Various Pretesting Activities (see attached list)

The American Community Survey
and the 2010 Census
What is the difference between the American Community Survey and
the Census?
• The American Community Survey (ACS) is conducted every year to provide up
to date information about the social and economic needs of your community.
The ACS shows how people live – our education, housing, jobs, and more. For
example, results may be used to decide where new schools, hospitals, and
fire stations are needed.
• The Census is conducted once every 10 years to provide an official count of
the entire U.S. population to Congress.

Didn’t I already answer the Census?
You may have answered the Census, but your address has also been chosen to
be part of a randomly selected sample for the American Community Survey.

Do I have to answer both the American Community Survey and the
Census?
Yes. Your response to both is important and required by law (Title 13, U.S.
Code).

Why was I chosen for the American Community Survey?
The Census Bureau chose this address—not you personally—as part of a
randomly selected sample.

Why can’t you use my Census answers for the American Community
Survey?
The American Community Survey includes questions that are not asked by the
Census, and the two serve different purposes.

USCENSUSBUREAU

American Community Survey Form

Census 2010 Form
Every household receives this form

A random sample of households also receive this form

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

This is the official form for all the people at this address.
It is quick and easy, and your answers are protected by law.

U.S. CENSUS BUREAU

5. Please provide information for each person living here. Start with a

Use a blue or black pen.

person living here who owns or rents this house, apartment, or mobile
home. If the owner or renter lives somewhere else, start with any adult
living here. This will be Person 1.
What is Person 1’s name? Print name below.

Start here
The Census must count every person living in the United
States on April 1, 2010.
Before you answer Question 1, count the people living in
this house, apartment, or mobile home using our guidelines.
• Count all people, including babies, who live and sleep here
most of the time.
The Census Bureau also conducts counts in institutions
and other places, so:
• Do not count anyone living away either at college or in the
Armed Forces.
• Do not count anyone in a nursing home, jail, prison,
detention facility, etc., on April 1, 2010.
• Leave these people off your form, even if they will return to
live here after they leave college, the nursing home, the
military, jail, etc. Otherwise, they may be counted twice.
The Census must also include people without a permanent
place to stay, so:
• If someone who has no permanent place to stay is staying
here on April 1, 2010, count that person. Otherwise, he or
she may be missed in the census.

1. How many people were living or staying in this house,

Last Name
MI

First Name

6. What is Person 1’s sex? Mark I
J ONE box.
K
Male

Female

7. What is Person 1’s age and what is Person 1’s date of birth?
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.
Age on April 1, 2010

Month

Day

Year of birth

➜ NOTE: Please answer BOTH Question 8 about Hispanic origin and

Question 9 about race. For this census, Hispanic origins are not races.

8. Is Person 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

apartment, or mobile home on April 1, 2010?

9. What is Person 1’s race? Mark I
J one or more boxes.
K

Number of people =

2. Were there any additional people staying here
April 1, 2010 that you did not include in Question 1?
Mark I
J
K all that apply.
Children, such as newborn babies or foster children
Relatives, such as adult children, cousins, or in-laws
Nonrelatives, such as roommates or live-in baby sitters
People staying here temporarily
No additional people

3. Is this house, apartment, or mobile home —
Mark I
J
K ONE box.
Owned by you or someone in this household with a
mortgage or loan? Include home equity loans.
Owned by you or someone in this household free and
clear (without a mortgage or loan)?
Rented?
Occupied without payment of rent?

4. What is your telephone number? We may call if we
don’t understand an answer.
Area Code + Number
–

–

OMB No. 0607-0919-C: Approval Expires 12/31/2011.
Form

D-1(12-5-2008)

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

Japanese
Asian Indian
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

Some other race — Print race. C

10. Does Person 1 sometimes live or stay somewhere else?
No

Yes — Mark I
J
K all that apply.
In college housing
In the military
At a seasonal
or second residence

For child custody
In jail or prison
In a nursing home
For another reason

➜ If more people were counted in Question 1, continue with Person 2.

USCENSUSBUREAU

The 2010 Census asks questions on: age, sex,
Hispanic origin, race, relationship, home: owned or rented.

The ACS asks additional questions on topics such as: education,
employment, health insurance, heating costs, transportation.

U.S. Department of Commerce
Economics and Statistics Administration
U.S. CENSUS BUREAU

ACS-54 (January 2009)