Information Collection

2010, 2011 & 2012 Forms

IC 190927 under ICR 200910-0607-001 · OMB 0607-0936.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0936 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ACS-1 2010, 2011 & 2012 Forms	Form
Attachment A ACS-0012(L)S - Prenotice Letter.pdf	Other-ACS-12(L)S - Prenotice Letter
Attachment B ACS-0013(L)SM - Introductory Letter.pdf	Other-ACS-13(L)SM - Introductory Let
Attachment D ACS-0010SM - Frequently Asked Question Brochure.pdf	Other-ACS-10SM - Frequently Asked Qu
Attachment E ACS-0030 - Instruction Guide Booklet.pdf	Instruction
Attachment F ACS-0020S - Reminder Card.pdf	Other-ACS-20S - Reminder Card
Attachment G ACS-0014(L)SM - Followup Letter.pdf	Other-ACS-14(L)SM - Followup Letter
Attachment H 2010 ACS Content Test Cognitive Interviewing Final Report.pdf	Other-2010 ACS Content Test Cognitiv
Attachment I Content Test Questions 112509.xls	Other-2010 ACS Content Test Proposed
Attachment J Internet Screen Shots.doc	Other-Internet Mode Test Proposed Sa
ACS-1 American Community Survey Attachment C ACS-0001 - Questionnaire.pdf	Form

IC Title:

2010, 2011 & 2012 Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ACS-1	American Community Survey	Attachment C ACS-0001 - Questionnaire.pdf	No		Paper Only
Other-ACS-12(L)S - Prenotice Letter			Attachment A ACS-0012(L)S - Prenotice Letter.pdf	No		Paper Only
Other-ACS-13(L)SM - Introductory Letter			Attachment B ACS-0013(L)SM - Introductory Letter.pdf	No		Paper Only
Other-Internet Mode Test Proposed Sample Screen Shots			Attachment J Internet Screen Shots.doc	Yes	Yes	Fillable Fileable
Other-ACS-10SM - Frequently Asked Question Brochure			Attachment D ACS-0010SM - Frequently Asked Question Brochure.pdf	No		Paper Only
Instruction			Attachment E ACS-0030 - Instruction Guide Booklet.pdf	No		Paper Only
Other-ACS-20S - Reminder Card			Attachment F ACS-0020S - Reminder Card.pdf	No		Paper Only
Other-ACS-14(L)SM - Followup Letter			Attachment G ACS-0014(L)SM - Followup Letter.pdf	No		Paper Only
Other-2010 ACS Content Test Cognitive Interviewing Final Report			Attachment H 2010 ACS Content Test Cognitive Interviewing Final Report.pdf	No		Paper Only
Other-2010 ACS Content Test Proposed Field Test Question Wording			Attachment I Content Test Questions 112509.xls	No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 169,667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 49 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	196,333	196,333
Annual IC Time Burden (Hours)	92,422	92,422
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.