Form GUS-1 2011 Government Units Survey

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

2011 GOVERNMENT UNITS SURVEY
Census of Governments

GUS-1 (07-12-2011) Draft 2

OMB No. 0607-0930: Approval Expires 12/31/2012

Due Date:

RETURN VIA MAIL TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

If you have any questions,
please call 1-888-202-2691
weekdays, 7am to 5pm EST.
Questions may also be emailed
to: govs.gus@census.gov

In correspondence pertaining
to this report, please refer to
the User ID printed below the
address box.

Report Online:
Respond to this survey via the Internet at the following
web address: http://
You will need your User ID and Password to access the
Internet form.
➤

User ID:

Password:

Introduction and Survey Purpose:
This survey collects descriptive information on the basic characteristics of local governments in preparation
for the 2012 Census of Governments. Data from this survey will also be used to produce the official count of local
government units in the United States and to update and verify the mailing addresses of government units.
General Instructions:
• Use a blue or black ink pen.
• Mark the box with an X next to the appropriate response to each question.
BACKGROUND INFORMATION
1 Was your government in existence on October 11, 2011? (For all questions in this survey, "your government" refers

17011016

Yes

(MM)

(DD)

(YYYY)

No – Enter effective date and skip to 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Is your government a fiscally dependent unit on another government, unit, agency, or office? (For example, your
government is unable to adopt its budget, levy taxes, set rates or charges, or issue bonded debt without another
government’s approval.)
Yes

➤

County Dependent
Other – Specify:

No

City Dependent

Township Dependent

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to the unit of government identified in the mailing label above.)

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BACKGROUND INFORMATION – Continued
3 Is the mailing address listed in address label on page 1 correct?
Yes
No – Provide address corrections below.
Address 1

Address 2

City

State

ZIP Code

ZIP+4

4 Is your government’s physical location the same as the location shown in the mailing address? (P.O. Box and rural
route addresses are not physical locations)
Yes
No – Enter physical location below.
Address 1

Address 2

City

State

ZIP Code

ZIP+4

5 Does your government have an Internet website that contains information about your government and its activities?
Yes – Enter the web address

17011024

No

6

Month
(MM)

Day
(DD)

On what date does your government’s fiscal year end? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(YYYY)

7 What year was your government first incorporated or formed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form GUS-1

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(e.g., www.mylocalgov.state.us):

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DEBT
8 Is your government authorized to issue long-term debt with an original term of more than
one year? (For example, bonds, mortgages, revenue bonds, special assessment bonds,
general obligation bonds, industrial development revenue bonds, conduit debt, etc.) . . . . . . . . . .

Yes

No

Yes

No

Yes

No

9 Is your government authorized to issue short-term debt with an original term of less than
one year? (For example, tax-anticipation notes, bond-anticipation notes, interest-bearing
warrants, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Is your government authorized to issue any other debt not specified above?
Yes – Specify:
No

11 Does your government require voter approval to issue certain types of debt? . . . . . . . . . . . . . . .
LICENSE AND PERMIT FEES

12 Does your government have the authority to impose any of the following types of license or permit fees?
(Mark "Yes" or "No" for each item)
A. Alcoholic beverages license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

B. Amusement license (For example, race tracks, theaters, athletic events, pinball and
video machines, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

C. Hunting and fishing license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

D. Motor vehicles license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

E. Motor vehicle operators license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

F. Public utilities license (Exclude franchise fees) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

G. Occupational or businesses license (For example, inspection and examination fees,
barber, chain store, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

H. Other licenses or permit fees (For example, building permits, marriage license, etc.)

17011032

No

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Yes – Specify:

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TAXES
13 Does your government have the authority to levy any of the following types of taxes?
(Mark "Yes" or "No" for each item)
A. Property tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

B. General sales and gross receipts tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

C. Alcoholic beverages sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

D. Amusements sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

E. Motor fuels sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

F. Insurance premiums sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

G. Pari-mutuels sales tax (For example, taxes measured by amounts wagered or bet on
horse-racing, dog racing, jai-alai, etc. including “breakage” collected by the government). . . .

Yes

No

H. Public utilities sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

I.

Tobacco products sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

J. Individual income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

K. Corporation net income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

L. Death and gift tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

M. Documentary and stock transfer tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

N. Severance tax (For example, taxes imposed distinctively on removal of natural
resources (e.g., oil, gas, coal, fish, etc.) from land or water and measured by the
value or quantity of products removed or sold) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

O. Other tax (For example, hotel tax, motel tax, car rental tax, etc.) – Specify

Yes

No

..............

14 Do employees of your government participate in any retirement or pension plans?

17011040

Yes – List plans
No

15 Do retirees of your government have the option of participating in any retiree healthcare plans?
Yes – List plans
No

Form GUS-1

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RETIREMENT/PENSION PLAN

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GOVERNMENT ACTIVITY
Yes

No

ferry boats, or related structures? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

18 Does your government operate a toll road? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

19 Does your government operate a transit authority? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

20 Does your government operate an airport? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

21 Does your government operate a sea or in-land port?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

22 Does your government operate a hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

23 Does your government own a gas utility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

24 Does your government own an electric utility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

25 Does your government supply water within its jurisdiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

26 Does your government own a water utility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

27 Does your government operate a sewer system? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

28 Is the sewer system separate from the water supply system? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

29 Does your government keep separate records for the sewer system and the water supply? . . . . .

Yes

No

30 Does your government operate a landfill? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

16 Does your government operate a liquor store? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Is your government responsible for highways, streets, roads, alleys, bridges, tunnels,

31 Does your government provide refuse collection or disposal? (For example, curbside or
containerized collection including recycling, periodic special collection programs, tire
disposal, leaf and Christmas tree collection, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17011057

(For example, "Section 8" assistance, housing and mortgage finance agencies, promotion of
homeownership, and assistance for repair and renovation of existing homes, etc.) . . . . . . . . . . . .

33 Does your government perform activities related to community development? (For example,
use of community development block grants, renewal of urban areas, clearing of slums,
redevelopment of rural areas, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

34 Does your government perform activities that affect natural resources? (For example,
irrigation, drainage, flood control, soil conservation, land reclamation, fisheries, forestry, etc.). . .

35 Does your government perform activities related to open space or land preservation?
(For example, land preservation for agricultural conservation, etc.) . . . . . . . . . . . . . . . . . . . . . . .

36 Does your government provide or financially support recreational and cultural facilities
or activities? (For example, parks, public beaches, galleries, zoos, botanical gardens,
memorials, community music, celebrations, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form GUS-1

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32 Does your government construct, operate, or support housing and redevelopment projects?

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PUBLIC SERVICES
37 Does your government provide police protection service? (Include contracted services) . . . . . . . .

Yes

No

38 Does your government provide fire protection services? (Include contracted services) . . . . . . . . .

Yes

No

Yes

No

Yes

No

Yes

No

A. Public libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

B. Academic libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

C. Law libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

D. Other library services - Specify

Yes

No

Yes

No

Yes

No

Yes

No

39 Does your government provide emergency medical services (EMS)? (Include contracted services)
Yes
No – Skip to 41

40 (If yes) Are emergency medical services separate from the fire services? . . . . . . . . . . . . . . . . . . .
41 Does your government provide regulation and inspection services? (For example,

buildings and construction regulation, licensing and regulation of financial institutions,
the examination of professional occupations, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42 Does your government provide services to the elderly, homeless, needy, veterans,
children, or disabled people in the community? (For example, transportation services,
medical and cash assistance, nursing homes, foster care, day care, veterans services,
homeless shelters, food banks, welfare programs, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 Does your government provide any of the following types of library services?

.............................................

44 Does your government provide any other activities or services not mentioned above?
Yes – Specify:
No

45 Does your government perform judicial or legal activities that relate to courts, legal

17011065

services, or legal counseling? (For example, criminal and civil court expenditures,
court related activities, legal departments, attorneys, child support enforcement, etc.) . . . . . . . . .

46 Does your government operate any correctional facilities? (For example, prisons, jails,
juvenile correctional facilities, etc. Exclude temporary holding or lockup facilities from
which inmates are usually transferred within 72 hours and not held beyond arraignment.) . . . . .

47 Does your government use any privately-owned correctional facilities?
(For example, detention centers, jails, other correctional facilities, etc.). . . . . . . . . . . . . . . . . . . . .

Form GUS-1

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JUDICIAL OR LEGAL ACTIVITIES

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FINANCE

48 How much revenue did your government receive in

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

the last completed fiscal year? (If none, enter $0.
Estimates are acceptable.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Include all taxes, charges, state or Federal grants, etc.
Consolidate amounts covering all funds and accounts
of your government, net of any duplicative transfers
between funds, amounts of expenditure from bond
funds, construction accounts, and other capital funds
Exclude borrowings

49 How much did your government expend in the last
completed fiscal year? (If none, enter $0. Estimates
are acceptable.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Include salaries, wages, capital outlay, interest on
debt current operations, payments to other
governments, etc.

50 What was your government’s annual gross payroll
(before deductions) in the last completed fiscal year?
(If none, enter $0. Estimates are acceptable.) . . . . . . . . . . . . . . . . .
Include salaries, wages, fees, commissions, overtime,
premium, night differential pay, bonuses, incentive
payments, amounts withheld for taxes, employee
contributions to retirement systems, etc.

51 How much outstanding debt did your government

17011073

have at the end of the last completed fiscal year?
(If none, enter $0. Estimates are acceptable.) . . . . . . . . . . . . . . . . .
Include bonds, mortgages, revenue bonds, special
assessment bonds, general obligation bonds,
industrial development revenue bonds, conduit debt,
tax-anticipation notes, bond-anticipation notes,
interest-bearing warrants, etc.

Form GUS-1

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Exclude fringe benefits, lump-sum payments, and the
value of living quarters and subsistence allowances
furnished for employees

8

REMARKS
52 Please use this space for any explanations that may be important to understanding any of your responses.

CONTACT INFORMATION

17011081

Area Code

Telephone Number

–

–

Ext.

Fax

–

–

E-mail address

THANK YOU FOR COMPLETING THE 2011 GOVERNMENT UNITS SURVEY
NOTE: Public reporting burden for this collection of information is estimated to vary from 30 minutes to 60 minutes per response, with
an average of 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0930, U.S.
Census Bureau, 4600 Silver Hill Road, GOVS-6K151, Washington, DC 20233. You may e-mail comments to govs.gus@census.gov; use
“Paperwork Project 0607-0930" as the subject. No agency may conduct and no person may be required to respond to a collection of information

Form GUS-1 unless it displays a valid Office of Management and Budget (OMB) approval number. The OMB approval number for this information
collection is 0607-0930.

§2"+r¤

Title

Name of person to contact regarding this report