State & Local Government Finance Forms

Supplemental state government data collection example
We are writing to request information for our Annual Survey of State Government Finances. This
annual survey enables the Census Bureau to develop statistical estimates of government revenue,
expenditure, debt, and assets for all 50 states. We publish these estimates in summarized format,
by Census Bureau category, for all states. The statistics are used by the Bureau of Economic
Analysis in that agency’s mission to develop the National Income and Product Accounts - Gross
Domestic Product (GDP), national income, and the like. The statistics also are used by other
Federal agencies, states, and policy makers, to develop a variety of important economic measures.
.
We would like to obtain copies of the report(s) specified below. The data requested are for your
government’s fiscal year that ended XXXX.
Name of financial source documents being requested or specified revenue or expenditure
items.
Please verify, correct, or add to the following information:
1. Mailing address (top of this page):
2. Telephone Number:
3. Fax Number:
4. E-mail address:
Official mailing labels are enclosed for your convenience in sending the materials to us. If you
have any questions about this request, the survey, or the transmission of the files, please contact
me at 1-866-820-7210, or via e-mail at: govs.state.finance@census.gov.
We request a variety of reports for this annual survey. Some are specialized, while others are
standard (such as annual financial reports). If any of the standard reports we request from your
agency are available from an Internet site, you may direct us to the web pages in lieu of providing
a hard copy. For any reports so available, we will eliminate this request for future surveys.
We appreciate your continued cooperation in this important annual survey.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of
information has been approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number
displayed in the upper right corner of this screen. Display of this number confirms that we have approval from OMB to conduct this survey. If
this number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided in this collection tool compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Public reporting burden for this collection of information is estimated at an average of 1 hour per response, including time for gathering 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@census.gov; use Paperwork Project 0607-0585 as the
subject

Supplemental state government data collection example
We are writing to request information for our Annual Survey of State Government Finances. This
annual survey enables the Census Bureau to develop statistical estimates of government revenue,
expenditure, debt, and assets for all 50 states. We publish these estimates in summarized format,
by Census Bureau category, for all states. The statistics are used by the Bureau of Economic
Analysis in that agency’s mission to develop the National Income and Product Accounts - Gross
Domestic Product (GDP), national income, and the like. The statistics also are used by other
Federal agencies, states, and policy makers, to develop a variety of important economic measures.
.
We would like to obtain copies of the report(s) specified below. The data requested are for your
government’s fiscal year that ended XXXX.
Census Revenue Electronic Report by Fund, Program, Dept., Object, SubOject
Census Expenditure Electronic Report by Fund, Program, Dept., Object, SubOject
Chart of Accounts
You may send your electronic files via our web upload site located at
http://harvester.census.gov/EBNET/. Instructions for uploading the electronic data files are
provided on the attachment to this letter. You will need your 14-digit user identification number
(User ID) to utilize the upload service.
Please verify, correct, or add to the following information:
1. Mailing address (top of this page):
2. Telephone Number:
3. Fax Number:
4. E-mail address:
Official mailing labels are enclosed for your convenience in sending the materials to us. If you
have any questions about this request, the survey, or the transmission of the files, please contact
me at 1-866-820-7210, or via e-mail at: govs.state.finance@census.gov.
We request a variety of reports for this annual survey. Some are specialized, while others are
standard (such as annual financial reports). If any of the standard reports we request from your
agency are available from an Internet site, you may direct us to the web pages in lieu of providing
a hard copy. For any reports so available, we will eliminate this request for future surveys.

We appreciate your continued cooperation in this important annual survey.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of
information has been approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number
displayed in the upper right corner of this screen. Display of this number confirms that we have approval from OMB to conduct this survey. If
this number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided in this collection tool compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Public reporting burden for this collection of information is estimated at an average of 1 hour per response, including time for gathering 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@census.gov; use Paperwork Project 0607-0585 as the
subject.

2

Sample local government finance supplemental letter
Dear Local Government Official:
The U.S. Census Bureau is conducting the 2014 Annual Survey of Local Government Finances.
We conduct this survey annually to develop comprehensive local government data used by
Federal agencies, state legislators, finance offices, research organizations and many other users.
Most of the data are obtained from a questionnaire (Form F-28) that was recently sent to you. In
order to complete our work, we need the additional information shown below.
Total Senior Citizens Tax Deferral Receipts from State
Amount Retained by County
Amount Distributed to Cities (please specify cities below)
Please fill in the amounts requested for the year ending XXXX on the attached spreadsheet and
return it in the postage paid envelope.
If you have any questions, please contact us at 1-800-242-4523 or govsfinstaff@census.gov
Your cooperation and assistance are greatly appreciated.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of
information has been approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number
displayed in the upper right corner of this screen. Display of this number confirms that we have approval from OMB to conduct this survey. If this
number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided in this collection tool compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Public reporting burden for this collection of information is estimated at an average of 1 hour per response, including time for gathering 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@census.gov; use Paperwork Project 0607-0585 as the
subject.

Sample local government finance supplemental letter
Dear Local Government Official:
The U.S. Census Bureau is conducting the 2014 Annual Survey of Local Government Finances.
We conduct this survey annually to develop comprehensive local government data used by
Federal agencies, state legislators, finance offices, research organizations and many other users.
Most of the data are obtained centrally from the New York state government. In order to
complete our work, we need the additional information shown below.
Report amount of fees retained by your county from tax collections. Do not include amounts of
taxes or licenses collected by the county agent for another government and forwarded to that
government.
Motor vehicle fees retained by county
Sales tax fees
Fees for collecting state recording fees,
Mortgage tax fees,
Transfer tax fees
Conservation license fees
Other fees
Please fill in the amounts requested for the year ending XXXX on the attached spreadsheet and
return it in the postage paid envelope.
If you have any questions, please contact us at 1-800-242-4523 or govsfinstaff@census.gov
Your cooperation and assistance are greatly appreciated.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of
information has been approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number
displayed in the upper right corner of this screen. Display of this number confirms that we have approval from OMB to conduct this survey. If this
number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided in this collection tool compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Public reporting burden for this collection of information is estimated at an average of 1 hour per response, including time for gathering 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@census.gov; use Paperwork Project 0607-0585 as the
subject.

Sample local government finance supplemental letter
Dear Local Government Official:
The U.S. Census Bureau is conducting the 2014 Annual Survey of Local Government Finances.
We conduct this survey annually to develop comprehensive local government data used by
Federal agencies, state legislators, finance offices, research organizations and many other users.
Most of the data are obtained centrally from the New York state government. In order to
complete our work, we need the additional information shown below.
Report amounts items listed below. Do not include revenue or expenditures for Food Stamp
Program except for administrative costs for disbursements.
Receipts:
State and Federal aid for all welfare programs
County appropriations
Recoveries and reimbursements from welfare recipients
Other receipts – specify
Disbursements:
Cash payments under Federally aided assistance programs (Temporary Assistance to Needy
Families)
Cash payments for general assistance
Vendor payments other than for medical and hospital care (Burial, Heating Assistance, etc.)
SSI payments to State
Administration of TANF assistance, foster care and other welfare activities not included in
items listed above (include Food Stamp Administration)
Please fill in the amounts requested for the year ending XXXX on the attached spreadsheet and
return it in the postage paid envelope.
If you have any questions, please contact us at 1-800-242-4523 or govsfinstaff@census.gov
Your cooperation and assistance are greatly appreciated.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of
information has been approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number
displayed in the upper right corner of this screen. Display of this number confirms that we have approval from OMB to conduct this survey. If this
number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided in this collection tool compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Public reporting burden for this collection of information is estimated at an average of 1 hour per response, including time for gathering 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@census.gov; use Paperwork Project 0607-0585 as the
subject.

Sample local government finance supplemental letter
Dear Local Government Official:
The U.S. Census Bureau is conducting the 2014 Annual Survey of Local Government Finances.
We conduct this survey annually to develop comprehensive local government data used by
Federal agencies, state legislators, finance offices, research organizations and many other users.
Most of the data are obtained centrally from the New York state government. In order to
complete our work, we need the additional information shown below.
We are requesting data concerning the financial transactions of the XXXX OTB Corporation for
the year that ended December 31, XXXX. We ask that your office supply us with the following:
Information concerning the distribution of the breakage, surcharge, and profits of the corporation,
as described below.
Distribution of Breakage
Breakage Paid to the State
Breakage Retained by the Corporation
Distribution of Surcharge and Surcharge Breakage
Distribution of Profits
Please fill in the amounts requested on the attached spreadsheet and return it in the postage paid
envelope.
If you have any questions, please contact us at 1-800-242-4523 or govsfinstaff@census.gov
Your cooperation and assistance are greatly appreciated.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of
information has been approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number
displayed in the upper right corner of this screen. Display of this number confirms that we have approval from OMB to conduct this survey. If this
number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided in this collection tool compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Public reporting burden for this collection of information is estimated at an average of 1 hour per response, including time for gathering 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@census.gov; use Paperwork Project 0607-0585 as the
subject.