Various Economic Area Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

2011 GOVERNMENT UNITS SURVEY
Census of Governments

GUS (1-19-2011) Draft 5

OMB No. 0607-0725: Approval Expires 08/31/2013

Due Date: March 4, 2011

RETURN VIA MAIL TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

If you have any questions,
please call 1-888-xxx-xxxx
weekdays, 7am to 5pm EST.
Questions may also be emailed
to: [email protected]

In correspondence pertaining
to this report, please refer to
the User ID printed above the
address box.

Introduction and Survey Purpose:
This survey collects descriptive information on the basic characteristics of local governments in preparation
for the 2012 Census of Governments. Data from this survey will also be used to produce the official count of local
government units in the United States and to update and verify the mailing addresses of government units.
General Instructions:
• Use a blue or black ink pen.
• Mark the box with an X next to the appropriate response to each question.
BACKGROUND INFORMATION
1 Has your government ceased to exist? (For all questions in this survey, "your government" refers to the unit of
government identified in the mailing label above.)

(MM)

(DD)

(YYYY)

Yes – Enter effective date and skip to 52 . . . . . . . . . . . . . . . . . . . . . . . . . . .
No

(For example, your government is unable to adopt its budget, levy taxes, set rates or charges, or issue bonded debt
without approval by another government.)

17001017

Yes

County Dependent

City Dependent

Township Dependent

Other – Specify:
No

3 Is the mailing address listed above correct?
Yes

No – Provide address corrections in the address label above.

4 Is your government’s physical location the same as the location shown in the mailing address? (P.O. Box and rural
route addresses are not physical locations)
Yes

USCENSUSBUREAU

No – Enter physical location:

§2!+2¤

2 Is your government a fiscally dependent unit on another government, unit, agency, office, etc. of another government?

2

BACKGROUND INFORMATION – Continued
5 Does your government have an Internet website that contains information about your government and its activities?
Yes – Enter the web address
(e.g., www.mylocalgov.state.us):

No

6

Month
(MM)

Day
(DD)

On what date does your government’s fiscal year end? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(YYYY)

7 What year was your government first incorporated or formed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DEBT
8 Is your government authorized to issue long-term debt with an original term of more than
one year? (For example, bonds, mortgages, revenue bonds, special assessment bonds,
general obligation bonds, industrial development revenue bonds, conduit debt, etc.) . . . . . . . . . .

Yes

No

Yes

No

Yes

No

9 Is your government authorized to issue short-term debt with an original term of less than
one year? (For example, tax-anticipation notes, bond-anticipation notes, interest-bearing
warrants, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Is your government authorized to issue any other debt not specified above?
Yes – Specify:
No

11 Does your government require voter approval to issue certain types of debt? . . . . . . . . . . . . . . .
LICENSE AND PERMIT FEES

12 Does your government have the authority to impose any of the following types of license or permit fees?
A. Alcoholic beverages license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

B. Amusement license (For example, race tracks, theaters, athletic events, etc.). . . . . . . . . . . . . .

Yes

No

C. Hunting and fishing license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

D. Motor vehicles license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

E. Motor vehicle operators license . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

F. Public utilities license (Exclude franchise fees.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

G. Occupational or businesses license (For example, inspection and examination fees,
barber, chain store, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

H. Other licenses or permit fees (For example, marriage license, building permits, etc.)
Yes – Specify:
No
Form GUS

§2!+:¤

17001025

(Mark "Yes" or "No" for each item)

3

TAXES
13 Does your government have the authority to levy any of the following types of taxes?
(Mark "Yes" or "No" for each item)
A. Property tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

B. General sales and gross receipts tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

C. Alcoholic beverages sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

D. Amusements sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

E. Motor fuels sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

F. Insurance premiums sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

G. Pari-mutuels sales tax (For example, taxes measured by amounts wagered or bet on
horseracing, dog racing, jai-alai, etc. including “breakage” collected by the government.). . . .

Yes

No

H. Public utilities sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

I.

Tobacco products sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

J. Individual income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

K. Corporation net income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

L. Death and gift tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

M. Documentary and stock transfer tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

N. Severance tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

O. Other tax (For example, hotel tax, motel tax, etc.) – Specify

Yes

No

.........................

RETIREMENT/PENSION PLAN

17001033

Yes – List plans
No

15 Do retirees of your government have the option of participating in any retiree healthcare plans?
Yes – List plans
No

Form GUS

§2!+B¤

14 Do employees of your government participate in any retirement or pension plans?

4

GOVERNMENT ACTIVITY
Yes

No

ferry boats, or related structures? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

18 Does your government operate a toll road? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

19 Does your government operate a transit authority? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

20 Does your government operate an airport? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

21 Does your government operate a sea or in-land port?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

22 Does your government operate a hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

23 Does your government own a gas utility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

24 Does your government own an electric utility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

25 Does your government supply water within its jurisdiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

26 Does your government own a water utility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

27 Does your government operate a sewer system? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

28 Is the sewer system separate from the water supply system? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

29 Does your government keep separate records for the sewer system and the water supply? . . . . .

Yes

No

30 Does your government operate a landfill? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

16 Does your government operate a liquor store? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Is your government responsible for highways, streets, roads, alleys, bridges, tunnels,

31 Does your government provide refuse collection or disposal? (For example, curbside or
containerized collection including recycling, periodic special collection programs, tire
disposal, leaf and Christmas tree collection, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17001041

(For example, "Section 8" assistance, housing and mortgage finance agencies, promotion of
homeownership, and assistance for repair and renovation of existing homes, etc.) . . . . . . . . . . . .

33 Does your government perform activities related to community development? (For example,
use of community development block grants, renewal of urban areas, clearing of slums,
redevelopment of rural areas, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

34 Does your government perform activities that affect natural resources? (For example,
irrigation, drainage, flood control, soil conservation, land reclamation, fisheries, forestry, etc.). . .

35 Does your government perform activities related to open space or land preservation?
(For example, land preservation for agricultural, conservation, recreational purposes, etc.) . . . . .

36 Does your government provide or financially support recreational and cultural facilities
or activities? (For example, parks, public beaches, galleries, zoos, botanical gardens,
memorials, community music, celebrations, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form GUS

§2!+J¤

32 Does your government construct, operate, or support housing and redevelopment projects?

5

PUBLIC SERVICES
37 Does your government provide police protection service? (Include contracted services) . . . . . . . .

Yes

No

38 Does your government provide fire protection services? (Include contracted services) . . . . . . . . .

Yes

No

services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

40 (If yes), Are emergency medical services separate from the fire services?. . . . . . . . . . . . . . . . . . .

Yes

No

Yes

No

Yes

No

A. Public libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

B. Academic libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

C. Law libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

D. Other library services - Specify

Yes

No

........

Yes

No

services, or legal counseling? (For example, criminal and civil court expenditures,
court related activities, legal departments, attorneys or child support enforcement.) . . . . . . . . . .

Yes

No

Yes

No

Yes

No

39 Does your government provide emergency medical services (EMS)? (Include contracted

41 Does your government provide regulation and inspection services? (For example,

buildings and construction regulation, licensing and regulation of financial institutions
and the examination of professional occupations.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42 Does your government provide services to the elderly, homeless, needy, veterans,
children, or disabled people in the community? (For example, transportation services,
medical and cash assistance, nursing homes, foster care, day care, veterans services,
homeless shelters, food banks, welfare programs, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 Does your government provide any of the following types of library services?
(Mark "Yes" or "No" for each item.)

.............................................

44 Does your government provide any other activities not mentioned above? Specify

JUDICIAL OR LEGAL ACTIVITIES
45 Does your government perform judicial or legal activities that relate to courts, legal

17001058

juvenile correctional facility, etc. Exclude temporary holding or lockup facilities from
which inmates are usually transferred within 72 hours and not held beyond arraignment.) . . . . .

47 Does your government use any privately-owned correctional facilities?
(For example, detention centers, jails, other correctional facilities, etc.). . . . . . . . . . . . . . . . . . . . .

Form GUS

§2!+[¤

46 Does your government operate any correctional facilities? (For example, prisons, jails,

6

FINANCE
Estimates are acceptable.

48 How much revenue did your government receive in the last
completed fiscal year? (If none, enter $0. Estimates are
acceptable. Include all taxes, charges, state or Federal grants,
etc. Consolidate amounts covering all funds and accounts of
your government, net of any duplicative transfers between
funds, amounts of expenditure from bond funds, construction
accounts, and other capital funds. Exclude borrowings.) . . . . . . . . . .

49 How much did your government expend in the last completed

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

fiscal year? (If none, enter $0. Estimates are acceptable. Include
salaries, wages, capital outlay, interest on debt, current
operations, payments to other governments, etc.) . . . . . . . . . . . . . . .

50 What was your government’s annual gross payroll (before
deductions) in the last completed fiscal year? (If none,
enter $0. Estimates are acceptable. Include salaries, wages,
fees, commissions, overtime, premium, night differential
pay, bonuses, incentive payments, amounts withheld for
taxes, employee contributions to retirement systems, etc.
Exclude fringe benefits, lump-sum payments, and the value
of living quarters and subsistence allowances furnished for
employees.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51 How much outstanding debt did your government have at
the end of the last completed fiscal year? (If none, enter $0.
Estimates are acceptable. Include bonds, mortgages, revenue
bonds, special assessment bonds, general obligation bonds,
industrial development revenue bonds, conduit debt,
tax-anticipation notes, bond-anticipation notes, interestbearing warrants, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REMARKS
Hours

Minutes

52 Approximately how long did it take you to complete this questionnaire? (Include the time
spent reading instructions, working on questions, and obtaining information, as well as the
time spent by all employees in collecting and providing this information.) . . . . . . . . . . . . . . . . . . . .

:

53 Overall, how easy or difficult did you find it to complete this questionnaire?
Very difficult
Somewhat difficult
Somewhat easy

54 Were any of the questions not applicable to your government?
17001066

No, all of them were applicable
Yes, some questions were not applicable – Specify question numbers

55 Did any of the questions require involvement from other people or departments for you to answer?
No, I did not need input from other people to answer the questions
Yes, I got input from other people to answer some questions – Specify question numbers

Form GUS

§2!+c¤

Very easy

7

REMARKS – Continued
56 What are the names and titles of the other people who were involved in providing data for this survey?
Name

Title

57 In Question 46 , did you include or exclude temporary holding or lockup facilities as part of your response?
Temporary holding and lockup facilities were included in Question 46
Temporary holding and lockup facilities were excluded from Question 46
This government does not have any temporary holding or lockup facilities

58 In your opinion, should this form be asking for other information that is not currently addressed?
No, the form is fine as it is
Yes, the form should ask questions about other topics – Specify

CONTACT INFORMATION
Title

17001074

Name of person to contact regarding this report

Area Code

Telephone Number

–

–

Ext.

Fax

–

E-mail address

THANK YOU FOR COMPLETING THE 2011 GOVERNMENT UNITS SURVEY
Form GUS

–

§2!+k¤

59 Please use this space for any explanations that may be important to understanding any of your responses.