Phase 4 Certificat Phase 4 Certification Form (States with a Single Congres

OMB Control No.: 0607-0988
Expiration Date: 11/30/2024
Form: Phase 4 Certification Form
Single CD States
(2026)

Phase 4 Certification Form (States with a Single Congressional District)

(Alaska, Delaware, North Dakota, South Dakota, Vermont, and Wyoming)
I certify there have been no changes to the state legislative districts (SLDs) checked below since they
were last submitted and/or verified through the Redistricting Data Program in 2024.
SLDU (Upper House)

SLDL (Lower House)

There have been changes to the state legislative district boundaries checked below since they were last
submitted and/or verified through the Redistricting Data Program in 2024. Select the option(s) below
that identify the district type and whether the changes involve whole or split blocks.
SLDU (Upper House) Whole Blocks

SLDL (Lower House) Whole Blocks

SLDU (Upper House) Split Blocks

SLDL (Lower House) Split Blocks

Name: _______________________________________________________________________________
Title: ________________________________________________________________________________
Address: _____________________________________________________________________________
Email: _______________________________________________________________________________
Phone: _______________________________________________________________________________
Fax: _________________________________________________________________________________
Signature: _____________________________________________ Date: __________________________
For questions about completing this form or any other questions on the redistricting topic, contact the
Redistricting & Voting rights Data Office at 301-763-4039 or at .
We estimate that participating in the Redistricting Data Program will take eight hours on average. Send
comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to . This collection has been approved by the
Office of Management and Budget (OMB). The eight-digit OMB approval number that appears on this
form confirms this approval. If this number were not displayed, we could not conduct this program. The
Census Bureau conducts this program under the legal authority of Public Law 94-171, as amended (Title
13 United States Code (U.S.C.), Section 141(c)).