Provider Forms

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
Washington, DC 20233-0001

OFFICE OF THE DIRECTOR

JUST A REMINDER.
Recently, the U.S. Census Bureau, in partnership with the Centers for Disease Control and
Prevention, sent your office a packet requesting participation in a survey we are conducting. If
you have already mailed back the information, thank you. If you received the packet but have
not yet had time to complete the information and return it, please do do as soon as possible.
Your response is important for the success of this survey.
If you have questions, need help filling out the form or did not receive it, please call our
toll-free number 1–888–595–1339.
Sincerely,

Thomas L. Mesenbourg
Acting Director
U.S. Census Bureau

Anne Schuchat, M.D.
Rear Admiral, United States Public Health Service
Director, National Center for Immunization and
Respiratory Disease

7317-SSSP (4-15-2009)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
1201 East 10th Street
Jefferson, IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use, $300
7317-SSSP (4-2009)

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U.S. Census Bureau
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