State & Local Government Finance Forms

AP-DLN
(04-2013)

A message from the Director, U.S. Census Bureau…
The U.S. Census Bureau has recently identified you as a defined benefit plan system and we need
information to add you to our frame. Information that we are requesting includes mailing address,
membership, payments, and cash and investments for the defined benefit plan.
The Annual Survey of Public Pensions, authorized by Title 13, United States Code, Section 182, provides
measures of revenue, expenditures, investments, and membership for state and local government
employee retirement systems in the United States. This survey is the only comprehensive source of
information on public employee retirement system finances in the United States. The information
collected serves as an integral part of the foundation for developing national economic and public policy
by measuring public activity.
Please respond to the questions online at the following address: respond.census.gov/aspp using the
User ID and Password below by October 31, 2014,
User ID:

Password:

If you need assistance with your response, please contact us by phone at 1-800-832-2839 weekdays
between 7 AM and 5 PM ET, or by email at [email protected].
Please retain a copy of your response for your records.
Thank you for providing this information. The Census Bureau appreciates your help.
Enclosures

Sample pension plan supplemental data request (electronic data collection only):
1. Is the addressee title/department and mailing address the same as shown above?
If no, correct information is:
Addressee Title or Department:
Street 1:
Street 2:
City:
State:
Zip:

Yes

No

2. What is the retirement system’s fiscal year end date?
3. What was the retirement system’s last fiscal year end date that occurred before July 1, 2014?
Use this fiscal year data to complete the remainder of the survey even though more recent data may be available.
4. What was the total number of contributing members of the retirement system during the fiscal year indicated in 3.?
5. What was the total amount of cash and investments (at market value) held at the end of the fiscal year indicated in 3.?
6. What was the amount of payments during the fiscal year indicated in 3.?
7. Use this space for any explanations that may be essential in understanding the reported data.
Include
8. Who should be contacted to answer questions about data reported in this survey?
Name of contact person:
Title of contact person:
Telephone:
Extension:
Fax:
Email address:
Thank-you for completing this survey.
Please keep a copy of the completed form for your records.
The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This collection of information has been
approved by the Office of Management and Budget (OMB) and given the number 0607-0585. Please note the number displayed in the upper right corner of this screen.
Display of this number confirms that we have approval from OMB to conduct this survey. If this number was not displayed, under the Paperwork Reduction Act, we
could not request your participation in this voluntary survey. Information provided in this collection tool compiled from or customarily provided in public records are
exempt from confidential treatment as cited in Title 13, United States Code, Section 9.
Public reporting burden for this collection of information is estimated to vary from 30 minutes to 1 hour per response, with an average of 45 minutes per response,
including time for gathering the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to: [email protected]; use Paperwork Project 0607-0585 as the subject.