Instructions: Please provide the highest price for each item based on the description provided. When prompted please provide the brand name and/or size of the item.
Do not include sale prices. Do not include organic prices.
The grocery price survey is intended to include information for one store location. Please complete a grocery price survey for each store location.
If the information included is for use across multiple stores, please select yes for additional stores and enter a list of stores with the store names and addresses.
WIC ID Number (if applicable):
Date:
Store Name:
Address:
City:
Zip Code:
WIC ID Number (if applicable):
Today M-D-Y
Do you have additional stores to include in the listed price changes?
Yes
No
DESCRIPTION PACKAGE SIZE PRICE UPC CODE No acidophilus-treated, condensed, organic, goat, nut, or rice. Store Brand, Fat free, Milk Gallon Store Brand, 1%, Milk Gallon Store Brand, Whole, Milk Gallon
DESCRIPTION PACKAGE SIZE PRICE UPC CODE No brown eggs, specialty eggs, or Eggland's Best Store Brand, Frest, Grade A, large 1 Dozen
DESCRIPTION PACKAGE SIZE PRICE UPC CODE May be low-fat, low cholesterol, low sodium, sliced, hoop, string, shredded, cubed, or block. No cheese food, spread, or product. No mixes, sticks, or crumbles. No peppers or other added ingredients. No cheese from the deli or cheese shop. Store Brand, Processed American, Block 16 oz pkg Store Brand, Cheddar, Block 16 oz pkg Store Brand, Colby, Block 16 oz pkg Store Brand, Monterey Jack, Block 16 oz pkg Store Brand, Colby Jack, Block 16 oz pkg Store Brand, Mozzarella, Block 16 oz pkg Store Brand, Swiss, Block 16 oz pkg Store Brand, Mozzarella, String 16 oz pkg Store Brand, Processed American, Sliced 16 oz pkg Store Brand, Cheddar, Shredded 16 oz pkg Store Brand, Colby, Shredded 16 oz pkg Store Brand, Monterey Jack, Shredded 16 oz pkg Store Brand, Colby Jack, Shredded 16 oz pkg Store Brand, Mozzarella, Shredded 16 oz pkg Store Brand, Swiss, Shredded 16 oz pkg
DESCRIPTION PACKAGE SIZE PRICE UPC CODE Must be 100% juice. May contain added calcium. No added sweeteners. No fruit punch, fruit drink, or drink ades Juicy Juice, Any Flavor 64 oz Containers Lucky Leaf, Apple Juice 64 oz Containers Northland, Any Cranberry Juice Blends 64 oz Containers Seneca, Apple Juice 64 oz Containers Libby's, Pineapple Juice 64 oz Containers Welch's, Grape Juice 64 oz Containers Welch's, Red Grape Juice 64 oz Containers Welch's, White Grape Juice 64 oz Containers Orange Juice, Refrigerated (Please input Brand Name) (no juice drinks, no Sunny-D) Must be 64 ounce 64 oz Containers 64 oz Containers
DESCRIPTION PACKAGE SIZE PRICE UPC CODE Examples include but are not limited to black beans, black-eyed peas, garbanzo beans (chick peas), great northern beans, white beans (navy or pea beans), kidney beans, mature lima (butter beans), fava beans, mung beans, pinto beans, split peas, and lentils. No organic, added sugar, fat, oil, or meat. No soups or baked beans. No immature varieties or legumes such as green peas or snap beans/ green beans. Dry Beans, or Peas (Please input Brand Name for Store Brand) Camellia 16 oz bag Store Brand: 16 oz bag Canned Beans (Please input Brand Name for Store Brand) Bush's 15-16 oz can Trappey's 15-16 oz can Store Brand: 15-16 oz can
DESCRIPTION PACKAGE SIZE PRICE UPC CODE No whipped, spreads, omega-3, organic or combinations with jelly, honey, marshmallows, chocolate, or similar ingredients Peanut Butter Creamy or Crunchy (Please input Brand Name for Store Brand) Jif 16-18 oz jar Peter Pan 16-18 oz jar Skippy 16-18 oz jar Store Brand: 16-18 oz jar
DESCRIPTION PACKAGE SIZE PRICE UPC CODE Only brands and varieties specified Cold Cereal General Mills Cheerios 12 oz General Mills Cheerios 18 oz General Mills Cheerios 21 oz General Mills Multi-Grain Cheerios 12 oz General Mills Multi-Grain Cheerios 18 oz General Mills Corn Chex 12 oz General Mills Corn Chex 18 oz General Mills Rice Chex 12 oz General Mills Rice Chex 18 oz General Mills Kix 12 oz General Mills Kix 18 oz General Mills Total 16 oz General Mills Wheaties 15.6 oz Kellogg's Corn Flakes 12 oz Kellogg's Corn Flakes 18 oz Kellogg's Corn Flakes 24 oz Kellogg's Frosted Mini Wheats- Original 18 oz Kellogg's Frosted Mini Wheats- Original 24 oz Kellogg's Rice Krispies- Regular 12 oz Kellogg's Rice Krispies- Regular 18 oz Kellogg's Rice Krispies- Regular 24 oz Kellogg's Special K Original 12 oz Kellogg's Special K Original 18 oz Kellogg's Crispix 12 oz Kellogg's Crispix 18 oz Kellogg's All- Bran Complete Wheat Flakes 18 oz Kellogg's All- Bran Complete Wheat Flakes 18.6 oz Post Honey Bunches of Oats with Almonds 14.5 oz Post Honey Bunches of Oats with Almonds 18 oz Post Honey Bunches of Oats Honey Roasted 14.5 oz Post Honey Bunches of Oats Honey Roasted 18 oz Post Honey Bunches of Oats Whole Grain Honey Crunch 18 oz Post Honey Bunches of Oats Vanilla 18 oz Post Grape Nuts Original 20.5 oz Post Grape Nuts Original 29 oz Quaker Life Original 13 oz Quaker Life Original 18 oz Quaker Life Original 24.8 oz Quaker Oatmeal Squares Brown Sugar 14.5 oz Quaker Oatmeal Squares Brown Sugar 21 oz Hot Cereal Cream of Wheat, Instant, Original, *packets only 12 oz Quaker, Instant Oatmeal, Original, *packets only 11.8 oz Quaker, Instant Grits, Original, *packets only 12 oz
price_gm_mg_cheerios_12oz
price_gm_mg_cheerios_18oz
price_kell_corn_flakes_12oz
upc_kell_corn_flakes_12oz
price_kell_corn_flakes_18oz
upc_kell_corn_flakes_18oz
price_kell_corn_flakes_24oz
upc_kell_corn_flakes_24oz
price_kell_frosted_mini_wh_18oz
upc_kell_frosted_mini_wh_18oz
price_kell_frosted_mini_wh_24oz
upc_kell_frosted_mini_wh_24oz
price_kell_rice_crisp_12oz
price_kell_rice_crisp_18oz
price_kell_rice_crisp_24oz
price_kell_special_k_12oz
price_kell_special_k_18oz
price_kell_all_bran_compl_18oz
upc_kell_all_bran_compl_18oz
price_kell_all_bran_compl_18.6oz
upc_kell_all_bran_compl_18.6oz
price_post_hbo_almonds_14.5oz
upc_post_hbo_almonds_14.5oz
price_hbo_honey_roast_14.5oz
upc_hbo_honey_roast_14.5oz
price_hbo_honey_roast_18oz
price_hbo_wg_honey_crun_18oz
upc_hbo_wg_honey_crun_18oz
price_post_grape_nuts_20.5oz
upc_post_grape_nuts_20.5oz
price_post_grape_nuts_29oz
price_qua_oat_squares_bs_14.5oz
upc_qua_oat_squares_bs_14.5oz
price_qua_oat_squares_bs_21oz
upc_qua_oat_squares_bs_21oz
DESCRIPTION PACKAGE SIZE PRICE UPC CODE Bimbo 100% Whole Wheat Bread 16 oz Nature's Own 100% Whole Wheat Bread 16 oz Nature's Own 100% Whole Wheat with Honey Bread 16 oz Pepperidge Farm 100% Whole Wheat Stone Ground Bread 16 oz Roman Meal Sungrain 100% Whole Grain Bread 16 oz Sara Lee 100% Whole Wheat Classic Bread 16 oz Wonder 100% Whole Wheat Bread 16 oz Arnold's 100% Whole Wheat Hamburger Bun 16 oz WHOLE GRAIN BROWN RICE No seasoned, white, frozen, gourmet blends, or organic.
Regular Brown Rice, Bag or Box (Please input Store Brand Name)
Mahatma 14-16 oz Store Brand: 14-16 oz Instant Brown Rice, Bag or Box (Please input Store Brand Name) Minute 14-16 oz Uncle Ben's 14-16 oz Store Brand: 14-16 oz Brown Rice, Boil in Bag (Please input Store Brand Name) Success 14-16 oz Uncle Ben's 14-16 oz Store Brand: 14-16 oz
price_rm_sungrain_wg_bread
price_sl_ww_classic_bread
DESCRIPTION PACKAGE SIZE PRICE UPC CODE Any 2nd stage, single ingredient baby fruit or vegetable only. No added sugar, starches, salt, DHA, or organic. Beech Nut Classics, Fruit Single Ingredient Only 4oz Jar Beech Nut Classics, Vegetable, Single Ingredient Only 4 oz jar Gerber, Fruit, Single Ingredient Only 8 oz- (2 pack of 4 oz) Gerber, Vegetable, Single Ingredient Only 8 oz- (2 pack of 4 oz)
price_bn_vegetable_single
price_gerber_fruit_single
price_gerber_vegetable_single
upc_gerber_vegetable_single