The American Community Survey

Attachment Q

ACS-18(L)(H)(GQ)(ATLANTA)(2013)
(7-2012)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau...
To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is an on going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS. Participating in the ACS is important
and also required by law (Title 13, United States Code, Sections 141, 193, 221, and 223).
Estimates from the ACS are used by federal, state, local, and tribal governments, as well as by
private nonprofit organizations and communities. For example:
• Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
• Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
• Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
• answer any questions you may have about the ACS or about interviewing residents of
your facility.
• collect and verify basic information about your facility, such as the facility name and
address.
census.gov

Attachment Q

• ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
• select a random sample of residents to take part in the ACS.
• interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. All the
information the U.S. Census Bureau collects is confidential by law (Title 13,
United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Atlanta Regional Office toll-free
number at 1–800–424–6974 (ext. 53955), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Enclosure

ACS-18(L)(H)(GQ)(ATLANTA)(2013)(7-2012)

Attachment Q

ACS-18(L)(H)(GQ)(CHICAGO)(2013)
(7-2012)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau...
To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is an on going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS. Participating in the ACS is important
and also required by law (Title 13, United States Code, Sections 141, 193, 221, and 223).
Estimates from the ACS are used by federal, state, local, and tribal governments, as well as by
private nonprofit organizations and communities. For example:
• Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
• Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
• Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
• answer any questions you may have about the ACS or about interviewing residents of
your facility.
• collect and verify basic information about your facility, such as the facility name and
address.

census.gov

Attachment Q

• ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
• select a random sample of residents to take part in the ACS.
• interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. All the
information the U.S. Census Bureau collects is confidential by law (Title 13,
United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Chicago Regional Office toll-free
number at 1–800–865–6384 (ext.1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Enclosure

ACS-18(L)(H)(GQ)(CHICAGO)(2013)(7-2012)

Attachment Q

ACS-18(L)(H)(GQ)(DENVER)(2013)
(7-2012)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau...
To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is an on going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS. Participating in the ACS is important
and also required by law (Title 13, United States Code, Sections 141, 193, 221, and 223).
Estimates from the ACS are used by federal, state, local, and tribal governments, as well as by
private nonprofit organizations and communities. For example:
• Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
• Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
• Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
• answer any questions you may have about the ACS or about interviewing residents of
your facility.
• collect and verify basic information about your facility, such as the facility name and
address.

census.gov

Attachment Q

• ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
• select a random sample of residents to take part in the ACS.
• interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. All the
information the U.S. Census Bureau collects is confidential by law (Title 13,
United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Denver Regional Office toll-free
number at 1–888–209–7659, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Enclosure

ACS-18(L)(H)(GQ)(DENVER)(2013)(7-2012)

Attachment Q

ACS-18(L)(H)(GQ)(LOS ANGELES)(2013)
(7-2012)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau...
To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is an on going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS. Participating in the ACS is important
and also required by law (Title 13, United States Code, Sections 141, 193, 221, and 223).
Estimates from the ACS are used by federal, state, local, and tribal governments, as well as by
private nonprofit organizations and communities. For example:
• Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
• Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
• Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
• answer any questions you may have about the ACS or about interviewing residents of
your facility.
• collect and verify basic information about your facility, such as the facility name and
address.

census.gov

Attachment Q

• ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
• select a random sample of residents to take part in the ACS.
• interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. All the
information the U.S. Census Bureau collects is confidential by law (Title 13,
United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Los Angeles Regional Office
toll-free number at 1–800–992–3530 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Enclosure

ACS-18(L)(H)(GQ)(LOS ANGELES)(2013)(7-2012)

Attachment Q

ACS-18(L)(H)(GQ)(NEW YORK)(2013)
(7-2012)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau...
To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is an on going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS. Participating in the ACS is important
and also required by law (Title 13, United States Code, Sections 141, 193, 221, and 223).
Estimates from the ACS are used by federal, state, local, and tribal governments, as well as by
private nonprofit organizations and communities. For example:
• Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
• Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
• Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
• answer any questions you may have about the ACS or about interviewing residents of
your facility.
• collect and verify basic information about your facility, such as the facility name and
address.

census.gov

Attachment Q

• ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
• select a random sample of residents to take part in the ACS.
• interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. All the
information the U.S. Census Bureau collects is confidential by law (Title 13,
United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s New York Regional Office toll-free
number at 1–800–991–2520 (ext. 3400), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Enclosure

ACS-18(L)(H)(GQ)(NEW YORK)(2013)(7-2012)

Attachment Q

ACS-18(L)(H)(GQ)(PHILADELPHIA)(2013)
(7-2012)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau...
To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is an on going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS. Participating in the ACS is important
and also required by law (Title 13, United States Code, Sections 141, 193, 221, and 223).
Estimates from the ACS are used by federal, state, local, and tribal governments, as well as by
private nonprofit organizations and communities. For example:
• Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
• Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
• Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
• answer any questions you may have about the ACS or about interviewing residents of
your facility.
• collect and verify basic information about your facility, such as the facility name and
address.

census.gov

Attachment Q

• ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
• select a random sample of residents to take part in the ACS.
• interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. All the
information the U.S. Census Bureau collects is confidential by law (Title 13,
United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Philadelphia Regional Office
toll-free number at 1–866–238–1374, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Enclosure

ACS-18(L)(H)(GQ)(PHILADELPHIA)(2013)(7-2012)