Form BAS-6 BAS-6:: Consolidated BAS (CBAS) Agreement Form

OMB Control No.: 0607-0151
Expiration Date: 11/30/2024

BOUNDARY AND ANNEXATION SURVEY (BAS)

FORM BAS-6

CONSOLIDATED BAS (CBAS) AGREEMENT FORM
GENERAL
INSTRUCTIONS

To register your county for a CBAS agreement, complete Section 1, then:
1.) Reach out to the BAS contacts for the governments in your county's jurisdiction. Email to request the BAS contact information.
2.) Complete Section 2, the Participation Roster, noting that communication could be with the BAS contacts or other contacts in the government.
3.) Return the completed form by email to . Please include "CBAS" in the subject line of the email.

State

Name of county, parish, borough, or equivalent area
STATE CODE

BAS ID
Section 1

(07-2024)

COUNTY CODE

CBAS CONTACT MAILING ADDRESS (Please enter the CBAS contact's information and mailing address where CBAS materials should be sent.)

Name:

Address:

Position:

City:

Department:

State:

Ext:

Telephone:

ZIP Code

Email:

Fax:

Instructions for completing Section 2:
1.) Enter the BAS ID and Government Name, including the type of government, i.e., "city", "town", or "township" for the government's in your jurisdiction.
2.) Enter a Y (Yes) or N (No) in the "Agreed?" column to note each contact's response to participating in CBAS.
3.) Enter the Contact Name, Position, and Phone Number from each government contacted. Please provide this for all governments in your jurisdiction.
4.) Enter the date of contact in the "Date of Contact" column.

Section 2
BAS ID

PARTICIPATION ROSTER
Government Name

Agreed?
Y/N

Contact Name

Position

Phone Number

Date of
Contact

We estimate that participating in the Boundary and Annexation Survey will take 7.5 hours on average. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, using Paperwork Reduction Project 0607-0151 as the subject, to . 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, we could not conduct this survey. The Census Bureau conducts this survey under the legal authority of the Title 13 United States Code, Section 6.

Section 2
BAS ID

PARTICIPATION ROSTER – Continued
Government Name

Agreed?
Y/N

FORM BAS-6
(07-2024)

Contact Name

Position

Phone Number

Date of
Contact

Section 2
BAS ID

PARTICIPATION ROSTER – Continued
Government Name

Agreed?
Y/N

FORM BAS-6
(07-2024)

Contact Name

Position

Phone Number

Date of
Contact