Annual Social and Economic Supplement to the Current Population Survey

CPS-580(ASEC)(L) ATLANTA
(11-2014)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

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
Enclosure
Further information
may be obtained from:
REGIONAL DIRECTOR
US CENSUS BUREAU
101 MARIETTA ST NW STE 3200
ATLANTA GA 30303-2711
Telephone: 404–730–3832
census.gov

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, for 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

• Wages or salary before
taxes and deductions

Name

Amount

$

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
premiums; assign premium
payments to policyholder.

• Over-the-counter expenses on

health-related products, not
reimbursed – e.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)