RETAIL PRICES - PART 3 fiIIiIr- .1 1 _.J .-,. ~ .. - ..---.-. .......,,, ..•...•.. , . 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 Questionnaire 2. 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 PRODUCTS SUBCATEGORY: BEEF QUANTITY UNIT PRICE DESCRIPTION COMMENTS TAX: RATE (by weight) INCLUDED IN REPORTED PRICE? DYES DNO DN/A MOST FREQUENTLY USED OUTLET: (Enter Name) . - - . - - . I Beef Steak Beef Roast Beef Hamburger SECOND MOST USED OUTLET: {Enter Namt?) -- - -- -- . Beef Steak Beef Roast Beef Hamburger SUBCATEGORY: PORK QUANTITY UNIT PRICE DESCRIPTION COMMENTS TAX: 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 Prices 10-2016 Page 1 of 36
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RETAIL PRICES -PART 3 fiIIiIr-.-,. .1 1 .. ---.-. ,,, .J ... · Beans, Green Carrots Lettuce Onions Tomatoes Spinach 05-2020 Part 3Retail Prices Page10of. ... Apple Juice (1361mI/46oz.)
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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
Page 1 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)
- 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
INCLUDED IN REPORTED PRICE?
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 Page 31 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
INCLUDED IN REPORTED PRICE?
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
05-2020 Part 3 Retail Prices Page 32 of 36
SUBCATEGORY: AUTO INSURANCE COST FOR A TWO(Typical cost for a 25 year old married male driver)YEAR OLD VEHICLE CURRENCY COMPANY/ DESCRIPTION
TAX: RATEINCLUDED IN REPORTED PRICE?
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 Page 33 of 36
SUBCATEGORY: HOUSEHOLD HELP HOURLY FIVE DAY SOCIALTAX: RATE WAGES COST SECURITY
DESCRIPTION
INCLUDED IN REPORTED PRICE? TAXDYES DNO DN/A
MOST FREQUENTL Y USED OUTLET: (Enter Name)
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.
05-2020 Part 3 Retail Prices Page 34 of 36
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 Page 35 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