Consent Form

CONSENT FORM

The U.S. Census Bureau routinely conducts research on how we, and our partners, collect information in order to produce the best statistics possible.  This study will determine if significant numbers of retail companies are shipping products directly to customers. If you agree to participate, you will be given a short questionnaire asking how your company ships products. Only staff involved in this research will have access to any responses you provide. This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0725, confirms this approval and expires on 12/31/2025. Without this approval, we could not conduct this study.

AUTHORITY AND CONFIDENTIALITY

This collection is authorized under Title 13 U.S. Code, Sections 131 and 182. The U.S. Census Bureau is required by Section 9 of the same law to keep your information confidential and can use your responses only to produce statistics.

The U.S. Census Bureau is conducting this survey on behalf of Bureau of Transportation Statistics (BTS) under the authority of 13 U.S.C. Section 8(b).

Your privacy is protected by the Privacy Act, Title 5 U.S. Code, Section 552a. The uses of these data are limited to those identified in the Privacy Act System of Record Notice titled “COMMERCE/CENSUS-4, Economic Survey Collection.” The Census Bureau is not permitted to publicly release your responses in a way that could identify you, your business, organization, or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.

Census Bureau staff have received training on privacy and confidentiality policies and practices. Access to PII/BII is restricted to authorized personnel only.

Furnishing this information is voluntary. There are no consequences for not providing the requested information. However, your cooperation in obtaining this much needed information is extremely important to ensure complete and accurate results.

BURDEN ESTIMATE 

We estimate that completing this interview will take 2 minutes on average, including the time for reviewing instructions, searching existing data sources (if necessary), gathering and maintaining the data needed (if necessary), and completing and reviewing the collection of information. You may send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey, to rachel.e.sloan@census.gov

Click here to participate in this research.

• I agree to participate in this research

Enter your information below:

First Name: __________________________________________________

Last Name: __________________________________________________

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