Phase 4 Verificati Phase 4 Verification Form (Congressional Districts)

OMB Control No.: 0607-0988
Expiration Date: 11/30/2024
Form: Phase 4 Verification Form
Congressional Districts
(120th)

Phase 4 Verification Form
Congressional Districts

I have reviewed the 120th congressional district (CD) boundaries and associated codes, and I certify
that the boundaries and codes correctly represent the districts submitted as part of Phase 4 of the
Redistricting Data Program.
I have reviewed the 120th CD boundaries and associated codes, and I certify that the boundaries and
codes are correct as shown, except for the block assignments specified in the table that appears on
the second page of this form.
I have reviewed the 120th CD boundaries and associated codes, and I certify that the boundaries and
codes are correct as shown, except for the block assignments I am sending in a block equivalency file
to in lieu of specifying the incorrect block assignments and/or codes in the table.
Name: _______________________________________________________________________________
Title: ________________________________________________________________________________
Address: _____________________________________________________________________________
Email: _______________________________________________________________________________
Phone: ______________________________________________________________________________
Fax: _________________________________________________________________________________
Signature:____________________________________________ Date:____________________________
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)).

County (code)

Census Tract

Census Block

Incorrect CD

Correct CD