2010, 2011 & 2012 Forms

American Community Survey Methods Panel Tests

OMB: 0607-0936

IC ID: 190927

⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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
Form	ACS-1	American Community Survey	Attachment C ACS-0001 - Questionnaire.pdf	No		Paper Only
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
Other-Internet Mode Test Proposed Sample Screen Shots			Attachment J Internet Screen Shots.doc	Yes	Yes	Fillable Fileable
Form	ACS Internet Test Followup - Behavioral Questions	ACS Internet Test Followup - Behavioral Questions for Nonrespondents and Internet Respondents	Attachment A_ ACS-Web Option Reinterview_FINAL_rev.docx	Yes	Yes	Fillable Fileable
Other-ACS Questions to be Re-asked in Internet Followup Interview			Attachment B ACS Questions for Internet Follow-up.doc	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 223,467	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	Previously Approved
Annual Number of Responses for this IC	250,133	100,000	150,133
Annual IC Time Burden (Hours)	140,896	63,334	77,562
Annual IC Cost Burden (Dollars)	0	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.