D-1670 SG Participation Option for States

OMB No. 0607-0795
U.S. DEPARTMENT OF COMMERCE

FORM D-1670(SG)
(6-5-2007)

Economics and Statistics Administration

U.S. CENSUS BUREAU

PARTICIPATION OPTION/GIS PREFERENCE/COUNTY SELECTION
FORM FOR STATE GOVERNMENTS
LOCAL UPDATE OF CENSUS ADDRESSES (LUCA) PROGRAM
2010 Decennial Census
Mark (X) only one Participation Option and GIS preference, then select the county(ies)
and/or county equivalent(s) you choose to include in your address list review.
Option 1 and Option 2 participants receive the Census Bureau’s Address List. All
participants will receive both the Address Count List and the shapefile. All materials
are in computer-readable format. The MAF/TIGER Partnership Software (MTPS)
application combines these files into a GIS software package.

ENTITY ID
A. State
B. Census Bureau
Regional Office

For more information about the LUCA program, visit our web site at
http://www.census.gov/geo/www/luca2010/state_booklet.pdf.
Return this completed form and your LUCA program registration materials to your
Census Bureau Regional Office.

1. Participation Option
Mark (X) one.

Option 1 – Title 13 Full Address List Review – Signed Confidentiality Agreement Form required by law
Option 2 – Title 13 Local Address List Submission – Signed Confidentiality Agreement Form required by law
Option 3 – Non-Title 13 Local Address List Submission – Signed Confidentiality Agreement Form not required

2. GIS Preference
Mark (X) one.

MTPS application and computer-readable files on CD-ROM
Shapefile on CD-ROM (will use GIS of choice)

3. County(ies) or county
equivalent(s) you
choose to review.

Send data for ALL county(ies) and/or county equivalents in our state.
Send data for only the following county(ies) and/or county equivalents in our state – Mark (X) below.

County code (County name)

USCENSUSBUREAU

County code (County name)

County code (County name)

If your state has more than 90 counties or county equivalents, please continue on the reverse side.

County code (County name)

County code (County name)

County code (County name)

FORM D-1670(SG) (6-5-2007)