Other Public Use Forms

Draft 1 (1-13-2009)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Your Answers Are Confidential
Your answers are confidential and protected by law. All census workers have taken an oath and are
subject to a jail term, a fine, or both if they disclose ANY information that could identify you or your
household. You answers will only be used for statistical purposes, and no other purpose. As allowed by
law, your census data become public after 72 years. This information can be used for family history
and other types of historical research.
You are required by law to provide the information requested. These federal laws are found in the
United States Code, Title 13.
Thank you for your cooperation. The Census Bureau appreciates your help.
Respondents are not required to respond to any information collection unless it displays a valid approval number from the office of
the Management and Budget.
• The approval number for the collection of personal and address information in 2010 is OMB XXXXXXXX X. Send any comments
concerning this collection to Paperwork Reduction Project XXXXXXXX X, U.S. Census Bureau, AMSD-3K138, 4600 Silver Hill
Road, Washington, DC 20233. Or email your comments to ; use “Paperwork Project XXXX-XXXX X” as
the subject.

USCENSUSBUREAU

D-31 PI (1-13-2009)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Your Answers Are Confidential
Your answers are confidential and protected by law. All census workers have taken an oath and are
subject to a jail term, a fine, or both if they disclose ANY information that could identify you or your
household. You answers will only be used for statistical purposes, and no other purpose. As allowed by
law, your census data become public after 72 years. This information can be used for family history
and other types of historical research.
You are required by law to provide the information requested. These federal laws are found in the
United States Code, Title 13.
Thank you for your cooperation. The Census Bureau appreciates your help.
Respondents are not required to respond to any information collection unless it displays a valid approval number from the office of
the Management and Budget.
• The approval number for the collection of personal and address information in 2010 is OMB XXXXXXXX X. Send any comments
concerning this collection to Paperwork Reduction Project XXXXXXXX X, U.S. Census Bureau, AMSD-3K138, 4600 Silver Hill
Road, Washington, DC 20233. Or email your comments to ; use “Paperwork Project XXXX-XXXX X” as
the subject.

USCENSUSBUREAU

D-31 PI (1-13-2009)