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RETAIL PRICES - PART 3

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DS-2020-Part-3, Retail Prices, MUST be submitted together with the following forms:1. DS-2020 - Parts 1-2, Outlet Report and Living Pattern Questionnaire2. DS-2021 - Part 4, Embassy or Consulate Store Survey (if applicable)Refer to 05-2020-1, Instructions for Completing the 05-2020 Parts 1-3, for guidance on filling out this form.

NOTE: This form is not subject to the Paperwork Reduction Act requirements. Only federal employees are authorized users of this form.

CATEGORY: MEAT AND DAIRY PRODUCTSSUBCATEGORY: BEEF QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)

INCLUDED IN REPORTED PRICE?DYES DNO DN/A

MOST FREQUENTLY USED OUTLET: (Enter Name) . - - . - - . IBeef Steak

Beef Roast

Beef Hamburger

SECOND MOST USED OUTLET: {Enter Namt?) -- - -- -- .Beef Steak

Beef Roast

Beef Hamburger

SUBCATEGORY: PORK QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)INCLUDED IN REPORTED PRICE?

DYES DNO DN/A

MOST FREQUENTLY USED OUTLET: (Enter Name)

Pork Chops

Loin Roast

Bacon

Ham-

D8-2020 Part 3 Retail Prices10-2016

of 36

SUBCATEGORY: PORK QUANTITY UNIT PRICE DESCRIPTION COMMENTS(Continued) (by weight)

ISECOND MOST USED OUTLET: (Enter Name)

Pork Chops

Loin Roast

Bacon

Ham

SUBCATEGORY: LAMB QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)INCLUDED IN REPORTED PRICE?

DYES DNO DN/AMOST FREQUENTL Y USED OUTLET: (Enter Name) I

Lamb Chops

Lamb, Leg of

- 1SECOND MOST USED OUTLET: (Enter Name)

Lamb Chops

Lamb, Leg of

SUBCATEGORY: POULTRY QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)INCLUDED IN REPORTED PRICE?

DYES DNO D N/A

IMOST FREQUENTLY USED OUTLET: (Enter Name)

Chicken - Whole

Chicken - Breast

Chicken - Leg

SECOND MOST USED OUTLET: (Enter Name) - --Chicken - Whole

Chicken - Breast

Chicken - Leg

05-2020 Part 3 Retail Prices Page2of36

SUBCATEGORY: SEAFOOD QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)

INCLUDOIN REPOTED Pr::r?YES NO N1A

- - -- - - -- -MOST FREQUENTL Y USED OUTLET: (Enter Name)

TypicalFish, Fresh(uncooked filet, specify type)

Substitute

SECOND MOST USED OUTLET: (Enter Name)I

Fish, FreshTypical

(uncooked filet, specify type)Substitute

,. " - --MOST FREQUENTLY USED OUTLET: (Enter Name)

Fish, CannedTypical

(specify type)Substitute

-- -SECOND MOST USED OUTLET: (Enter Name) I

Fish, CannedTypical

(specify type)Substitute

SUBCATEGORY: DAIRY PRODUCTS QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)

INCLUDEDINREPORTEDPRICE?DYES 0NO D N/A


EggsTypical

(each or dozen)Substitute

TypicalIce Cream

Substitute

TypicalCheese(natural, firm to hard)

Substitute

YogurtTypical

(Plain) ~"h",.i.".o

SUBCATEGORY: DAIRY PRODUCTS QUANTITY UNIT PRICE DESCRIPTION COMMENTS

SECOND MOST USED OUTLET: (Enter Name)

Typical

Ice Cream

Eggs(each or dozen)

Substitute

Typical

Substitute

TypicalCheese(natural, firm to hard)

Substitute

TypicalYogurt(Plain)

Substitute

SUBCATEGORY: MILKTAX: RATE _

INCLUDED IN REPORTED PRICE?-N/A

(by volume)

QUANTITY I UNIT PRICE DESCRIPTION COMMENTS

Typical


Milk, Fresh

Substitute

Substitute

TypicalMilk, Non-Dairy


TypicalMilk, Fresh

Substitute

TypicalMilk, Non-Dairy

Substitute

05·2020 Part 3 Retail Prices 0f36

SUBCATEGORY: BREAD, FLOUR QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)INCLUDED IN REPORTED PRICE?

[]YESDNO 0 N/AMOST FREQUENTL Y USED OUTLET: I(Enter Name)

Bread, White or WheatTypical

(sliced)Substitute

TypicalFlour(Bread or General Purpose)

Substitute

SECOND MOST USED OUTLET: (Enter Name)- I

Bread, White or WheatTypical

(sliced)Substitute

FlourTypical

(Bread or General Purpose)Substitute

SUBCATEGORY: CEREAL QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (bywe/ght)

INCLUDED IN REPORTED PRICE?DYES ONO 0 N/A - - - - . -- - - - _. -- .-. -- -

MOST FREQUENTL Y USED OUTLET: (Enter Name)

Cereal Typical(ready-to-eat) Substitute

Oatmeal, Instant Typical

Substitute


Cereal Typical(ready-to-eat) Substitute

TypicalOatmeal, Instant

Substitute

05·2020 Part 3 Retail Prices PageS of 36

SUBCATEGORY: RICE/PASTA QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)

INCLUDED REPOOED PRICE?YES NO 0 N/A -MOST FREQUENTL Y USED OUTLET: {Enter Name) - - ... -

TypicalRice, Regular

Substitute

Pasta Typical(uncooked) Substitute

- - JSECOND MOST FREQUENTLY USED OUTLET: (Enter Name)

TypicalRice, Regular

Substitute

Pasta Typical(uncooked) Substitute

SUBCATEGORY: TEA/COFFEE QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)


- - - - - - I

MOST FREQUENTLY USED OUTLET: (Enter Name) - ._-Tea, Bags Typical(specify # bags)

Substitute

TypicalCoffee, instant

Substitute

Coffee, groundTypical

Substitute

Coffee, whole beanTypical

Substitute

K-Cups Typical(coffee pods) Substitute

05-2020 Part 3 Retail Prices of 36

SUBCATEGORY: TEA/COFFEE QUANTITY UNIT PRICE DESCRIPTION COMMENTS(Continued) (by weight)

SECOND MOST USED OUTLET: (Enter Name) _. ~ .. - - - - I

Tea, Bags Typical

(specify # bags) Substitute

TypicalCoffee, instant

Substitute

TypicalCoffee, ground

Substitute

TypicalCoffee, whole bean

Substitute

K-Cups Typical

(coffee pods)Substitute

SUBCATEGORY: SOFT DRINKS QUANTITY UNIT PRICE DESCRIPTION COMMENTSIBOTTLED WATER (by volume)TAX: RATE

INCLUDED IN REPORTED PESE?DYES DNO N/A -


TypicalSoft Drink, Carbonated

Substitute

TypicalBoUled Drinking Water

Substitute

SECOND MOST USED OUTLET: (Enter Name) .. .-

TypicalSoft Drink, Carbonated

Substitute

TypicalBottled Drinking Water

Substitute


SUBCATEGORY: CANDY/SWEETENER QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)INCLUDED IN REPORTED PRICE?

DYES ONOONtA..IMOST FREQUENTL Y USED OUTLET: (Enter Name) --

Candy, Chocolate BarTypical

Substitute

TypicalSugar, Granulated

Substitute

TypicalHoney

Substitute

SECOND MOST USED OUTLET: (En~e) - ---I-

Candy, Chocolate Bar Typical

Substitute

TypicalSugar, Granulated

Substitute

TypicalHoney

Substitute

SUBCATEGORY: BABY FOOD QUANTITY (blA~JJht) PRICE DESCRIPTION COMMENTSTAX: RATEINCLUDED IN REPORTED PRICE?

DYES 0NO D NtA- - -., - .- _ .

MOST FREQUENTLY USED OUTLET: (Enter Name) I

Baby FoodTypical

(exclude meat)Substitute


Baby FoodTypical

(exclude meat)Substitute


SUBCATEGORY: FATS, OTHER QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by volume)INCLUDED IN REPORTED PRICE?

DYES DNO D N/A


TypicalCooking Oil

Substitute

TypicalOlive Oil

Substitute

TypicalButter

Substitute

TypicalPeanut Butter

Substitute

SECOND MOST USED OUTLET: (Enter Name) - - -

TypicalCooking Oil

Substitute

TypicalOlive Oil

Substitute

TypicalButter

Substitute

TypicalPeanut Butter

Substitute

05-2020 Part 3 Retail Prices 9

CATEGORY: FRUITS AND VEGETABLESSUBCATEGORY: FRUITS, FRESH QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)

INCLEfD INR~RTED ~lCE?YES NO N/A - .. - - - -_ ..


Oranges

Apples

Bananas

Blueberries

Strawberries

SECOND MOST USED OUTLET: (Enter Name) I

Oranges

Apples

Bananas

Blueberries

Strawberries

SUBCATEGORY: VEGETABLES,FRESH QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)INCLUDEDIN REPORTEDPRICE?

DYES DNO D N/AMOST FREQUENTL Y USED OUTLET: (Enter Name) I

Potatoes

Beans, Green

Carrots

Lettuce

Onions

Tomatoes

Spinach


SUBCATEGORY: VEGETABLES,FRESH QUANTITY UNIT PRICE DESCRIPTION COMMENTS(Continued)

(by weight)

SECOND MOST USED OUTLET: (Enter Name) . - . -Potatoes

Beans, Green

Carrots

Lettuce

Onions

Tomatoes

Spinach

SUBCATEGORY: FRUITS, CANNED QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by weight)

INCLUDEON REP0'DED P[jE?YES NO N/A


Peaches(822-879gr/29-31 oz. )Pineapples(822-879gr/29-31 oz.)Pears(822-879gr/29-31 Oz.)

- - .- .. . -- ISECOND MOST USED OUTLET: (Enter Name) -- -Peaches(822-879gr/29-31 oz.)Pineapples(822-879gr/29-31 oz.)Pears(822-879gr/29-31 oz.)SUBCATEGORY: FRUIT JUICES QUANTITY UNIT PRICE DESCRIPTION COMMENTSTAX: RATE (by volume)

INCLUDEDINREPORTEDPRICE?DYES DNO D N/A

_.- - - --- - _. - . -MOST FREQUENTL Y USED OUTLET: (Enter Name) ..Apple Juice(1361 mI/46oz.)Orange Juice(1361 mI/46oz.)DS-2020 Part 3 Retail Prices Page

SUBCATEGORY: FRUIT JUICES QUANTITY UNIT PRICE DESCRIPTION COMMENTS(Continued) (by volume)

SECOND MOST USED OUTLET: (Enter Name) IApple Juice(1361 ml/46oz.)Orange Juice(1361 ml/46oz.)

SUBCATEGORY: VEGETABLES, QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTSCANNED (by weight)TAX:RATE

INCLUDEDINREPORTEDPRICE?DYES ONOONtA - - -_.- -MOST FREQUENTLY USED OUTLET: (Enter Name) _ _._- - -

Peas, Green ,(425-482gr.l15-17oz.)

Corn(425-482gr.l15-17oz.)Tomatoes(425-482gr.l15-17oz.)

.... _---SECOND MOST USED OUTLET: (En.ter Name) . -- -- .Peas, Green(425-482gr.l15-17oz.)Corn(425-482gr.l15-17oz.)

Tomatoes(425-482gr.l15-17oz.)SUBCATEGORY: VEGETABLES, QUANTITY UNIT PRICE . BRAND/DESCRIPTION COMMENTSFROZEN (by weight)

TAX:RATEINCLUDE'[j REP0'EjP PfjE?YES NO NtA

MOST FREQUENTLY USED OUTLET: (Enter Name) - - -

Mixed Vegetables(284gr.l1 Ooz.)

French Fries(284gr.l1 Ooz.)

-SECOND MOST USED OUTLET: (Enter Name) .Mixed Vegetables(284gr.l1 Ooz.)

French Fries(284gr.l1 Ooz.)


CATEGORY: ALCOHOL AND TOBACCOSUBCATEGORY: WINE, TABLE QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS

TAX: RATE (by volume)INCLUDED IN REPORTED PRICE?

DYES DNODN/A-

MOST FREQUENTLY USED OUTLET: (Enter Name) --

Wine, Table, non-vintageTypical

(750ml)Substitute


Wine, Table, non-vintageTypical

(750ml)Substitute

SUBCATEGORY: WHISKEY QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTSTAX: RATE (by volume)

INCLUDED IN REPORTED PRICE?DYES DNoD N/A

MOST FREQUENTLY USED OUTLET: (Enter Name) JWhiskey, non-premium Typical(bourbon, scotch, rye,etc.)(750ml) Substitute

SECOND MOST USED OUTLET: (Enter Name) ~

Whiskey, non-premium Typical(bourbon, scotch, rye,etc.)(750ml) Substitute

SUBCATEGORY: BEER QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTSTAX: RATE (by volume)

INCLUDED IN REPORTED PRICE?DYES DNODN/A

MOST FREQUENTLY USED OUTLET: I(EDter Name) . - - - - .... . - J

TypicalBeer(e.g. 12oz./355ml)

Substitute


SUBCATEGORY: BEER QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTS(Continued) (by volume)

-___ JSECOND MOST USED OUTLET: (Enter Name) - -

TypicalBeer(e.g. 12oz./355ml)

Substitute

SUBCATEGORY: CIGARETTES QUANTITY UNIT PRICE BRAND/DESCRIPTION COMMENTSTAX: RATE


MOST FREQUENTLY USED OUTLET: (Enter Name) - - ..-Typical

Cigarettes(carton of 200)

Substitute

- -SECOND MOST USED OUTLET: (Enter Name)

TypicalCigarettes(carton of 200)

Substitute

CATEGORY: CLOTHINGSUBCATEGORY: MEN'S CLOTHING PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION

TAX: RATEINCLUDED IN REPORTED PRICE?

DYES DNoD N/A- -MOST FREQUENTL Y USED OUTLET: (Enter Name)

TypicalSlacks, Man's Dress

Substitute

TypicalShirt, Man's Dress

Substitute

TypicalShoes, Man's Dress

Substitute


SUBCATEGORY: MEN'S CLOTHING PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION(Continued)


TypicalSlacks, Man's Dress

Substitute

TypicalShirt, Man's Dress

Substitute

TypicalShoes, Man's Dress

Substitute

SUBCATEGORY: WOMEN'S CLOTHING PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTIONTAX: RATE

INCLUDED IN REPORTED PRICE?DYES DNo DNJA

IMOST FREQUENTLY USED OUTLET: (Enter Name)-- - - - - - -

TypicalBlouse, Woman's

Substitute

TypicalSkirt, Woman's

Substitute

TypicalSlacks, Woman's Dress

Substitute

TypicalDress, Woman's

Substitute

TypicalShoes, Woman's Dress

Substitute


SUBCATEGORY: WOMEN'S CLOTHING PRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTION(Continued)

SECOND MOST USED OUTLET: (Enter Name) ITypical

Blouse, Woman'sSubstitute

TypicalSkirt, Woman's

Substitute

TypicalSlacks, Woman's Dress

Substitute

TypicalDress, Woman's

Substitute

TypicalShoes, Woman's Dress

Substitute

SUBCATEGORY: CHILDREN'S CLOTHINGPRICE BRAND, COUNTRY OF ORIGIN, AND DESCRIPTIONTAX: RATE


IMOST FREQUENTLY USED OUTLET: (Enter Name) _. - -Typical

Jeans, Child'sSubstitute

TypicalShoes, Child's Athletic

Substitute- -- _.


TypicalJeans Child's

Substitute

TypicalShoes, Child's Athletic

Substitute-05-2020 Part 3 Retail Prices

CATEGORY: PERSONAL CARESUBCATEGORY: TOILETRIES QUANTITY UNIT PRICE DESCRIPTION


DYES ONOONtA .. - - -- -- - - -IMOST FREQUENTL Y USED OUTLET: (Enter Name)

Toothpaste Typical

(198g/7oz.) Substitute

Disposable Razors Typical

(pkg. of 5-10) Substitute

Sanitary Napkins/Tampons Typical(box of 24) Substitute

Shampoo Typical(473ml/16 fluid oz.) Substitute

Mouthwash Typical(473 ml/16 fluid oz.) Substitute

- - .. - - - - -- . - -- ..- - -SECOND MOST USED OUTLET: (Enter Name)

Toothpaste Typical(198 g/7 oz.)

Substitute

Disposable Razors Typical

(pkg.of5-10) Substitute

Sanitary Napkins/Tampons Typical(box of 24) Substitute

Shampoo Typical(473ml/16 fluid oz.) Substitute

Mouthwash Typical(473ml/16 fluid oz.) Substitute


SUBCATEGORY: LAUNDRY AND DRY PRICE DESCRIPTIONCLEANINGTAX: RATE

INCLUDED IN REPORTED PRICE?DYES DNo DN/A J- - _.

MOST FREQUENTLY USED OUTLET: (Enter Name)- I

Launder Man's Shirt

Dry Cleaning, Man's Slacks

Dry Cleaning, Woman's Suit (2 pc)- --lSECOND MOST USED OUTLET: (Enter Name)

Launder Man's Shirt


Dry Cleaning, Woman's Suit (2 pc).- - - _ .. -- ..

SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES:

Launder Man's Shirt


Dry Cleaning, Woman's Suit (2 pc)

SUBCATEGORY: HAIR SERVICES PRICE TIP DESCRIPTIONTAX: RATE

INCLUDED IN REPORTED PRICE?

DYES DN0D N/A

MOST FREQUENTLY USED OUTLET: (Enter Name)I

Haircut, Man's Regular

Shampoo, Haircut, & Blow Dry, Woman's

Hair Color, Woman's

Haircut, Child's


SUBCATEGORY: HAIR SERVICES PRICE TIP DESCRIPTION(Continued)SECOND MOST USED OUTLET: (Enter Name)


Shampoo, Haircut, & Blow Dry, Woman'sI

Hair Color, Woman's

Haircut, Child's

SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES: .1


Shampoo, Haircut, & Blow Dry, Woman's

Hair Color, Woman's

Haircut, Child's

CATEGORY: HOUSEHOLD FURNISHINGSSUBCATEGORY: APPLIANCES PRICE BRAND AND DESCRIPTION


DYES DNoDN/A


Microwave, Portable, mid-size Typical

(800-1000 watt)Substitute

TypicalToaster, Two Slice

Substitute

Coffee Maker, dripTypical

(10-12 cup)Substitute

Home Coffee Brewing System Typical

(single serve)Substitute

BlenderTypical

(10-speed, 6 Cups)Substitute

D5·2020 Part 3 Retail Prices of 36

SUBCATEGORY: APPLIANCES PRICE BRAND AND DESCRIPTION(Continued)

iSECOND MOST USED OUTLET: (Enter Name)

Microwave, Portable, mid-sizeTypical

(800-1000 watt)Substitute

TypicalToaster, Two Slice

Substitute

Coffee Maker, dripTypical

(10-12 cup)Substitute

Home Coffee Brewing SystemTypical

(single serve)Substitute

TypicalBlender(10-speed, 6 cups)

Substitute

SUBCATEGORY: WASHING MACHINE PRICE BRAND AND DESCRIPTIONTAX: RATE

INCLUDED IN REPORTEDPRICE?DYES ONOONtA


Washing MachineTypical

(specify capacity)Substitute

- ,SECOND MOST USED OUTLET: (Enter Name)-

Washing MachineTypical

(specify capacity)Substitute

05·2020 Part 3 Retail Prices of 36

SUBCATEGORY: COMPUTER QUANTITY UNIT PRICE BRAND AND DESCRIPTIONACCESSORIESTAX: RATE

INCLUDED IN REPORTED POE?DYES DNo N/A

JMOST FREQUENTLY USED OUTLET: (Enter Name)

Cartridge, Black InkTypical

(single)Substitute

Paper, packageTypical

(500 sheets)Substitute

- - - -SECOND MOST USED OUTLET: (Enter Name)

Cartridge, Black InkTypical

(single)Substitute

Paper, packageTypical

(500 sheets)Substitute

SUBCATEGORY: HOUSEHOLD QUANTITY UNIT PRICE DESCRIPTIONCONSUMABLESTAX: RATE

INCLUDED IN REPORTED PRICE?DYES DNO D N/A


Diapers, DisposableTypical

(package of 48)Substitute

Laundry Detergent TypicalLiquid/Powder(oz./gr.) Substitute

D5·2020 Part 3 Retail Prices 9

SUBCATEGORY: HOUSEHOLD CONSUMABLES QUANTITY UNIT PRICE I DESCRIPTION(Continued)


Diapers, DisposableTypical

(package of 48)Substitute

Laundry Detergent TypicalLiquid/Powder

(oz./gr.) Substitute

SUBCATEGORY: TELEPHONE SERVICE(Mobile Phone & Internet Service)

TAX: RATE SERVICE COST PROVIDER/DESCRIPTION OF SERVICEINCLUDED IN REPORTED PRICE?

DYES DNO D N/A

Mobile Phone MonthlyFee

Internet Service, MonthlyDial Up

CATEGORY: MEDICALSUBCATEGORY: MEDICINE QUANTITY UNIT PRICE DESCRIPTIONTAX: RATE


....IMOST FREQUENTL Y USED OUTLET: (Enter Name)

Pain Reliever Compound Typical

(100 Tabs, 325 mg strength) Substitute

Adult Cough Syrup Typical

(12oz/354ml) Substitute

Adult Multi-Vitamins Typical

(100 tablets) Substitute

Children's Vitamins Typical

(100 tablets) Substitute

Allergy Medication Typical

(25-30 tablets) Substitute


SUBCATEGORY: MEDICINE QUANTITY UNIT PRICE DESCRIPTION(Continued)(Enter Name) -

SECOND MOST USED OUTLET: --Pain Reliever Compound Typical(100 Tabs, 325 mg strength) Substitute

Adult Cough Syrup Typical(120z/354ml) Substitute

Adult Multi-Vitamins Typical(100 tablets) Substitute

Children's Vitamins Typical(100 tablets) Substitute

Allergy Medication Typical(25-30 tablets) Substitute

SUBCATEGORY: DOCTOR PRICE DESCRIPTIONTAX: RATE

INCLUDEDINREPORTEDPRICE?DYES DNoDN/A

MOST FREQUENTLY USED OUTLET: (Enter Name) .. ._ .I. _. - ~ .. - _. - _. - -- - - - -General Practitioner, General Visit

Pediatrician, General Visit

SECOND MOST USED OUTLET: (Enter Name) IGeneral Practitioner, General Visit


SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES: I- -General Practitioner, General Visit


Number of visits by State Department Regional Medical Officer (RMO) to post in the past twelve months:

Is there a State Department Nurse Practitioner at post? DYES D NO

D5-2020 Part 3 Retail Prices of 36

SUBCATEGORY: DENTIST PRICE DESCRIPTIONTAX: RATEINCLUDED IN REPORTEDPRICE?

DYES DNO DN/A

MOST FREQUENTLY USED OUTLET: (Enter Name) JFilling, Simple One Surface

Extraction, Simple

Prophylaxis

Bitewing

SECOND MOST USED OUTLET: ~nterName)--- -- - - - -

Filling, Simple One Surface

Extraction, Simple

Prophylaxis

Bitewing

SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES: (Enter Name) -1

Filling, Simple One Surface

Extraction, Simple

Prophylaxis

Bitewing

SUBCATEGORY: HOSPITAL FACILITIES PRICE DESCRIPTIONTAX: RATE

INCLUDED IN REPORTED PRICE?DYES DNO D N/A

.. - - - .IMOST FREQUENTL Y USED OUTLET: (Enter Name) - - - ~~ - -- _._-

Private Room

Semi-Private Room--


SUBCATEGORY: HOSPITAL FACILITIES PRICE DESCRIPTION(Continued)SECOND MOST USED OUTLET: (Enter Name)

Private Room

Semi-Private Room

CATEGORY: RECREATIONSUBCATEGORY: AUDIONISUAL PRICE BRAND AND DESCRIPTIONSUPPLIES


DYES DNo DN/A

MOST FREQUENTL Y USED OUTLET: (Enter Name) -- -- - - -Movie Typical

(single, no sets)Substitute

DVD Player Typical

(no combo player) Substitute

SECOND MOST USED OUTLET: (Enter Name)- -- .- -

Movie Typical(single, no sets)

Substitute

DVD Player Typical(no combo player) Substitute

SUBCATEGORY: PHOTOGRAPHIC PRICE DESCRIPTIONSUPPLIESTAX: RATE

INCLUOB IN REf5RTEO aICE?YES NO N/A


Digital Photo Print Typical

(Single Print 4X6)Substitute

SD Card Typical

(16GB-64GB)Substitute


SUBCATEGORY: PHOTOGRAPHIC PRICE DESCRIPTIONSUPPLIES (Continued)

SECOND MOST USED OUTLET: (Enter Name) ITypical

Digital Photo Print(Single Print 4X6)

Substitute

TypicalMicro SO Card

(16GB-64GB)Substitute

SUBCATEGORY: CABLE/SATELLITE TV PRICE DESCRIPTION


DYES D NO D N/A-

MOST FREQUENTL Y USED OUTLET: (Enter Name)- - -~ - -- -

TypicalCable TV

Substitute

TypicalSatellite TV

Substitute

SECOND MOST USED OUTLET: (Enter Name) I- ~-Typical

Cable TVSubstitute

TypicalSatellite TV

Substitute

05·2020 Part 3 Retail Prices 9

SUBCATEGORY: READING MATERIAL PRICE DESCRIPTIONTAX: RATE


DYES DNO DN/A .-- - - _. - - - _. -


TypicalBook, Paperback(300 to 500 pages)

Substitute

Newspaper, Daily Local

SECOND MOST USED OUTLET: (Enter Name) ~

Book, PaperbackTypical

(300 to 500 pages)Substitute

Newspaper, Daily Local

SUBCATEGORY: RECREATIONAL PRICE DESCRIPTIONEQUIPMENT


DYES DNO DN/A

MOST FREQUENTLY USED OUTLET: (Enter Name) J-Typical

BicycleSubstitute


TypicalBicycle

Substitute

DS·202(fPart-3-Retaii Prices of 36

SUBCATEGORY: RECREATIONAL PRICE DESCRIPTIONACTIVITIESTAX: RATE


(Enter Name)_.

lMOST FREQUENTLY USED OUTLET:

Movie TheaterEvening

Matinee

TypicalPerforming Arts

Substitute

TypicalSports Events

Substitute

TypicalGym Membership

Substitute

SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES: (Enter Name)-

Movie TheaterEvening

Matinee

TypicalPerforming Arts

Substitute

Sport EventsEvening

Matinee

TypicalGym Membership

Substitute


SUBCATEGORY: PET FOOD QUANTITY UNIT PRICE DESCRIPTIONTAX: RATE (by weight)


DYES DNO DN/A

(Enter Name) IMOST FREQUENTLY USED OUTLET:

TypicalDry Cat Food

Substitute

TypicalDry Dog Food

Substitute

SECOND MOST USED OUTLET: (Enter Name)- I.- - - - -

TypicalDry Cat Food

Substitute

TypicalDry Dog Food

Substitute

SUBCATEGORY: VETERINARY VISIT QUANTITY UNIT . PRICE DESCRIPTIONTAX: RATEINCLUDED IN REPORTED PRICE?

DYES DNO ON/A


TypicalVeterinary Visit

Substitute


TypicalVeterinary Visit

Substitute


CATEGORY: PUBLIC TRANSPORTATIONSUBCATEGORY: TAXI DISTANCE UNIT PRICE TIP DESCRIPTIONTAX: RATE

(miles/km) (%)INCLUDED IN REP,[!:TED P~E?DYES NO N/A


Taxi (1 1/4 mi/2km or 15 minutes)

Comments:

SUBCATEGORY: MUNICIPAL BUS DISTANCE(mWe~~Im)

PRICE DESCRIPTIONTAX: RATEINCLUDED IN REPOaED P~E?

DYES NO N/AMOST FREQUENTL Y USED OUTLET: (Enter Name)

Bus (3-4 mi/5-6 km at commuter rush hour)

Comments:

SUBCATEGORY: SUBWAY DISTANCE UNIT PRICE DESCRIPTIONTAX: RATE (miles/km)INCLUD~N REPEjTED '[BfCE?

YES NO N/AMOST FREQUENTLY USED OUTLET: (Enter Name)

Subway (5-6 mi/8-10 km at commuter rush hr

Comments:

SUBCATEGORY: AIRFARE DISTANCE UNIT PRICE DESCRIPTIONTAX: RATE (Round trip) (miles/km) (Round trip)INCLUDED IN REP?3TED PESE?

DYES NO N/A-MOST FREQUENTL Y USED OUTLET: (Enter Name) I

(round trip full Fare Coach Class, norestrictions, to destination at least 1,000miles from post)Comments:

- -- ,--05·2020 Part 3 Retail Prices

CATEGORY: PERSONALLY OWNED VEHICLE

SUBCATEGORY: AUTO FUEL UNIT PRICE COMMENTTAX: RATE (gallonlliter)


DYES DNO DN/A

MOST FREQUENTL Y USED OUTLET: (Enter Name)I- -- - - ~

Regular Octane

Fuel High Octane

Diesel~

IDUTY-FREE/SPECIAL ARRANGEMENTS: (Enter Name).Regular Octane

Fuel High Octane

Diesel

- Report price of fuel obtained duty-free -- either at the duty location, with coupons, or a tax refund program at a local station or any other specialarrangement

- Percentage of post/duty station personnel eligible to purchase duty-free gasoline, through any means: %

SUBCATEGORY: AUTO MAINTENANCE PRICE DESCRIPTIONTAX: RATE


DYES DNo ON/A

MOST FREQUENTL Y USED OUTLET: (Enter Name)I

Oil Change(labor, 5 quarts of oil, and oil filter)

Motor Tune Up

Labor Charge Per Hour

05-2020 Part 3 Retail Prices ot36

SUBCATEGORY: AUTO MAINTENANCE PRICE DESCRIPTION(Continued)

- - . - -ISECOND MOST USED OUTLET: (Enter Name)

Oil Change{labor, 5 quarts of oil, and oil filter)

Motor Tune Up

Labor Charge Per Hour_.

ISPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES: (Enter Name). - .- -

Oil Change{labor, 5 quarts of oil, and oil filter)

Motor Tune Up

Labor Charge Per Hour

SUBCATEGORY: AUTO PARTS QUANTITY UNIT PRICE BRAND AND DESCRIPTIONTAX: RATE


DYES DNO D NfA-

MOST FREQUENTLY USED OUTLET: (Enter Name)I- --

TypicalTire, Radial

Substitute

SECOND MOST USED OUTLET: (Enter Name) lTypical

Tire, RadialSubstitute

SPECIAL ARRANGEMENTS FOR GOVERNMENT EMPLOYEES: (Enter Name) II

r I

TypicalTire, Radial

Substitute


SUBCATEGORY: AUTO INSURANCE COST FOR A TWO(Typical cost for a 25 year old married male driver)YEAR OLD VEHICLE CURRENCY COMPANY/ DESCRIPTION


DYES DNo DN/A

(Enter Name)- _. -

MOST FREQUENTLY USED OUTLET:. - - - - -

1. All inclusive/All Risk(total of 2, 3, and 4)

2. Liability

3. Comprehensive

4. Collision

Is locally purchased liability insurance required by host-country law? DYES DNO

Is there a Tax on Insurance? DYES DNo r If Yes, provide Tax Rate:

If employees typically purchase additional insurance from a U.S. based or off-shore company, identify the company, explain and report the price below in thecomments section.

Additional required insurance not reported above:

Comments: I

Number of years of safe driving needed to qualify for the discount:

CATEGORY: HOUSEHOLD HELPSUBCATEGORY: CHILDCARE HOURLY FIVE DAY DESCRIPTION

TAX: RATE RATE COST

INCLUDED IN REPORTED PRICE? -DYES DNO ON/A

MOST FREQUENTL Y USED OUTLET: (Enter Name) IChildcare, outside Parents' Home

Childcare, in Parents' Home

OS-2020 Part 3 Retail Prices of 36

SUBCATEGORY: HOUSEHOLD HELP HOURLY FIVE DAY SOCIALTAX: RATE WAGES COST SECURITY

DESCRIPTION

INCLUDED IN REPORTED PRICE? TAXDYES DNO DN/A


Housekeeper

Cook

According to the data in the most recent living Pattern Questionnaires (LPQs) completed by post/duty station personnel:

Average number ofHousehold Help Necessary for:hours worked per week

HousekeeperDSecurity D Shopping/Food Preparation(may include cooking)

Cook (only) D Language Difficulties D Extra cleaning/laundry due to climate

D Other (Please specify in comments section)

Justification for Household Help:Explain fully why each type of household help listed above is needed at the post. Use additional pages as necessary.


CATEGORY: FOOD AWAY

This part of the form collects information pertaining to the restaurants typically frequented by post employees and family memberswhen eating out. It differs from the Per Diem form which collects similar information for individuals visiting post on Temporary Duty.

BREAKFAST Restaurant PricesReport Combined Price of Tax Rates Service Charge or Tip Rates

Bacon, 2 Eggs, Juice, (If not included (If customary andToast, and Coffee or Tea in prices) not included in prices)

Restaurant Informationi.e., the price of a typical

American breakfast(If bacon is not available, % Flat % Flat

please incorporate the priceof another meat)

1. Most Frequently Used RestaurantName:Prices in local currency: 0 YES ONO2. Second Most Used RestaurantName:Prices in local currency: 0 YES ONOComments:

LUNCH Restaurant PricesUst prices for the following Tax Rates Service Charge or Tip Rates

Main Course a la carte items not included (If not included (If customary andin main entree in prices) not included in prices)Restaurant Information

One Coffee,Chicken entree Side Tea, or % Flat % Flat

Order Soda1. Most Frequently Used RestaurantName:Prices in local currency: 0 YES DNO2. Second Most Used RestaurantName:Prices in local currency: 0YES ONOComments:

I

05-2020 Part 3 Retail Prices ot36

FAST FOOD Restaurant Prices

Restaurant Information Hamburger French Fries Pizza Coffee, Tea, Tax Rates(If not included in prices)

(Large) (Large) (10in.) Soda (Medium)N/A

% Flat1. Most Frequently Used Restaurant

Name:

Prices in local currency: 0YES ONO

2. Second Most Used Restaurant

Name:p. . I I OYES ONOflees In oca currency:Comments:

DINNER Restaurant Prices

Main Course List prices for the following a la carte Tax Rates Service Charge or Tip Ratesitems not included in main entree. (If not included (If customary and

Restaurant Informationin prices) not included in prices)

Two Coffee,Chicken entree Appetizer Side Dessert Tea, or % Flat % Flat

Orders Soda1. Most Frequently Used Restaurant

Name:

Prices in local currency: 0YES ONO2. Second Most Used Restaurant

Name:

Prices in local currency: 0YES ONO

Comments:


retail prices -part 3 fiiiiir-.-,. .1 1 .. ---.-. ,,, .j ... · beans, green carrots lettuce onions...

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