Att H - CPS-580(ASEC)(L), ASEC Respondent Letter_nosig

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

A Message 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, income from various
sources, and health insurance coverage during the year 2021. The average 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, Sections 141 and
182, and Title 29, United States Code, Sections 1–9. Section 9 of this law requires us to keep all
information about you and your household strictly confidential. The Census Bureau is required by law
to protect your information. The Census Bureau is not permitted to publicly release your responses in a
way that could identify you or your household. The information provided to us may only be shared with
other Census Bureau staff for the work-related purposes as identified in the Privacy Act System of
Record Notice COMMERCE/Census-3, Demographic Survey Collection (Census Bureau Sampling
Frame).
Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data. The Office of Management and Budget
control number for the CPS is 0607-0354, and the expiration date is December 31, 2021. 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 2020 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.
If you have any questions, please visit census.gov/cps, or call your Census Bureau Regional Office at
1–800–424–6974, #53939.
Send comments regarding the time estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: Demo Survey Comments 0607-0354, U.S. Census
Bureau, 4600 Silver Hill Road, ADDP-8H590, Washington, D.C. 20233. You may e-mail comments to
DEMO.PAPERWORK@census.gov; use "Demo Survey Comments 0607-0354" as the subject.
Thank you for your continued cooperation.

Director

Enclosure
CPS-580(ASEC)(L) ATLANTA
(11-2020)

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
2021, 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.

Income
Wages or salary before taxes
and deductions
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
Withdrawls from retirement
accounts (401K, IRA, KEOGH,
SEP, and so on)
Public assistance or welfare
Rental properties, estates, or trusts
Medical Expenditures
Out-of-pocket premiums paid for all
health insurance policies except
Medicare deductions from Social
Security benefits; assign premium
payments to policyholder.
Medical care and equipment
expenses, not reimbursed; e.g.,
copayments for Dr. visits, prescription
medication, hearing/vision aids, etc.
Over-the-counter expenses on
health-related products, not
reimbursed (e.g., aspirin, cold
remedies, etc.)

FORM CPS-580(ASEC)(L) (11-2020)

$

Name

Name

Name

Name

Amount

Amount

Amount

Amount

$

$

$