Survey of Health Insurance and Program Participation

SHIPP-1(L)

(02-2010)

FROM THE DIRECTOR

U.S. CENSUS BUREAU

As you may have heard, the U.S. Census Bureau is currently carrying out the 2010 Census of the

United States population. We sincerely thank you for your time and cooperation with that effort. In

addition to the population count every 10 years, the Census Bureau conducts many other surveys

and censuses year-round in order to keep researchers and policymakers informed with the most

current data available on the economic and social profile of the Nation.

We are writing to ask for your cooperation with one of these surveys – the Survey of Health Insurance

and Program Participation. The purpose of the survey is to get a more accurate portrait of the health

care situation in the U.S. – to determine the number of adults and children who have health coverage,

the sources of their coverage, and the number of people who are uninsured. This information will be

used to assess and develop more accurate methods of measuring health coverage and will help

policymakers make informed decisions about how to improve America’s health care system.

Sometime in the next week or so, a representative from the Census Bureau will be calling your

household to request your participation in this brief voluntary survey, which is estimated to take about

12 minutes.

The Office of Management and Budget has approved this survey under project 0607–XXXX. We are

conducting this survey under the authority of Title 13, Section 182 of the United States Code. Section 9

of Title 13 requires us to keep all information about you and your household strictly confidential. We

may use this information only for statistical purposes. Any Census Bureau employee who violates these

provisions is subject to a fine up to $250,000 or a prison sentence of up to five years or both. Although

there are no penalties for not answering any of the questions, each unanswered item lessens the accuracy

and usefulness of the final statistics.

Thank you in advance for your participation.

Sincerely,

Robert M. Groves

SHIPP-1(L)

(02-2010)

FREQUENTLY ASKED QUESTIONS

WHERE CAN I SEND COMMENTS REGARDING THIS SURVEY?

Send comments regarding any aspect of this collection of information, including the burden estimate and suggestions for reducing this burden, to: Paperwork Project 0607-XXXX, U.S. Census Bureau, 4600 Silver Hill Road, Room 3K138, Washington, DC 20233. You may e-mail comments to [email protected]; ; use "Paperwork Project 0607-XXXX" as the subject.

WHY WAS I SELECTED?

While participation is voluntary and there are no penalties for not answering questions, it is very important that we have your cooperation in the survey to ensure the validity and accuracy of the data. Your household was selected randomly from a list of phone numbers.

WHAT LAWS AUTHORIZE YOU TO CONDUCT THIS SURVEY?

Title 13, Section 182 of the United States Code authorizes the Census Bureau to conduct this survey. The survey is authorized by the Office of Management and Budget under Project 0607-XXXX. This valid approval number legally certifies this information collection.

WHAT CONFIDENTIALITY PROTECTION DO I HAVE?

Title 13, Section 9 of the United States Code requires us to keep all information about you and your household strictly confidential. The confidentiality of the information you provide is assured to the full extent permitted by law in accordance with the Privacy Act of 1974. The information you provide will only be used for statistical purposes.

HOW WILL THE INFORMATION BE USED?

Results from this survey will be used to improve our questionnaires so that the statistics we produce are more accurate. We may combine data from this survey with data we obtain from other government agencies, such as Medicare and Medicaid enrollment records. The same confidentiality laws that protect your survey answers (Title 13, United States Code, Section 9) also protect any additional information we collect. If you wish to request that your information not be combined with information we obtain from other agencies, we ask that you notify the Census Bureau Telephone Interviewer at the time of the interview.

WHEN IS THE EXPIRATION DATE FOR THIS SURVEY?

The expiration date for this survey is September 30, 2010.