Form SC-900 Special Census Cost Estimate Request Form

Special Census Program

SC-900 Special Census Cost Estimate 2020 DRAFT_8.0

Governmental Unit Cost Estimate Request

OMB: 0607-0368

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SC-900

U.S. DEPARTMENT OF COMMERCE

FORM
(08-29-2022)

U.S. CENSUS BUREAU

OMB Control Number: 0607-0368
Expiration Date: MM/DD/YYYY

SPECIAL CENSUS COST ESTIMATE
REQUEST FORM
GENERAL INSTRUCTIONS
A Special Census is a basic enumeration of population, housing units, and group quarters conducted by
the U.S. Census Bureau at the request of a governmental unit. Special Censuses are conducted on a
cost reimbursable basis. The first step for a governmental unit interested in having a Special Census
conducted is to request an official cost estimate from the Census Bureau.
To request a cost estimate, the governmental unit should email the following items to
DCMD.Special.Census@census.gov:
1. An official letter from your jurisdiction requesting a Special Census cost estimate.
a. The letter should indicate if you are requesting a cost estimate for a full or partial Special Census.
A full Special Census covers the jurisdiction of the entire governmental unit. A partial Special
Census must contain at least one full tract that is completely within the jurisdiction of the
governmental unit and can contain additional contiguous tracts or blocks.
b. This letter should be signed by the Highest Elected Official or designee.
2. A completed SC-900 "Special Census Cost Estimate Request Form."
a. The fillable SC-900 should be submitted electronically.
b. The SC-900 must be filled out completely, including your estimated population and housing unit
counts.
Note: Please email (DCMD.Special.Census@census.gov) if your governmental unit is unable to fill out
the SC-900 form electronically.
Your request for a cost estimate will not be considered until both items (official letter and completed
SC-900) are received by the Census Bureau. Once both required items are received, the Special
Census Program will notify you of receipt.

The Census Bureau estimates that completing this voluntary form will take 45 minutes on average. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to . Use "Paperwork Reduction Project 0607-0368" as the subject.
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval
number that appears at the upper right of the form confirms this approval. If this number were not displayed, the
Census Bureau could not conduct this program. The Census Bureau conducts the Special Census under the legal
authority of the Title 13, U.S. Code, Section 196.

SPECIAL CENSUS COST ESTIMATE REQUEST FORM
The information you provide on this form (SC-900) will be used to help the Census Bureau determine
estimated costs for conducting a Special Census in your jurisdiction. Please provide the information
requested. Attach additional pages as necessary. Approximately 30 days after all materials are received,
the Census Bureau will send you a Special Census Cost Estimate and a Memorandum of Agreement
for your consideration. The Special Census Program office will contact you if more information is
needed during the cost estimate phase.

I. JURISDICTION CONTACT INFORMATION
A. Governmental Unit Name
B. Governmental Unit Address – Please include
both the mailing address (example, PO Box)
and the location address, if they are different.

1. Mailing Address – Number and street
City
State

ZIP Code

Mark (X) in this box if both the mailing address
and location address are the same , then SKIP to item
C. Otherwise, continue with item 2 below.
2. Location Address – Number and street
City
State
C. Does this Governmental Unit have a website?

ZIP Code

Yes – Provide Governmental Unit URL

D. Contact Person(s)
PRIMARY

ALTERNATE

1. Name

2. Title

3. Telephone

4. FAX Number

5. E-mail address

E. Do you have a specific time frame in which
you would like to conduct a Special Census?

2
FORM SC-900 (08-29-2022)

Yes – Specify time periods (MM/DD/YYYY)
Between
No

and
Page 2

II. CHARACTERISTICS OF THE AREAS IN WHICH
SPECIAL CENSUS IS TO BE CONDUCTED
Will this Special Census include the entire governmental
unit or only specific areas within the governmental unit?
"(A Special Census is only specific areas of the
governmental unit is referred to as a partial Special
Census. A partial Special Census must contain at least
one full tract, with or without additional contiguous
blocks.)"
B1. If you are interested in a partial Special Census, what
county or counties is the Special Census area in?

Special Census will include:
1
2

Entire Governmental Unit – SKIP to item C1
Only specific areas within Governmental Unit –
Continue with item B1

County(s) partial Special Census is located in

CENSUS TRACT #
2. Please identify and list to the right the specific
census tracts to be included in the partial
Special Census. Please use Census 2020
tabulation geography.

TRACT

TR 2001.01

TR 0003.00

"Note, all partial Special Censuses must
contain at least one full Census tract and
the full tract must be within the
governmental unit's jurisdiction."
Attach additional sheets, if needed.
For example:

If applicable, please identify and list to the
right any additional contiguous census
blocks to be included in the partial
Special Census. Please use Census 2020
tabulation geography.
Attach additional sheets, if needed.
For example:

ASSISTANCE:

Page 3

CENSUS TRACT #

TRACT

BLOCK

CENSUS BLOCK #

CENSUS TRACT #
TR

TR 2001.01

BL 1003

TR 0003.00

BL 2026

For assistance with identifying tract or tract/block numbers or with using the census maps or TIGER
shapefiles, please see our website:
https://tigerweb.geo.census.gov/tigerwebmain/TIGERweb.main.html
or contact the Special Census Program at DCMD.Special.Census@census.gov
FORM SC-900 (08-29-2022)

II. CHARACTERISTICS OF THE AREA(S) IN WHICH SPECIAL
CENSUS IS TO BE CONDUCTED – Continued
C1. Using the Census Bureau definition shown below, do
any of the areas to be included in the Special
Census contain GROUP QUARTERS?

1
2

Yes – Complete item C2
No – SKIP to item D1

Group quarters are places where people live or stay in a group living arrangement that is owned or managed
by an entity or organization providing housing and/or services for the residents, and residency is commonly
restricted to those receiving these services. These services may include custodial or medical care as well as
other types of assistance. Group quarters include such places as college residence halls, residential treatment
centers, skilled-nursing facilities, group homes, military barracks, correctional facilities, and workers' dormitories.
C2. For each type of Group Quarters listed in a through g (see below), indicate whether the area to be included in the
Special Census contains this type of Group Quarter.
For "Yes" responses – Enter the total number of each type of group quarters and the estimated combined
population for that type of group quarters at the time of the Special Census enumeration.
For example: There is a college with 4 dormitories and each dormitory houses 200 students –
TYPE

Total No.

1. College/University Student Housing . . . . . . . . .

11
22

2. Residential Treatment Center

.............

11
22

Yes
No

Total No.

a. College/University Student Housing

............

1
2

b. Residential Treatment Centers

. . . . . . . . . . . . . . . . .1
2

c. Skilled Nursing Facilities

. . . . . . . . . . . . . . . . . .. . .

1
2

(NOTE: Assisted living quarters are counted as
individual housing units, not as part of a group quarters.)
.............................

1
2

e. Military Quarters

...........................

1
2

f. Correctional Facilities

.......................

1
2

g. Workers’ Group Living Quarters and Job Corps
Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1
2

800

Yes
No

TYPE

d. Group Homes

Estimated Population

Yes
No
Yes
No
Yes
No

Yes
No
Yes
No
Yes
No
Yes
No

NOTES – Please use this space for any explanation that may be essential in understanding your reported data.

FORM SC-900 (08-29-2022)

Page 4

II. CHARACTERISTICS OF THE AREA(S) IN WHICH SPECIAL
CENSUS IS TO BE CONDUCTED – Continued
D1. Using the Census definition shown below, do any of
the areas to be included in this Special Census
contain TRANSITORY LOCATIONS, where people
stay that have no usual home elsewhere?

1
2

Yes – Complete item D2
No – SKIP to Section III

Transitory locations are locations where people are unlikely to live year-round due to the transitory/temporary/impermanent
nature of the location. Transitory locations include places such as campgrounds, recreational vehicle (RV) parks, marinas,
hotels, motels, racetracks, circuses, or carnivals. NOTE: Only include the transitory locations where you believe the people
staying there have no other usual home elsewhere. For example, do not include RV parks, unless they specifically house
people with no usual home elsewhere.
D2. For each type of Transitory Location listed in a through f (see below), indicate whether the area to be included in the
Special Census contains this type of Transitory Location.
For "Yes" responses – Enter the total number of locations and the estimated combined population for
that type of transitory location at the time of the Special Census enumeration.
Total No. of
Locations

TYPE
a. Recreational Vehicle (RV) Park

................

1
2

b. Campgrounds

.............................1
2

c. Hotels/Motels

.............................

1
2

d. Marinas

.................................

1
2

e. Racetracks

...............................

1
2

f. Circuses/Fairs/Carnivals

.....................

1
2

Estimated Population

Yes
No
Yes
No
No
Yes
No
Yes
No
Yes
No
Yes
No

III. ESTIMATED POPULATION AND HOUSING UNIT COUNTS FOR
AREAS IN WHICH SPECIAL CENSUS WILL BE CONDUCTED
A.

What is the estimated housing unit count for the
areas to be included in this Special Census?

B1. What is the estimated population count for persons
living in housing units in the areas to be included in this
Special Census?
NOTE: The 2020 Census population per household for
your jurisdiction may be useful in your estimation of the
population associated with new housing units.
2.

What is the total estimated population of persons
living in group quarters in the areas to be included in
this Special Census?
Include in this population estimate any and all of the
group quarters population that were specified in
Section II, item C2.

3. What is the total estimated population of persons
living in transitory locations in the areas to be included
in this Special Census?
Include in this population estimate any and all of the
transitory locations populations that were specified in
Section II, item D2.
Page 5

Enter housing unit count
estimate

As of –

Enter population count
estimate

As of –

Enter population count
estimate

As of –

Enter population count
estimate

As of –

Month

Year

FORM SC-900 (08-29-2022)

IV. DATA USED TO DETERMINE POPULATION AND HOUSING
ESTIMATES
A. Which of the following types of data were used to determine the housing unit and population estimates
provided in Section III?
Please specify yes or no for each listed type of data. If you answer "Yes" to any listed type of data, please
enter the value of the actual or estimated increase from the 2020 Census that was used in determining
your population and/or housing unit estimates in Section III. Please enter only the value of the increase.
B. TYPE
1. Increased school enrollment

..................