2010, 2011 & 2012 Forms

American Community Survey Methods Panel Tests

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.