Information Collection

2010, 2011 & 2012 Forms

IC 190927 under ICR 201010-0607-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 American Community Survey 2010, 2011 & 2012 Forms	Form
Form ACS Internet Test ACS Internet Test Followup - Behavioral Questions for Nonrespondents and Internet Respondents 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
Attachment B ACS Questions for Internet Follow-up.doc	Other-ACS Questions to be Re-asked i
ACS-1 American Community Survey Attachment C ACS-0001 - Questionnaire.pdf	Form
ACS Internet Test ACS Internet Test Followup - Behavioral Questions for No Attachment A_ ACS-Web Option Reinterview_FINAL_rev.docx	Form

IC Title:

2010, 2011 & 2012 Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-ACS-12(L)S - Prenotice Letter		No		Paper Only
Other-ACS-13(L)SM - Introductory Letter		No		Paper Only
Form	ACS-1	No		Paper Only
Other-ACS-10SM - Frequently Asked Question Brochure		No		Paper Only
Instruction		No		Paper Only
Other-ACS-20S - Reminder Card		No		Paper Only
Other-ACS-14(L)SM - Followup Letter		No		Paper Only
Other-2010 ACS Content Test Cognitive Interviewing Final Report		No		Paper Only
Other-2010 ACS Content Test Proposed Field Test Question Wording		No		Paper Only
Other-Internet Mode Test Proposed Sample Screen Shots		Yes	Yes	Fillable Fileable
Form	ACS Internet Test Followup - Behavioral Questions	Yes	Yes	Fillable Fileable
Other-ACS Questions to be Re-asked in Internet Followup Interview		No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 123,467

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	Previously Approved
Annual Number of Responses for this IC	150,133	-46,200	196,333
Annual IC Time Burden (Hours)	77,562	-14,860	92,422
Annual IC Cost Burden (Dollars)	0	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.

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