2015 ASEC Parallel

Attachment F
CPS-580(ASEC)(L) Denver
(11-2014)

FROM THE DIRECTOR
U.S. CENSUS BUREAU
Thank you for your past cooperation in the U.S. Census Bureau's Current Population Survey (CPS). Your
participation in this study continues to play a major role in the development of the employment and
unemployment data, which are so important to understanding our Nation's economic situation.
One of our field representatives or telephone center interviewers will call on your household soon to update the
regular labor force information. He or she also will ask questions about other subjects that will provide
government and private organizations the information needed to understand the economic situation of our
population. These questions will concern work experience and income from various sources during the year
2014. The estimated time for each interview is 25 minutes, in addition to the time needed for the regular labor
force information. To explain the need for this information and how these data are used, we have enclosed a fact
sheet about this survey that may answer some of the questions you might have.
We are conducting this survey under the authority of Title 13, United States Code, Section 182. Section 9 of this
law requires us to keep all information about you and your household strictly confidential. We may use this
information only for statistical purposes. Any Census Bureau employee who violates these provisions is subject
to a fine up to $250,000 or a prison sentence up to five years or both. Although there are no penalties for not
answering any questions, each unanswered item lessens the accuracy and usefulness of the final statistics. The
Office of Management and Budget control number for the CPS is 0607-0354, and the expiration date is January
31, 2017. Without this number, we would not be able to conduct this survey.
Some income sources, and medical out-of-pocket expenditures, that the field representative will be asking about
appear on the back of this letter. Space is provided for you to enter the income amounts received, and medical
expenditures paid, by members of your household who are 15 years old or over. Although the income sources
mentioned are not all-inclusive and some may not have been received by anyone in your household, we request
that you look up the 2014 income records for yourself and the rest of your household before the representative
calls on you. This will ensure the accuracy of the statistics collected and will also serve to minimize the time
required for the interview.
Send comments regarding the time estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: Paperwork Project 0607-0354, U.S. Census Bureau, 4600 Silver Hill
Road, AMSD-3K138, Washington, D.C. 20233. You may e-mail comments to Paperwork@census.gov; use
“Paperwork Project 0607-0354” as the subject.
Thank you for your continued cooperation.
Sincerely,
John H. Thompson
Director
Enclosure
Further information
may be obtained from:
REGIONAL DIRECTOR
US CENSUS BUREAU
6900 W JEFFERSON AVE STE 100
DENVER CO 80235-2355
Telephone: 800-5096

HOLD FOR REFERENCE
A Census Bureau field representative or telephone center interviewer will be calling on your household soon to ask you about
income received and medical expenditures paid, f o r members of this household 15 years of age and over from sources such as
those listed below. Consult your records and enter the amounts received or spent during 2014, as applicable, in the columns
provided for each person 15+ in your household. Then, when the field representative calls on you, you can refer to this form. This
form should not be delivered or mailed in lieu of an actual interview.
Name
Income

Name
Amount

• Wages or salary before
taxes and deductions

Name
Amount

$

$

Name
Amount

$

Amount

$

• Income from his/her own
nonfarm business, partnership,
or professional practice after
expenses
• Income from his/her own
farm after expenses
• Social Security or Supplemental
Security Income (SSI)
• Unemployment Compensation
• Interest on savings, CD’s,
bonds, retirement accounts,
and so on
• Dividends on stocks,
mutual funds, and so on
• Pensions and Company retirement
• Income from retirement accounts
(401K, IRA, KEOGH, SEP, and so on)
• Public assistance or welfare
• Estates or trusts
Medical Expenditures
• Premium expenditures for health
Insurance Policies- Include
total spending on all policies
except Medicare Part B.

I

:

....

premiums; assign premium
payments to policyholder.
·
• Over-the-counter expenses on healthrelated products, not reimbursede.g., aspirin, cold remedies, etc.

• Medical care and equipment
expenses, not reimbursed - e.g.,
copayments for Dr. visits,
prescription medication,
hearing/vision aids, etc.
Occasionally, we may combine data from the CPS with data we obtain from other government agencies to provide
a comprehensive set of summary information about employment, income, and participation in various government
programs. The same confidentiality laws that protect your survey answers also protect any additional information
we collect (Title 13, United States Code, Section 9). To ensure your protection, the laptops used for the data
collection are password protected and all survey responses are encrypted. If you wish to request that your
information not be combined with information we obtain from other agencies, we ask that you notify the Field
Representative at the time of the interview.
FORM CPS-580(ASEC)(L) (11-2014)