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pdfOMB No. 1220-0050
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U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
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U.S.
DE
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U.S. CENSUS BUREAU
Acting as a collecting agent for
U.S. Department of Labor
Bureau of Labor Statistics
Your Daily Expenses
Help us learn about the buying habits of people in the United States
Pierre-Vending
Machine.jpg
Jeanette & LindaPastry Shop.jpg
Stephen - Writing
Checks.jpg
Nhien & Jenny Flower Shop.jpg
George - Gas
Station.jpg
When you write down how you spend your money in this diary, you will
help us understand more about the products and services that are bought
by the people in the United States.
By law (Title 13, U.S. Code), we must keep your information confidential; we use
it for statistical purposes only.
If you have comments regarding this survey, please send them to the Division of
Consumer Expenditure Surveys, 2 Massachusetts Avenue N.E., Room 3985,
Washington, DC 20212.
Please record your expenses and purchases
for the following period
Day
Date
1
2
3
4
5
6
7
I will return on: _______________________________________
If you have any questions, please call:
Field representative’s name:
Telephone:
Field representative supervisor’s name:
Telephone:
FORM CE-801 (1-2019)
Black (40% and 100%); Pantone at 100% -- Red(199), Blue(281)
05/24/2018 REVISED
General
General Instructions
Instructions
■
Fill out this diary for an entire week, writing
down EVERYTHING you and the people on
your list spend money on each day – the
products you buy, the services you use, the
household expenses you have during the week
– no matter how large or small they are.
■
We recommend that you record your expenses
each day. Think about where you went and what
you’ve done.
■
Talk to the people on your list every day to
find out how they spent their money.
■
Include payments by
Cash
Check
Food Stamps
Credit/Debit Card
Money Order
WIC Voucher
■
Automatic
Withdrawal
Payroll
Deduction
Store Charge
Card
Gift Certificate
Keep receipts and other records so that you will
remember to record what you bought
or paid for. Use the pocket at the back of the
diary to store them.
Some record types include:
Receipts
Bills
Pay Stubs
Bank Statements
Catalog/Internet Purchases
Credit Card Statements
Include items that you bought for people who
are not on your list, such as gifts.
Do
Do NOT
NOT record
record
■
Expenses of people on your list while
they were away from home overnight.
■
Business or farm operating expenses
■
Sales tax, except for Meals, Snacks, and
Drinks Away from Home
FORM CE-801 (1-2019)
05/24/18 REV
FRONT OF FRONT FLAP-ATTACH TO COVER/TITLE PAGE,
Black Ink (40% and 100%)
FOLD IN
How to Fill Out
Your Diary
The diary is divided into 7 days and each
day is divided into 4 parts.
Enter each item in the appropriate part
for each day.
1. Food and Drinks for Home Consumption
■
Describe the item.
■
Mark whether the item was fresh, frozen,
bottled/canned, or other.
■
Enter the cost without tax and deduct any
discounts or coupons.
■
Mark the column if the item was purchased
for someone not on your list (e.g. gifts).
■
Enter the name of the store, business, or
website where the item was purchased.
2. Meals, Snacks, and Drinks Away from
Home
■
Mark one of the four choices that best
describes the type of meal.
■
Enter the name of the restaurant, vendor, or
cafeteria where you made this purchase.
■
Mark one of the four choices that best
describes where you made the purchase.
■
Enter the total cost with tax and tip.
■
If alcohol was part of the purchase, check
whether it was wine, beer, and/or other
alcohol and enter the total cost of the alcohol.
3. Clothing, Shoes, Jewelry, and Accessories
■
Describe the item and enter the cost without
tax.
■
Mark the appropriate sex and age range of
the person for whom the item was bought.
■
Mark the last column if the item was
purchased for someone not on your list (e.g.
gifts).
4. All Other Products, Services, and
Expenses
■
Describe the item and enter the total cost
without tax.
■
Mark the column if the item was purchased for
someone not on your list (e.g. gifts).
■
Enter the name of the store, business, or website
where the item was purchased.
See back ap for answers to
Frequently Asked Questions
There is an Additional Pages section
on pages 18–23 in case you run out of
lines on any particular day.
If you are unsure about whether to
include an item or where to record an
item, write it down wherever it seems
best or make a note and ask your eld
representative.
FORM CE-801 (1-2019)
BACK SIDE OF FRONT FLAP, ATTACH TO RECORD DAILY EXPENSES PAGE
Black Ink (40% and 100%) 05-24-2018 REVISED
Record Your Daily Expenses
The people on your list:
Record the purchases and expenses made by ALL of these people.
Notes
FORM CE-801 (1-2019)
CE-801 Black Ink (40% and 100%)
5-24-2018 REVISED
Thank you for agreeing to ll out this diary.
We understand that this task takes time; however, your information is
very important to us and will be used for many purposes that affect all
Americans. Among the most important, it is used to help calculate the
Consumer Price Index, or CPI, which is a basic measure of the rate of
inflation.
Here are some of the uses of the Consumer Price Index:
♦ Provide cost-of-living wage adjustments for millions of American workers
♦ Adjust Social Security payments
♦ Determine the cost of school lunches
♦ Adjust Federal income-tax brackets
For more information about the survey, visit: http://www.bls.gov/cex and http://www.census.gov
Office Use: Place the barcode label here
Questions?
Some Frequently Asked Questions are answered on the flap attached to the back cover.
If you still have questions after reviewing these, please call your field representative.
1
FORM CE-801 (1-2019)
)""
080101
Black Ink (40% and 100%)
5-24-2018 REVISED
Examples
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
bread
101
eggs
102
apples
104
beer
105
milk
106
4
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
OTHER FOOD – Give a
complete description, such as 1
scalloped potatoes.
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
1
2
3
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Level of detail needed
describe, such as whole ham,
bacon, spareribs, etc.
orange juice
107
candy
108
vegetable oil
109
baby food
110
potato chips
111
frozen meals
112
ketchup
113
soup
114
soda
115
pork chops
116
shrimp
117
cookies
118
ground beef
119
carbonated water
120
apple pie
121
ground coffee
122
bagels
123
wine
124
juice boxes
125
other
3
chicken wings PORK – Specify the cut and
103
frozen
bottled/
canned
2
BEEF – Specify the cut and
describe, such as round roast,
ground beef, etc.
1
Cost
1
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
4
X
4
4
without tax
1
49
1
50
6
78
2
80
4
29
2
99
3
99
2
50
2
99
4
95
2
79
8
97
1
59
4
96
1
98
6
36
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
Foodway Grocery Store
11 20
X
3
50
5
87
X
89
X
X
4
99
X
2
79
5
25
42
00
Total Wine
20
85
Amazon.com
NY Bagel Bakery
"
126
127
128
2 of the
3
4
Use the pocket on the1 inside
back
cover to store your receipts
1
2 until 3you’re
4
ready to record your purchases.
129
130
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
131
132
133
134
135
136
2
FORM CE-801 (1-2019)
)"#
080102
CE-801, Pantone Blue 313 (20%, 40%, 70, & 100%) Pantone Yellow 101 (70%), Black (30% and 100%)
5-24-2018 REVISED
Examples
Meals, Snacks, and Drinks Away from Home
4
1
2
3
4
Lupo Verde Italian restaurant
X
202
1
McDonald’s
1
2
3
4
1
2
3
1
2
3
X
1
Full
Service
Places
2
2
1
2
4
1
204
4
1
1
2
3
4
3
4
3
with tax & tip
62
4
2
3
4
X Starbucks
2
3
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
X
23
1
50
45
00
4
X
2
1
X X
15 00
X
1
4
Enter the
total cost of
the alcohol
7 25
Millbrook school cafeteria
206
Total Cost
X
X YMCA vending machine
X
205
Employer
or School
Cafeteria
3
X Mister Days sports bar
203
X
Vending
Machines
or Mobile
Vendors
other
3
X
Fast Food
Take-out
Delivery
beer
dinner
2
Restaurant or Vendor
wine
lunch
1
201
If alcoholic
beverages
included,
mark (X) all
that apply
Mark (X) one that best describes
where you made this purchase
snack/other
breakfast
Mark (X) one that
best describes
the type of meal
3
4
2 09
X
12
00
15
00
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
301
302
303
dress shirts
running shoes
wallet
304
baseball cap
305
bib
306
307
308
Child
Under 2
without tax
Level of detail needed
SHOES – If sports shoes, specify
sport, such as football cleats, etc.
JEWELRY – Specify type of
jewelry, such as watches, etc.
EYEWEAR – Specify prescription or
non-prescription.
necklace
Was the item for:
Cost
non-prescription sunglasses
75 00
69 00
29 00
14 99
3
50
250 00
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
X
X
X
15 00
X
X
5
59 00
child’s costume (returned for refund)
Mark (X) If
purchased for
someone not
on your list
X
X
X
X
All Other Products, Services, and Expenses
What did you buy or pay for?
401
cold medicine (non-prescription)
402
gasoline
403
highway tolls
404
music cd
406
cigarettes
dry cleaning (clothes)
407
lottery tickets
408
bus fare
409
piano lessons
410
electric drill
411
Net ix subscription
412
413
405
Level of detail needed
DOCTOR BILLS – Specify
type of doctor visited, such
as an internist, orthodontist,
etc.
MEDICINE – Specify if
prescription or
non-prescription.
TOOLS – Specify if power or
hand tool.
DRY-CLEANING – Specify
whether household item
(such as drapes) or apparel.
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
6
95
12
86
Liberty
2
00
Tri-River bridge
10
99
8
99
Jim’s Mart
15
50
Green cleaners
1
00
Jim’s Mart
1
50
MetroCounty transit
150 00
X
X
Walmart
Amazon.com
Private Individual
65
00
Village Hardware
9
99
Net ix
veterinarian fees
85
00
Bay County Vets
dog food
21
45
Pets&More.com
3
FORM CE-801 (1-2019)
)"$
080103
CE-801, Pantone Blue 313 (20%, 40%, 70% & 100%), Pantone Yellow 101 (70%), Black (30% & 100%)
5-24-2018 REVISED
ENTER
DAY AND
DATE
DAY 1
See pages 2-3 for examples. If you need additional space, use pages 18-23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
4
FORM CE-801 (1-2019)
)"%
080104
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40%, and 100%)
5-24-2018 REVISED
FR USE:
DAY 1
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
If alcoholic
beverages
included,
mark (X) all
that apply
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2019)
)"&
080105
5-24-2018 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20% 40%, and 100%)
5
ENTER
DAY AND
DATE
DAY 2
See pages 2-3 for examples. If you need additional space, use pages 18-23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
6
FORM CE-801 (1-2019)
)"
080106
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40% and 100%)
5-24-2018 REVISED
FR USE:
DAY 2
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
If alcoholic
beverages
included,
mark (X) all
that apply
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
other
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2018)
)"(
080107
11-2-2017 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)
7
ENTER
DAY AND
DATE
DAY 3
See pages 2-3 for examples. If you need additional space, use pages 18-23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
8
FORM CE-801 (1-2019)
)")
080108
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40% and 100%)
5-24-2018 REVISED
FR USE:
DAY 3
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
If alcoholic
beverages
included,
mark (X) all
that apply
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2019)
)"*
080109
5-24-2018 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)
9
ENTER
DAY AND
DATE
DAY 4
See pages 2-3 for examples. If you need additional space, use pages 18–23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
10
FORM CE-801 (1-2019)
)"+
080110
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20% 40%, and 100%)
5-24-2018 REVISED
FR USE:
DAY 4
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
If alcoholic
beverages
included,
mark (X) all
that apply
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2019)
)",
080111
5-24-2018 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)
11
ENTER
DAY AND
DATE
DAY 5
See pages 2-3 for examples. If you need additional space, use pages 18-23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
12
FORM CE-801 (1-2019)
)"080112
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20%, 40% and 100%)
5-24-2018 REVISED
FR USE:
DAY 5
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
If alcoholic
beverages
included,
mark (X) all
that apply
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2019)
)".
080113
5-24-2018 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)
13
ENTER
DAY AND
DATE
DAY 6
See pages 2-3 for examples. If you need additional space, use pages 18-23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
14
FORM CE-801 (1-2019)
)"/
080114
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20%, 40% and 100%)
5-24-2018 REVISED
FR USE:
DAY 6
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
If alcoholic
beverages
included,
mark (X) all
that apply
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2019)
)"0
080115
5-24-2018 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)
15
ENTER
DAY AND
DATE
DAY 7
See pages 2-3 for examples. If you need additional space, use pages 18-23.
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
16
FORM CE-801 (1-2019)
)"1
080116
Black Ink (30%, 40%, & 100%), Pantone Blue 313 (20%, 40% and 100%)
5-24-2018 REVISED
FR USE:
DAY 7
None
VC
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
If alcoholic
beverages
included,
mark (X) all
that apply
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
FORM CE-801 (1-2019)
)"2
080117
5-24-2018 REVISED
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40% and 100%)
17
Additional Pages
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
18
FORM CE-801 (1-2019)
)"3
080118
5-24-2018 REVISED
Black Ink (100%), Pantone Blue 313 (20%, 40% and 70%)
Additional Pages
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
If alcoholic
beverages
included,
mark (X) all
that apply
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
201
202
203
204
205
206
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
301
302
303
304
305
306
307
308
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
401
402
403
404
405
406
407
408
409
410
411
412
413
19
FORM CE-801 (1-2019)
)"4
080119
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
5-24-2018 REVISED
Additional Pages
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
20
FORM CE-801 (1-2019)
)"5
080120
5-24-2018 REVISED
Black Ink (100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
Additional Pages
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
If alcoholic
beverages
included,
mark (X) all
that apply
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
207
208
209
210
211
212
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
309
310
311
312
313
314
315
316
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
414
415
416
417
418
419
420
421
422
423
424
425
426
21
FORM CE-801 (1-2019)
)"6
080121
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
5-24-2018 REVISED
Additional Pages
Food and Drinks for Home Consumption
Is this item:
Mark (X) one
What did you buy or pay for?
fresh
frozen
Cost
bottled/
canned
other
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
FORM CE-801 (1-2019)
22
)"7
080122
5-24-2017 REVISED
Black Ink (100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
Additional Pages
Meals, Snacks, and Drinks Away from Home
Mark (X) one that
best describes
the type of meal
If alcoholic
beverages
included,
mark (X) all
that apply
Full
Service
Places
Vending
Machines
or Mobile
Vendors
Employer
or School
Cafeteria
Total Cost
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
1
2
3
4
1
2
3
4
1
2
3
beer
wine
with tax & tip
Enter the
total cost of
the alcohol
other
dinner
Fast Food
Take-out
Delivery
lunch
Restaurant or Vendor
breakfast
snack/other
Mark (X) one that best describes
where you made this purchase
213
214
215
216
217
218
Clothing, Shoes, Jewelry, and Accessories
What did you buy or pay for?
Cost
without tax
Was the item for:
Child
Under 2
Boy
2-15
Girl
2-15
Man
16 &
over
Woman
16 &
over
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Mark (X) If
purchased for
someone not
on your list
317
318
319
320
321
322
323
324
All Other Products, Services, and Expenses
What did you buy or pay for?
Cost
without tax
Mark (X) If
purchased for
someone not
on your list
Store or Website
where purchased
427
428
429
430
431
432
433
434
435
436
437
438
439
23
FORM CE-801 (1-2019)
)"8
080123
Black Ink (40% & 100%), Pantone Blue 313 (20%, 40%, 70% and 100%)
5-24-2018 REVISED
Keep your records in this pocket.
(These records are only for your reference; we will not keep them.)
■
■
■
■
■
■
Receipts
Bills
Pay Stubs
Bank Statements
Catalog/Internet Purchases
Credit Card Statements
FORM CE-801 (1-2019)
05-24-2018 REVISED
Frequently
requently Asked
sked Questions
uestions
(continued on other side)
1. How detailed should my descriptions be?
Refer to pages 2–3 for examples of the level of
detail needed in each part. Do not rely solely
on brand names.
2. How should I record multiple quantities?
You may group identical items on the same line and
enter a total cost of all the items, or you
may write each item on a separate line with the
individual cost.
3. How should I record pre-payments such
as a subway fare card?
Record the expense when you pay for it, not when
you use it.
4. How should I record credit card
purchases?
Record the purchase on the day that you use
your credit card to pay for it, not on the day you
receive or pay your credit card bill.
5. Should I record automatic deductions
taken from my paycheck or bank
account?
Yes, record automatic deductions (such as
health insurance premiums taken out of your
account or paycheck) only if they are deducted
that week. Write them in the section called All
Other Products, Services, and Expenses.
6. Should I record typical monthly bills?
Yes, record typical monthly bills only if you pay
them during the week that you have the diary.
Write them in the section called All Other
Products, Services, and Expenses.
7. What should I do when I use coupons,
discount cards, or loyalty cards?
Subtract the discount from the original price
and write the amount that you paid.
8. Can I just give you receipts instead of
writing the information down?
No, we need you to write the information in the
diary. We encourage you to save your receipts
to review them with your field representative
at the end of the week. You can use the pocket
on the inside of the back cover to store your
receipts until you’re ready to record your
purchases.
9. How should I record items if I don’t
know whether it includes tax?
Write down the amount paid.
10. What if I make a contribution or
charitable donation?
Record money contributions or donations in
the section called All Other Products, Services,
and Expenses.
(continued on other side)
FORM CE-801 (1-2019)
FINAL FLAP - ATTACH TO BACK COVER (SEE DUMMY)
Black Ink (30% and 100%), Pantone Blue 313 (20% and 100%)
05-24-2018 REV
Frequently
requently Asked
sked Questions
uestions
(continued on other side)
11. What about gift certi cates or gift
cards?
If you buy a gift certificate to give to someone,
write down the cost of it under the appropriate
section (e.g., a certificate to a clothing store
would go under Clothing, Shoes, Jewelry, and
Accessories and a certificate to a department
store would go under All Other Products,
Services, and Expenses. If you use a gift card,
write down the full amount for your purchase
as if paid with cash.
12. What do I do about returns & exchanges?
If an item is bought and returned during the
diary week, it can be erased or crossed out. If
it was bought outside the week and returned
during the week, do not make an entry. If an
item is exchanged during the week, erase or
cross out the item that was returned and enter
the new item and its cost on the day the
exchange was made.
13. Should I record subsidized/reimbursed
expenses?
Yes, but if someone not on your list pays for
or helps pay for an expense or if you will be
reimbursed for an expense, only record the
amount that you or someone on your list has
to pay.
14. What should I do about shipping &
handling costs?
Include the shipping & handling cost in the total
price of the item. If the shipping & handling
covered multiple items, include the shipping &
handling in the total price of one item from the
order.
15. What’s the difference between a
concession stand and a mobile vendor?
A concession stand has to stay in a permanent
location and a mobile vendor does not. Some
mobile vendors may seem permanent because
they are usually in the same location, but they
are still considered mobile vendors because
they have the option to change locations.
16. How do I categorize the establishment
for Meals, Snacks, and Drinks Away from
Home?
■
Fast food, Take-out, Delivery, Concession
You pay BEFORE you eat/drink
■
Full Services Places
You pay after you eat/drink
■
Vending Machines or Mobile Vendors
Include vending machines, carts, and
trucks that move from place to place
■
Employer and School Cafeterias
Includes school meal pre-payments
FORM CE-801 (1-2019)
ATTACH THIS FLAP TO POCKET PAGE (FOLD IN, BACK OF FAQ 1-10)
Black Ink (30% and 100%), Pantone Blue 313 (20% and 100%) 05-24-2018 REV
Coffee.jpg
Car Dashboard& CD.jpg
Gifts.jpg
Haircut.jpg
Money.jpg
Pizza.jpg
Daily Reminder List
Please review the list of expenses below with the people on your list at the end of each day.
If you have forgotten to record any expense, please do so on the appropriate page.
Did you or anyone on your list pay for . . .
■ meals, drinks, or snacks from restaurants, fast food,
cafeterias, vending machines, concession stands,
etc.?
■ catered events or meal plans?
■ medicine or medical/dental services?
■ food & drinks from a grocery store or other speciality
food store such as a bakery, candy shop, or liquor
store?
■ typical bills such as utility bills, cable bills,
telephone bills, etc.?
■ clothing, shoes, jewelry, accessories or clothing
services such as dry cleaning?
■ automatic deductions from a paycheck such
as insurance premiums?
■ personal care items or services such as cosmetics,
soaps, haircuts, etc.?
■ bank/ATM service fees?
■ housekeeping supplies or services for home
decoration/maintenance?
■ credit card interest or finance charges?
■ toys, books, electronics, hobby supplies, etc.?
■ internet or catalog orders?
■ cigarettes, tobacco, or other smoking supplies?
■ fees for lessons or instructions?
■ commuting costs such as public transportation,
parking fees, gasoline, or tolls?
■ gifts, contributions, donations?
■ entertainment or recreational activities?
FR USE: Use the example below to transcribe the Control Number:
RO
code
Control Number
Week
Example
21
RO
code
Survey
code
(1-2)
PSU
state
(3-4)
05
26
Survey
code
(1-2)
PSU
state
(3-4)
PSU
county
(5-7)
999
Frame
Sample
Designation
Sequence
#1
Sequence
#2
(16-17)
HH
No.
(18)
CU
No.
(19-20)
Spinoff
Indicator
(21-22)
01
1
01
00
Sequence
#1
Sequence
#2
(12-15)
(16-17)
HH
No.
(18)
CU
No.
(19-20)
Spinoff
Indicator
(21-22)
(8)
(9-11)
(12-15)
U
D15
0001
Control Number
Vegetables.jpg
PSU
county
(5-7)
Frame
(8)
Hand Swiping Credit
Card.jpg
Sample
Designation
(9-11)
Kid with Toys
.jpg
1
2
Week
Clothing.jpg
Hammer and Nail
.jpg
1
2
Newspaper.jpb
FORM CE-801 (1-2019)
Revised 5/24/2018
| File Type | application/pdf |
| Author | OneFormUser |
| File Modified | 2018-06-14 |
| File Created | 2018-06-05 |