2011 Field Test of the Re-engineered Survey of Income and Program Participation

Attachment F

Form COA-DRAFT1 U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU Change of Address Form
PREPRINTED ADDRESS LABEL ABOUT HERE ADDRESS CORRECTION HERE ____________________________________________________________________________________ I s the preprinted address information correct? Yes No If no, please provide correct address in the box provided to the right. H as anyone moved out of the above address since January 2011 or is planning to move? Yes No Please list the names and addresses of those who have moved or are moving below.
	Name	Street	City	State	ZIP-code	Date moved or Moving date (Month/Year)	Phone Numbers
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Thank you for your assistance. Please return this page in the enclosed postage-paid envelope to: U.S. Census Bureau ATTN: RESIPP 1201 E. 10th Street Jeffersonville, IN 37132-0001