BE-100(US) Survey of International Travel Expenditures (US Resident

OMB No. 0608- 00xx: Approval Expires xx/xx/200x

SURVEY OF INTERNATIONAL TRAVEL EXPENDITURES (U.S. Residents)

Please answer the following questions as they relate to the trip you have just completed only:

1. Which region(s) did you visit (see map)? 2. What was the primary

purpose of your travel?

	Europe		Asia and Pacific
	South / Central America		Middle East
	Caribbean / Bermuda		Africa

	Business
	Personal

	Less than a week		1 month to less than 3 months
	1 week to less than 2 weeks		3 months to less than 6 months
	2 weeks to less than 1 month		6 months or more

3. How long was your trip?

In the questions below, please report all travel expenditures by you or your company for your trip abroad. Please include any expenses for accommodations, food and drink, entertainment, recreation, shopping, and transportation while outside of the U.S.A. Do not include international airfare.

[If you cannot exclude your airfare because it was part of a package tour, check this box       and include your package tour, including airfare, in your response to question 4]

4. How much money did you spend for your trip BEFORE you left the U.S.A.?

	U.S. Dollars ($)
	Another Currency? (specify:___________)

Currency:

Amount:

___________

What % of this total amount spent BEFORE your trip (amount in #4 above) was spent with…

5. …Credit, debit, or charge card with U.S. Businesses?

%

6. …Credit, debit, or charge card with non-U.S. Businesses?

%

7. …Cash or check?

%

TOTAL=100%

8. For this specific trip outside of the U.S.A., how much money did you spend DURING your trip?

___________

Currency:

Amount:

	U.S. Dollars ($)
	Another Currency? (specify:___________)

What % of this total amount spent DURING your trip (amount in #8 above) was spent…

9. …Purchasing directly with a credit, debit, or charge card?

%

10. …Using cash withdrawal or advance from a credit, debit, or charge card?

%

11. …Using cash brought from home or travelers’ checks?

%

TOTAL=100%

	Male
	Female

12. What is your age? ________ 13. Gender:

Thank you for your time!

Completion of this form is voluntary and is not a requirement for clearance through U.S. Customs and Border Protection. Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.