Form Enclosure 1 Enclosure 1 ACS Strategic Framework Mailing Materials

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Enclosure I - ACS Strategic Framework Mailing Materials

American Community Survey (ACS) Strategic Framework Mailing Materials Cognitive Interviews

OMB: 0690-0030

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Enclosure I:
ACS Strategic Framework Mailing Materials

Treatment 1:
Classic with a Twist

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

An important message from the Director:
Your household has been selected to participate in the American Community Survey.
Since 2005, the U.S. Census Bureau has been conducting this survey to provide our nation with
an up-to-date picture of how we live. This survey helps determine the needs of communities
across the nation, covering topics like education, employment, and housing.

Please respond now at https://respond.census.gov/acs
Using your computer or smartphone, follow the instructions
on the enclosed card to log in to the secure website and
respond today.
The information that you provide is so important that
your response is required by law (Title 13, U.S. Code,
Sections 141, 193, and 221).
Questions? Please call 1-800-354-7271 if you have
questions or if you need help completing the survey.
Your prompt response online will save taxpayers’ money and conserve natural resources. If you
are unable to respond online, there is no need to contact us. You will receive a questionnaire in
a few weeks. Thank you for your participation.
Sincerely,

Steven D. Dillingham

The Census Bureau serves as the leading source of quality data
about the nation’s people and economy.

ACS-13(LX)SF-M1-CWT (10-04-2019)

census.gov

Frequently Asked Questions
What is the American Community Survey?
The American Community Survey is an official survey from the U.S. Census Bureau. This survey
was created to provide up-to-date, accurate information about the country every year, not just
census years. Governments, businesses, and nonprofit organizations use the information to make
decisions about how to meet the changing needs of communities.
Is this a legitimate survey?
Yes. The Census Bureau has been conducting this survey since 2005. Only government agencies
can use an internet address with the “.gov” extension. You can verify that this is an official
government survey by going to https://www.census.gov/acs or by calling 1-800-354-7271. Call
Monday–Friday: 9 a.m. to 9 p.m., Saturday: 9 a.m. to 7 p.m., or Sunday: 11 a.m. to 9 p.m.
Why was I selected?
Your address was selected through scientific sampling and represents thousands of other
households like yours. The Census Bureau randomly selects about 3.5 million addresses
throughout the country each year to respond to this survey.
Am I required to fill out the survey?
Yes. Your response to this survey is required by law (Title 13, U.S. Code, Sections 141, 193, and
221). Title 13, as changed by Title 18, imposes a penalty for not responding. To create an
accurate picture of your community, it is critical that you respond.
Will my response be confidential?
Yes. The Census Bureau is required by law to protect this information. The Census Bureau is not
permitted to publicly release your responses in a way that could identify you. We are conducting
this survey under the authority of Title 13, U.S. Code, Sections 141 and 193. Federal law
protects your privacy and keeps your answers confidential (Title 13, U.S. Code, Section 9). Per
the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data.
How will the Census Bureau use the information I provide?
By law, the Census Bureau can only use your responses to produce statistics. Your information
will be used in combination with information from other households to produce data for your
community. Similar data will be produced for communities across the United States and Puerto
Rico. We may combine your answers with information that you gave to other agencies to
enhance the statistical uses of these data. This information will be given the same protections as
your survey information. Based on the information that you provide, you may be asked to
participate in other Census Bureau surveys that are voluntary.

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

A reminder from the Director: Please complete the American Community Survey

Respond now at https://respond.census.gov/acs
Log in with this User ID:
Why should you respond to the American Community Survey? Responses to this survey help
your local government, businesses, and nonprofit organizations understand the needs of your
community. Your community may need new or improved:
Roads to help
your work commute

Services for disabled
veterans and the elderly

Opportunities for
local businesses

Outdoor areas
for recreation

This survey is so important that your response is required by law.
If you are unable to respond online, there is no need to contact us. You will receive a
questionnaire in about two weeks. If you have questions or need help completing the survey,
please call 1-800-354-7271. Thank you for helping your community.
Sincerely,

Steven D. Dillingham

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

THE AMERICAN COMMUNITY SURVEY

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-20(LX)SF-M2-CWT-PSM (10-03-2019)

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

An important message from the Director:
Recently, we contacted you about participating in the American Community Survey. If you
have already responded, thank you. If not, please choose ONE way to complete the survey.
Respond today at https://respond.census.gov/acs
on your computer or smartphone.

OR
Fill out the questionnaire and mail it back
in the postage-paid envelope.
Many households across the nation have already responded to this survey. We need your
response too. Your response helps provide the most accurate picture possible of your
community. Together we can help prepare for a better future.
Your response is required by law. Responding is a civic duty much like paying taxes or
responding to jury duty. Please call 1-800-354-7271 if you have questions or need help
completing the survey. Thank you for your time.
Sincerely,

Steven D. Dillingham

Nota: Vea al otro lado para responder en español.

ACS-14(LX)SF-M3-CWT (10-04-2019)

census.gov

Mensaje importante:
Hay dos maneras para completar la Encuesta sobre la Comunidad Estadounidense. Escoja
solamente UNA manera de responder.
Opción 1 – Por internet: Vaya a https://respond.census.gov/acs para
completar la encuesta en español por computadora o smartphone.
Opción 2 – Por teléfono: Llame al 1-877-833-5625 para hablar con un
empleado de la Oficina del Censo que habla español. Usted puede completar
la encuesta por teléfono o pedir que le envíen un cuestionario en español.

Draft 2 (10/4/19)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-CWT (10-04-2019)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-29(PCX)SF-M4-CWT (10-04-2019)

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-CWT (10-04-2019)

ACS-29(PCX)SF-M4-CWT (10-04-2019)

Draft 2 (10/4/19)

Please respond to the

Please respond to the

American Community Survey
HOW?

American Community Survey

Respond online at https://respond.census.gov/acs
- OR - Fill out the questionnaire we recently sent you and
mail it back. If you need help, call 1-800-354-7271.
Respond now. A U.S. Census Bureau interviewer may
call or visit your home to help you complete the survey
if we don’t receive your response soon.

WHEN?
WHY?

HOW?

Respond online at https://respond.census.gov/acs
- OR - Fill out the questionnaire we recently sent you and
mail it back. If you need help, call 1-800-354-7271.
Respond now. A U.S. Census Bureau interviewer may
call or visit your home to help you complete the survey
if we don’t receive your response soon.

WHEN?

Your response is required by law. Our nation
depends on accurate information to prepare for the
future. Your response can help your community.

WHY?

Thank you for your participation.

Your response is required by law. Our nation
depends on accurate information to prepare for the
future. Your response can help your community.

Thank you for your participation.
census.gov

Please respond to the

Please respond to the

American Community Survey
HOW?

American Community Survey

Respond online at https://respond.census.gov/acs
- OR - Fill out the questionnaire we recently sent you and
mail it back. If you need help, call 1-800-354-7271.
Respond now. A U.S. Census Bureau interviewer may
call or visit your home to help you complete the survey
if we don’t receive your response soon.

WHEN?
WHY?

census.gov

Your response is required by law. Our nation
depends on accurate information to prepare for the
future. Your response can help your community.

Thank you for your participation.

HOW?

Respond online at https://respond.census.gov/acs
- OR - Fill out the questionnaire we recently sent you and
mail it back. If you need help, call 1-800-354-7271.
Respond now. A U.S. Census Bureau interviewer may
call or visit your home to help you complete the survey
if we don’t receive your response soon.

WHEN?
WHY?

Your response is required by law. Our nation
depends on accurate information to prepare for the
future. Your response can help your community.

Thank you for your participation.
census.gov

census.gov

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Due Date:
December 20, 2019

An important message from the Director:
Time is running out. We have sent you several requests to complete the American Community
Survey. Your response is required by law. If you don’t respond by Friday, December 20, a U.S.
Census Bureau interviewer may visit your home to help you complete the survey.
How will you complete the survey by December 20, 2019? (Choose ONE way.)
ONLINE:

Go to https://respond.census.gov/acs
Log in with this User ID:

BY MAIL:

Fill out and return the survey form you received in the mail
a few weeks ago.

BY PHONE:

Call 1-800-354-7271 to complete a phone interview.
Monday–Friday: 9 a.m. to 9 p.m.,
Saturday: 9 a.m. to 7 p.m., Sunday: 11 a.m. to 9 p.m.

Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham

Mensaje Importante: Si tiene preguntas o necesita ayuda para llenar la encuesta, llámenos al
1-877-833-5625 para hablar con un empleado de la Oficina del Censo que habla español.

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

FINAL NOTICE
RESPOND NOW

ACS-23(LX)SF-M5-CWT-PSM (10-04-2019)

Treatment 2:
Fresh Look

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

A message from the Director of the U.S. Census Bureau:
Your household has been selected to participate in the
American Community Survey. The Census Bureau has conducted this
survey since 2005. This survey provides an up-to-date picture of how
we live, and it helps local leaders determine the needs of your
community.

THE AMERICAN
COMMUNITY
SURVEY
The American
Community Survey
(ACS) is the
premier source for
detailed population
and housing
information about
our nation.
The ACS helps
local officials,
community leaders,
and businesses
understand the
changes taking
place in their
communities.

Please use the enclosed instruction card to respond now at:

https://respond.census.gov/acs
When you respond to this survey, you are doing your part to ensure
that decisions about your community can be made using the best data
available. The information that you provide is so important that your
response is required by law (Title 13, U.S. Code, Sections 141, 193,
and 221).
If you are unable to complete the survey online, there is no need to
contact us. We will send you a paper questionnaire in a few weeks. If
you need help or have questions, please call us at 1-800-354-7271.
Thank you for your participation.
Sincerely,

Steven D. Dillingham

ACS-13(LX)SF-M1-FL (10-04-2019)

census.gov

Frequently Asked Questions
What is the American Community Survey?
The American Community Survey is an official survey from the U.S. Census Bureau. This survey
was created to provide up-to-date, accurate information about the country every year, not just
census years. Governments, businesses, and nonprofit organizations use the information to make
decisions about how to meet the changing needs of communities.
Is this a legitimate survey?
Yes. The Census Bureau has been conducting this survey since 2005. Only government agencies
can use an internet address with the “.gov” extension. You can verify that this is an official
government survey by going to https://www.census.gov/acs or by calling 1-800-354-7271. Call
Monday–Friday: 9 a.m. to 9 p.m., Saturday: 9 a.m. to 7 p.m., or Sunday: 11 a.m. to 9 p.m.
Why was I selected?
Your address was selected through scientific sampling and represents thousands of other
households like yours. The Census Bureau randomly selects about 3.5 million addresses
throughout the country each year to respond to this survey.
Am I required to fill out the survey?
Yes. Your response to this survey is required by law (Title 13, U.S. Code, Sections 141, 193, and
221). Title 13, as changed by Title 18, imposes a penalty for not responding. To create an
accurate picture of your community, it is critical that you respond.
Will my response be confidential?
Yes. The Census Bureau is required by law to protect this information. The Census Bureau is not
permitted to publicly release your responses in a way that could identify you. We are conducting
this survey under the authority of Title 13, U.S. Code, Sections 141 and 193. Federal law
protects your privacy and keeps your answers confidential (Title 13, U.S. Code, Section 9). Per
the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data.
How will the Census Bureau use the information I provide?
By law, the Census Bureau can only use your responses to produce statistics. Your information
will be used in combination with information from other households to produce data for your
community. Similar data will be produced for communities across the United States and Puerto
Rico. We may combine your answers with information that you gave to other agencies to
enhance the statistical uses of these data. This information will be given the same protections as
your survey information. Based on the information that you provide, you may be asked to
participate in other Census Bureau surveys that are voluntary.

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Dear Resident:
A few days ago, you should have received a notice to complete the
American Community Survey online. If you have already responded,
thank you. If not, please do so now.

THE AMERICAN
COMMUNITY
SURVEY
Did you know?
Non-profit groups
use the American
Community Survey to
plan and build parks
and playgrounds in
communities across
the country.
The American
Community Survey
helps direct more
than $675 billion in
federal funding every
year to communities
nationwide.
You can help your
community by
responding today!

Respond now at https://respond.census.gov/acs
Log in with this User ID:
Your answers help identify local needs such as job training, highway
construction, and health care services.
Your response is so important that it is required by law.
If you are unable to answer online, you will receive a paper
questionnaire in about two weeks. If you need help completing the
survey or have questions, please call 1-800-354-7271.
Thank you for helping your community.
Sincerely,

Steven D. Dillingham
Director

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

THE AMERICAN COMMUNITY SURVEY

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-20(LX)SF-M2-FL-PSM (10-03-2019)

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

American Community Survey Form Enclosed
About two weeks ago, you should have received a letter asking you
to respond to the American Community Survey. As promised, we
are sending you a survey form.
If you have already responded, thank you. If not, you now have two
ways to respond–please choose the one that works best for you:
Respond today at https://respond.census.gov/acs
on your computer or smartphone.
OR
Fill out the survey form and mail it back in the
postage-paid envelope.
Your response to the American Community Survey is required
by law. Just as the law requires us to report for jury duty, pay
taxes, and earn a license to drive, it also requires us to respond to
this survey.
If you need help completing the survey or have questions, please
call 1-800-354-7271.
We look forward to receiving your response.

Did you know?
Millions of
households
participate in the
American
Community Survey
every year.
When you respond
to this survey, you
are helping your
community make
decisions using the
best data available.
Thank you for
being the voice of
your community.

Sincerely,

Steven D. Dillingham
Director

Nota: Vea al otro lado para responder en español.

ACS-14(LX)SF-M3-FL (10-04-2019)

census.gov

Mensaje importante:
Hay dos maneras para completar la Encuesta sobre la Comunidad Estadounidense. Escoja
solamente UNA manera de responder.
Opción 1 – Por internet: Vaya a https://respond.census.gov/acs para
completar la encuesta en español por computadora o smartphone.
Opción 2 – Por teléfono: Llame al 1-877-833-5625 para hablar con un
empleado de la Oficina del Censo que habla español. Usted puede completar
la encuesta por teléfono o pedir que le envíen un cuestionario en español.

Draft 2 (10/4/19)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-FL (10-04-2019)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-29(PCX)SF-M4-FL (10-04-2019)

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-FL (10-04-2019)

ACS-29(PCX)SF-M4-FL (10-04-2019)

Draft 2 (10/4/19)

We
need
your
response.
The American Community Survey

If you are one of the thousands of people
who have already responded to the
American Community Survey, we thank you.
If you have not completed the survey, please do
so right away:
can complete the survey online at
➤ You
https://respond.census.gov/acs
- OR Fill
out
and
return
the form we sent you a
➤ few days ago.

The American Community Survey

The American Community Survey

If you are one of the thousands of people
who have already responded to the
American Community Survey, we thank you.
If you have not completed the survey, please do
so right away:
can complete the survey online at
➤ You
https://respond.census.gov/acs
- OR Fill
out
and
return
the form we sent you a
➤ few days ago.

Your response is so important that it is required
by law.

Your response is so important that it is required
by law.

U.S. Census Bureau staff may call or visit you to
help you complete the survey if we don’t receive
your response. If you have questions or need
help completing the survey, call 1-800-354-7271.

U.S. Census Bureau staff may call or visit you to
help you complete the survey if we don’t receive
your response. If you have questions or need
help completing the survey, call 1-800-354-7271.

Your participation helps ensure that community leaders
have the information they need to make decisions that
affect our lives.

We
need
your
response.

We
need
your
response.

census.gov

If you are one of the thousands of people
who have already responded to the
American Community Survey, we thank you.
If you have not completed the survey, please do
so right away:
can complete the survey online at
➤ You
https://respond.census.gov/acs
- OR out and return the form we sent you a
➤ Fill
few days ago.

Your participation helps ensure that community leaders
have the information they need to make decisions that
affect our lives.

We
need
your
response.
The American Community Survey

census.gov

If you are one of the thousands of people
who have already responded to the
American Community Survey, we thank you.
If you have not completed the survey, please do
so right away:
can complete the survey online at
➤ You
https://respond.census.gov/acs
- OR out and return the form we sent you a
➤ Fill
few days ago.

Your response is so important that it is required
by law.

Your response is so important that it is required
by law.

U.S. Census Bureau staff may call or visit you to
help you complete the survey if we don’t receive
your response. If you have questions or need
help completing the survey, call 1-800-354-7271.

U.S. Census Bureau staff may call or visit you to
help you complete the survey if we don’t receive
your response. If you have questions or need
help completing the survey, call 1-800-354-7271.

Your participation helps ensure that community leaders
have the information they need to make decisions that
affect our lives.

census.gov

Your participation helps ensure that community leaders
have the information they need to make decisions that
affect our lives.

census.gov

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Due Date:
December 20, 2019

An important message from the Director:
Time is running out. We have sent you several requests to complete the American Community
Survey. Your response is required by law. If you don’t respond by Friday, December 20, a U.S.
Census Bureau interviewer may visit your home to help you complete the survey.
How will you complete the survey by December 20, 2019? (Choose ONE way.)
ONLINE:

Go to https://respond.census.gov/acs
Log in with this User ID:

BY MAIL:

Fill out and return the survey form you received in the mail a
few weeks ago.

BY PHONE:

Call 1-800-354-7271 to complete a phone interview.
Monday–Friday: 9 a.m. to 9 p.m.,
Saturday: 9 a.m. to 7 p.m., Sunday: 11 a.m. to 9 p.m.

Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham

Mensaje Importante: Si tiene preguntas o necesita ayuda para llenar la encuesta, llámenos al
1-877-833-5625 para hablar con un empleado de la Oficina del Censo que habla español.

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

FINAL NOTICE
RESPOND NOW

ACS-23(LX)SF-M5-FL-PSM (10-04-2019)

Treatment 3:
To the Point

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Dear Resident:
Your household has been selected to participate in the American Community Survey. Every
year, the U.S. Census Bureau contacts households across the country to participate in this
important, mandatory survey.

Please respond now at https://respond.census.gov/acs
Log in to our secure website using the enclosed instruction card.

ABOUT THE SURVEY

Your response to the American Community Survey helps
your community plan for projects such as new schools,
health clinics, and playgrounds as well as services for the
elderly and veterans.

DO I HAVE TO RESPOND?

Yes. This survey is so important to your community and
the nation that your response is required by law (Title
13, U.S. Code, Sections 141, 193, and 221).

NEED A PAPER FORM?

If you are unable to respond online, we will send you a
paper questionnaire in about two weeks. You do not
need to contact us.

If you need help filling out the survey or have any questions, please call us at 1-800-354-7271.
We are available to answer any questions or concerns you have.
Thank you for helping your community.
Sincerely,

Steven D. Dillingham
Director

ACS-13(LX)SF-M1-TTP (10-03-2019)

census.gov

Additional information about the American Community Survey

Is this a legitimate survey?

Yes. The U.S. Census Bureau has been conducting this
survey since 2005. Only government agencies can use an
internet address with the “.gov” extension. You can
verify that this is an official government survey by calling
1-800-354-7271 (Mon-Fri: 9 a.m. to 9 p.m., Sat: 9 a.m. to
7 p.m., Sun: 11 a.m. to 9 p.m.) or by visiting us at
https://www.census.gov/acs.

Why was I selected?

Your address was selected through scientific sampling
and represents thousands of other households like yours.
The Census Bureau randomly selects about 3.5 million
addresses throughout the country each year to respond
to this survey.

Am I required to fill out
the survey?

Yes. Your response to this survey is required by law (Title
13, U.S. Code, Sections 141, 193, and 221). Title 13, as
changed by Title 18, imposes a penalty for not
responding. To create an accurate picture of your
community, it is critical that you respond.

Will my response be
kept confidential?

Yes. The Census Bureau is required by law to protect
this information. The Census Bureau is not permitted to
publicly release your responses in a way that could
identify you. We are conducting this survey under the
authority of Title 13, U.S. Code, Sections 141 and 193.
Federal law protects your privacy and keeps your
answers confidential (Title 13, U.S. Code, Section 9). Per
the Federal Cybersecurity Enhancement Act of 2015,
your data are protected from cybersecurity risks through
screening of the systems that transmit your data.

How will the Census Bureau
use the information I provide?

By law, the Census Bureau can only use your responses
to produce statistics. Your information will be used in
combination with information from other households to
produce data for your community. Similar data will be
produced for communities across the United States and
Puerto Rico. We may combine your answers with
information that you gave to other agencies to enhance
the statistical uses of these data. This information will be
given the same protections as your survey information.
Based on the information that you provide, you may be
asked to participate in other Census Bureau surveys that
are voluntary.

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Reminder: Please complete the American Community Survey
Dear Resident:
Did you know that the American Community Survey helps your local government, businesses,
and nonprofit organizations determine the needs of your community? These might include:
Services to help the elderly,
veterans, and the disabled

Opportunities for new
businesses in your area

Parks and playgrounds for
enjoyment and recreation

Access to high-speed
internet service

If you’ve already responded to our recent request to complete this survey online, thank you. If
not, please respond now using your computer or smartphone.

Respond now at https://respond.census.gov/acs
Log in with this User ID:
Your response is so important that it is required by law. If you are waiting to respond by
paper questionnaire, you will receive one in about two weeks. You do not need to contact us. If
you need help with this survey or have questions, call us at 1-800-354-7271.
Thank you for helping your community.
Sincerely,

Steven D. Dillingham
Director

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

THE AMERICAN COMMUNITY SURVEY

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-20(LX)SF-M2-TTP-PSM (09-27-2019)

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Dear Resident:
As we promised in an earlier letter, a paper questionnaire for the American Community Survey
is enclosed. If you’ve already answered the survey online, thank you. If not, we would greatly
appreciate your response at this time.
Please choose ONE way to respond:
Option 1: Go to https://respond.census.gov/acs and
respond online today.
Option 2: Fill out the paper questionnaire and mail it back
in the postage-paid envelope.
YOUR RESPONSE COUNTS

Responding to this survey is a civic responsibility—
similar to voting or serving on a jury. Your response, along
with others in your area, represents your community.

WE NEED YOUR RESPONSE

Many households have already responded. We need your
response too. This survey is so important to your
community and the nation that your response is required
by law.

GET STARTED NOW

It’s easy to get started. You can even use your
smartphone.

If you need help filling out the survey or have any questions, please call us at
1-800-354-7271.
Thank you for helping your community.
Sincerely,

Steven D. Dillingham
Director

Nota: Vea al otro lado para responder en español.

ACS-14(LX)SF-M3-TTP (10-04-2019)

census.gov

Mensaje importante:
Hay dos maneras para completar la Encuesta sobre la Comunidad Estadounidense. Escoja
solamente UNA manera de responder.
Opción 1 – Por internet: Vaya a https://respond.census.gov/acs para
completar la encuesta en español por computadora o smartphone.
Opción 2 – Por teléfono: Llame al 1-877-833-5625 para hablar con un
empleado de la Oficina del Censo que habla español. Usted puede completar
la encuesta por teléfono o pedir que le envíen un cuestionario en español.

Draft 6 (10/4/19)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-TTP (10-04-2019)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-29(PCX)SF-M4-TTP (10-04-2019)

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-TTP (10-04-2019)

ACS-29(PCX)SF-M4-TTP (10-04-2019)

Draft 6 (10/4/19)

The American Community Survey

The American Community Survey

Helping Communities
Make Informed Decisions

Helping Communities
Make Informed Decisions

Dear Resident:

Dear Resident:

If you’ve already responded to the American Community Survey, thank you.
If not, please:

If you’ve already responded to the American Community Survey, thank you.
If not, please:

Respond now using your
computer or smartphone at
https://respond.census.gov/acs

OR

Fill out the questionnaire that we
sent you and mail it back in the
return envelope.

Respond now using your
computer or smartphone at
https://respond.census.gov/acs

OR

Fill out the questionnaire that we
sent you and mail it back in the
return envelope.

Your response is required by law. U.S. Census Bureau staff may call or visit you to help
you complete the survey if we don’t receive your response soon. If you need help filling
out the survey or have questions, call 1-800-354-7271. We are happy to help you.

Your response is required by law. U.S. Census Bureau staff may call or visit you to help
you complete the survey if we don’t receive your response soon. If you need help filling
out the survey or have questions, call 1-800-354-7271. We are happy to help you.

Sincerely,

Sincerely,

Steven D. Dillingham
Director

census.gov

Steven D. Dillingham
Director

census.gov

The American Community Survey

The American Community Survey

Helping Communities
Make Informed Decisions

Helping Communities
Make Informed Decisions

Dear Resident:

Dear Resident:

If you’ve already responded to the American Community Survey, thank you.
If not, please:

If you’ve already responded to the American Community Survey, thank you.
If not, please:

Respond now using your
computer or smartphone at
https://respond.census.gov/acs

OR

Fill out the questionnaire that we
sent you and mail it back in the
return envelope.

Respond now using your
computer or smartphone at
https://respond.census.gov/acs

OR

Fill out the questionnaire that we
sent you and mail it back in the
return envelope.

Your response is required by law. U.S. Census Bureau staff may call or visit you to help
you complete the survey if we don’t receive your response soon. If you need help filling
out the survey or have questions, call 1-800-354-7271. We are happy to help you.

Your response is required by law. U.S. Census Bureau staff may call or visit you to help
you complete the survey if we don’t receive your response soon. If you need help filling
out the survey or have questions, call 1-800-354-7271. We are happy to help you.

Sincerely,

Sincerely,

Steven D. Dillingham
Director

census.gov

Steven D. Dillingham
Director

census.gov

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Due Date:
December 20, 2019

An important message from the Director:
Time is running out. We have sent you several requests to complete the American Community
Survey. Your response is required by law. If you don’t respond by Friday, December 20, a U.S.
Census Bureau interviewer may visit your home to help you complete the survey.
How will you complete the survey by December 20, 2019? (Choose ONE way.)
ONLINE:

Go to https://respond.census.gov/acs
Log in with this User ID:

BY MAIL:

Fill out and return the survey form you received in the mail a
few weeks ago.

BY PHONE:

Call 1-800-354-7271 to complete a phone interview.
Monday–Friday: 9 a.m. to 9 p.m.,
Saturday: 9 a.m. to 7 p.m., Sunday: 11 a.m. to 9 p.m.

Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham

Mensaje Importante: Si tiene preguntas o necesita ayuda para llenar la encuesta, llámenos al
1-877-833-5625 para hablar con un empleado de la Oficina del Censo que habla español.

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

FINAL NOTICE
RESPOND NOW

ACS-23(LX)SF-M5-TTP-PSM (10-04-2019)

Treatment 4:
Outside Researcher Design

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Dear Resident:
Your household has been selected to participate in the American Community Survey, which is a
survey conducted by the U.S. Census Bureau.
Your response matters. The survey helps your local government, businesses, and nonprofit
organizations meet the needs of your community. As a representative of your community, you
are the voice that informs us about these needs.
You are required by law to complete this survey (Title 13, U.S. Code, Sections 141, 193, and
221). Follow the two steps below to provide your response to this survey:

1) Go to https://respond.census.gov/acs
2) Enter the requested information.
(You will need the enclosed card to do this.)
If you are unable to respond online, you do not need to contact us. We will send you a paper
questionnaire in about two weeks.
If you have questions or need help completing the survey, please call 1-800-354-7271.
Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

The Census Bureau serves as the leading source of
quality data about the nation’s people and economy.
ACS-13(LX)SF-M1-OR (10-03-2019)

census.gov

Frequently Asked Questions
What is the American Community Survey?
The American Community Survey is an official survey from the U.S. Census Bureau. As a
randomly selected representative of your community, you are the voice of your neighbors and
peers. To create an accurate understanding of your community and its needs, your response will
be used in combination with responses from other households to produce data for your
community. Similar data will be produced for communities across the United States.
Am I required to fill out the survey?
Yes. Your response to this survey is required by law (Title 13, U.S. Code, Sections 141, 193, and
221). Title 13, as changed by Title 18, imposes a penalty for not responding.
Will my response be confidential?
Yes. The Census Bureau is required by law to protect this information. The Census Bureau is not
permitted to publicly release your responses in a way that could identify you. We are conducting
this survey under the authority of Title 13, U.S. Code, Sections 141 and 193. Federal law
protects your privacy and keeps your answers confidential (Title 13, U.S. Code, Section 9). Per
the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data.
How will the Census Bureau use the information I provide?
By law, the Census Bureau can only use your responses to produce statistics. Your information
will be used in combination with information from other households to produce data for your
community. Similar data will be produced for communities across the United States and
Puerto Rico. We may combine your answers with information that you gave to other agencies to
enhance the statistical uses of these data. This information will be given the same protections as
your survey information. Based on the information that you provide, you may be asked to
participate in other Census Bureau surveys that are voluntary.
Why was I selected?
Your address was selected through scientific sampling and represents thousands of other
households like yours. The Census Bureau randomly selects about 3.5 million addresses each
year to respond to the survey.

The American Community Survey

Follow these two steps: (1) Go to https://respond.census.gov/acs (2) Enter information that appears on this
card. Need help or have questions? Call 1-800-354-7271.

The American Community Survey
ATENCIÓN: Responde ahora por el internet en español https://respond.census.gov/acs con una
computadora o con un smartphone. Necesita ayuda o tiene preguntas? Llame al 1-877-833-5625.

1-800-638-5945,
1-877-221-9436.
1-866-225-2297,
1-800-772-6728

ACS-34 IM (09-05-2019)

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Dear Resident:
A few days ago, you should have received a notice from the U.S. Census Bureau asking you to
complete the American Community Survey.
You are required by law to complete this survey (Title 13, U.S. Code, Sections 141, 193, and
221). The survey helps your local government, businesses, and nonprofit organizations meet the
needs of your community.
If you’ve already responded, thank you. If not, please do so today by following these two steps:

1) Go to https://respond.census.gov/acs
2) Enter your 10-digit User ID:
If you are unable to respond online, you do not need to contact us. We will send you a paper
questionnaire in about two weeks.
If you have questions or need help completing the survey, please call 1-800-354-7271.
Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

THE AMERICAN COMMUNITY SURVEY

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-20(LX)SF-M2-OR-PSM (09-27-2019)

DC

U.S. Census Bureau
Washington, DC 20233-0001
Office of the Director

Dear Resident:
We are following up with you because we have not received a response to the
American Community Survey from your household.
You are required by law to complete this survey (Title 13, U.S. Code, Sections 141, 193, and
221).
Please respond now. Either:
Fill out the paper survey in this mailing and send it back in the postage-paid envelope
OR
Fill out the online survey by following these two steps:

1) Go to https://respond.census.gov/acs
2) Log in with the User ID printed on the front of
your questionnaire.
If you have questions or need help completing the survey, please call 1-800-354-7271.
Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

Nota: Vea al otro lado para responder en español.

ACS-14(LX)SF-M3-OR (09-27-2019)

census.gov

Mensaje importante:
Hay dos maneras para completar la Encuesta sobre la Comunidad Estadounidense. Escoja
solamente UNA manera de responder.
Opción 1 – Por internet: Vaya a https://respond.census.gov/acs para
completar la encuesta en español por computadora o smartphone.
Opción 2 – Por teléfono: Llame al 1-877-833-5625 para hablar con un
empleado de la Oficina del Censo que habla español. Usted puede completar
la encuesta por teléfono o pedir que le envíen un cuestionario en español.

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-OR (10-04-2019)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-29(PCX)SF-M4-OR (10-04-2019)

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-29(PCX)SF-M4-OR (10-04-2019)

ACS-29(PCX)SF-M4-OR (10-04-2019)

DC

The American Community Survey
Helping communities make informed decisions

DC

The American Community Survey
Helping communities make informed decisions

Dear Resident:

Dear Resident:

If you’ve already responded to the American Community Survey, thank you.
If not, please complete it now. Your response is required by law.

If you’ve already responded to the American Community Survey, thank you.
If not, please complete it now. Your response is required by law.

EITHER fill out the paper survey we sent you a few days ago and
return it in the postage-paid envelope

EITHER fill out the paper survey we sent you a few days ago and
return it in the postage-paid envelope

OR respond online at https://respond.census.gov/acs with the
10-digit User ID that appears on the materials we sent you.

OR respond online at https://respond.census.gov/acs with the
10-digit User ID that appears on the materials we sent you.

If you have any questions or need help filling out the survey, please call us at
1-800-354-7271. We are happy to help you.

If you have any questions or need help filling out the survey, please call us at
1-800-354-7271. We are happy to help you.

census.gov

DC

The American Community Survey
Helping communities make informed decisions

census.gov

DC

The American Community Survey
Helping communities make informed decisions

Dear Resident:

Dear Resident:

If you’ve already responded to the American Community Survey, thank you.
If not, please complete it now. Your response is required by law.

If you’ve already responded to the American Community Survey, thank you.
If not, please complete it now. Your response is required by law.

EITHER fill out the paper survey we sent you a few days ago and
return it in the postage-paid envelope

EITHER fill out the paper survey we sent you a few days ago and
return it in the postage-paid envelope

OR respond online at https://respond.census.gov/acs with the
10-digit User ID that appears on the materials we sent you.

OR respond online at https://respond.census.gov/acs with the
10-digit User ID that appears on the materials we sent you.

If you have any questions or need help filling out the survey, please call us at
1-800-354-7271. We are happy to help you.

If you have any questions or need help filling out the survey, please call us at
1-800-354-7271. We are happy to help you.

census.gov

census.gov

U.S. Census Bureau

DC

Washington, DC 20233-0001
Office of the Director

Due Date:
December 20, 2019

Dear Resident:
Your household has been selected to participate in the American Community Survey, which is a
survey conducted by the U.S. Census Bureau.
You are required by law to complete this survey (Title 13, U.S. Code, Sections 141, 193, and
221).
Please respond now. If you do not respond by December 20, a Census Bureau interviewer may
come to your home to complete the survey in person.

How will you complete the survey by December 20, 2019? (Select ONE.)
ONLINE:

Go to https://respond.census.gov/acs and enter your 10-digit
User ID:

BY MAIL:

Fill out the paper survey you received in the mail a few weeks ago
and send it back.

BY PHONE: Call 1-800-354-7271 to complete a phone interview.
Mon to Fri: 9 a.m.–9 p.m., Sat: 9 a.m.–7 p.m., Sun: 11 a.m.–9 p.m.
Thank you. Your response is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

Mensaje Importante: Si tiene preguntas o necesita ayuda para llenar la encuesta, llámenos al
1-877-833-5625 para hablar con un empleado de la Oficina del Censo que habla español.
census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

FINAL NOTICE
RESPOND NOW

ACS-23(LX)SF-M5-OR-PSM (10-04-2019)

Mailing one envelope
(used in all treatments)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132
OFFICIAL BUSINESS
Penalty for Private Use $300

THE AMERICAN COMMUNITY SURVEY

YOUR RESPONSE IS
REQUIRED BY LAW

OFFICIAL U.S. GOVERNMENT MAIL

ACS-46(EX)SF-M1 (10-03-2019)

Mailing three envelopes
(used in all treatments)

DC
U.S. Census Bureau

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

OFFICIAL U.S. GOVERNMENT MAIL

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

AMERICAN COMMUNITY SURVEY
FORM ENCLOSED

YOUR RESPONSE IS
REQUIRED BY LAW

Flap Side

OFFICIAL BUSINESS
Penalty for Private Use $300

ACS-46(EX)SF-M3 (09-10-2019)

draft 3 (9-10-2019) 6385-47(REX)SF-M3 envelope 9 x 11-1/2" W open window 5 x 7/8

C

OFFICIAL BUSINESS
Penalty for Private Use $300

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 16081

WASHINGTON DC

NATIONAL PROCESSING CENTER
U.S. CENSUS BUREAU
PO BOX 5240
JEFFERSONVILLE IN 47199-5240

FFATTFADDDTAADTFADDFAFTDFFAADFFFAFDTFDTAFATFDFATADTTFDFDTFFFFATTF
6385-47(REX)SF-M3 (09-10-2019)

00 708 200644 000000000 47199 5240

Flap side

POSTAGE WILL BE PAID BY THE U.S. CENSUS BUREAU

Instruction Card
(used in Classic with a Twist, Fresh Look, and To the Point
treatments)

The American Community Survey

IMPORTANT: Please reply now at https://respond.census.gov/acs using your computer or smartphone.
Need help or have questions? Call 1-800-354-7271.

The American Community Survey
ATENCIÓN: Responde ahora por el internet en español https://respond.census.gov/acs con una
computadora o con un smartphone. Necesita ayuda o tiene preguntas? Llame al 1-877-833-5625.

1-800-638-5945,
1-877-221-9436.
1-866-225-2297,
1-800-772-6728

ACS-34 IM (09-05-2019)

Questionnaire front and back
(used in all treatments)

13190012

DC

The American Community Survey

Start Here
You have two ways to respond:

➜

On your computer or smartphone:
https://respond.census.gov/acs

Please print the name and telephone number of the
person who is filling out this form. We will only
contact you if needed for official Census Bureau business.
Last Name

OR
First Name

Complete this form and mail it
back in the enclosed envelope.

MI

Area Code + Number

The American Community Survey is
conducted by the U.S. Census Bureau.
Your response to this survey is
required by law. Federal law protects
your confidentiality (Title 13, U.S. Code,
Sections 9, 141, 193, and 221).

—

➜

How many people are living or staying at this address?
• INCLUDE everyone who is living or staying here for more
than 2 months.
• INCLUDE yourself if you are living here for more than 2
months.
• INCLUDE anyone else staying here who does not have
another place to stay, even if they are here for 2 months or
less.

If you need help or have questions
about completing this form, please call
1-800-354-7271.

• DO NOT INCLUDE anyone who is living somewhere else for
more than 2 months, such as a college student living away or
someone in the Armed Forces on deployment.

Text Telephone (TTY):
Call 1–800–582–8330.

Number of people

¿NECESITA AYUDA? Llame al
1-877-833-5625.
For more information about the
American Community Survey, visit our
website at: https://www.census.gov/acs

➜

Fill out pages 2–7 for everyone, including yourself,
who is living or staying at this address for more than
2 months. Then complete the rest of the form.

ACS-1(QX)SF-M3

FORM
(10-03-2019) Draft 6

§.4!-¤

OMB No. 0607-0810
OMB No. 0607-0936

13190483

Mailing
Instructions
➜ Please make sure you have:

• Listed all names and answered the questions on pages 2–7.
• Answered all Housing questions.
• Answered all Person questions for each person.
➜ Then:

• Put the completed questionnaire into the enclosed postage-paid
return envelope.
• Make sure the barcode above your address shows in the window
of the return envelope.
If the return envelope has been misplaced, please mail the questionnaire to:
National Processing Center
U.S. Census Bureau
P.O. Box 5240
Jeffersonville, IN 47199-5240

Thank you for participating in the American Community Survey.

For Census Bureau Use
POP

EDIT CLERK

EDIT

PHONE

TELEPHONE CLERK

JIC1

JIC2

JIC3

JIC4

The Census Bureau estimates that, for the average
household, this form will take 40 minutes to complete,
including the time for reviewing the instructions and
answers. Send comments regarding this burden
estimate or any other aspect of this collection of
information, including suggestions for reducing this
burden, to: Paperwork Project, U.S. Census Bureau,
4600 Silver Hill Road, ADDC – 4H277,
Washington, D.C. 20233. You may e-mail comments to
acso.pra@census.gov; use "Paperwork Project" as the
subject. Please DO NOT RETURN your questionnaire
to this address. Use the enclosed preaddressed
envelope to return your completed questionnaire.
Respondents are not required to respond to any
information collection unless it displays a valid
approval number from the Office of Management
and Budget. This 8-digit number appears in the
bottom right on the front cover of this form.

Form ACS-1(QX)SF-M3 (10-03-2019)

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File Typeapplication/pdf
AuthorOneFormUser
File Modified2019-10-11
File Created2019-10-04

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