRAND AND DESCRIPTION COMMENTS
Peas, Green (425-482gr/15-17oz.)
Corn (425-482gr/15-17oz.)
Tomatoes (425-482gr/15-17oz.)
(gram/ounce
SUBCATEGORY: VEGETABLES, FROZEN
QUANTITY
UNIT PRICE
BRAND AND DESCRIPTION COMMENTS
Peas, Green (284gr/10oz.)
French Fries (284gr/10oz.)
DS-2021
Page 6 of 9
CATEGORY: FRUITS AND VEGETABLES
SUBCATEGORY: VEGETABLES, FRESH
(by weight)
QUANTITY UNIT PRICE BRAND AND DESCRIPTION COMMENTS
CATEGORY: PERSONAL CARE
SUBCATEGORY: TOILETRIES
QUANTITY UNIT PRICE BRAND AND DESCRIPTION COMMENTS
Toothpaste
(198g/7oz.)
Typical
Substitute
Razor Blades
(pkg. of 5-10 twin blades)
Typical
Substitute
Sanitary Napkins
(box of 24)
Typical
Substitute
Shampoo
(450ml/16 fl oz.)
Typical
Substitute
CATEGORY: HOUSEHOLD FURNISHINGS
QUANTITY UNIT PRICE BRAND AND DESCRIPTION COMMENTS
SUBCATEGORY: HOUSEHOLD
CONSUMABLES
Diapers, Disposable
(pkg. of 48)
Typical
Substitute
Laundry Detergent,
Liquid or Powdered
(ml/fl oz. or grams)
Typical
Substitute
DS-2021
Page 7 of 9
CATEGORY: MEDICAL
QUANTITY UNIT PRICE BRAND AND DESCRIPTION COMMENTS
SUBCATEGORY: MEDICINE
Pain Reliever Compound
(100 tabs, 325 mg. strength)
Typical
Substitute
CATEGORY: RECREATION
SUBCATEGORY: AUDIO AND VISUAL
SUPPLIES
QUANTITY
QUANTITY
QUANTITY
PRICE BRAND AND DESCRIPTION
PRICE BRAND AND DESCRIPTION
PRICE BRAND AND DESCRIPTION
COMMENTS
Music CD
(single, no sets)
Movie DVD
(single, no sets)
Typical
Substitute
Typical
Substitute
DS-2021
Page 8 of 9
SUBCATEGORY: PHOTOGRAPHIC
SUPPLIES
Film processing, 35mm
(24 exposure process)
Camera Film, 35mm
(24 exposure)
Typical
Substitute
Typical
Substitute
COMMENTS
SUBCATEGORY: READING MATERIALS
Book, paperback
Newspaper, local
Typical
Substitute
COMMENTS
News magazine, weekly
Typical
Substitute
Daily
DS-2021
Page 9 of 9
CATEGORY: FOOD AWAY
MEAL PRICE COMMENTSFOOD ITEM
Breakfast
Combined Price of Bacon,
2 Eggs, Juice, Toast, and
Coffee or Tea
Lunch
(side order if not
included with entree)
Chicken - entree
Coffee, Tea, or Soda
Hamburger, large
French Fries, large
Coffee, Tea, or Soda
Chicken - entree
Soup
Fast Food
Dinner
(sides if not included
with entree)
One side order
Dessert
Salad
Two side orders
Dessert
Coffee, Tea, or Soda
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