Comment and Feedba Comment and Feedback Question

Version A
13197280

Mailing
Instructions

➜

Then...
• put the completed questionnaire into the postagepaid return envelope. If the envelope has been
misplaced, please mail the questionnaire to:
U.S. Census Bureau
P.O. Box 5240
Jeffersonville, IN
47199-5240

➜ Please make sure you have...

• listed all names and answered the
questions on pages 2, 3, and 4
• answered all Housing questions

• make sure the barcode above your address
shows in the window of the return envelope.

• answered all Person questions for
each person.

Thank you for participating in the
American Community Survey.

You may use the space below to share any comments.

For Census Bureau Use
POP

EDIT

EDIT CLERK

PHONE

TELEPHONE CLERK

JIC1

JIC2

JIC3

JIC4

The Census Bureau estimates that, for the average household,
this form will take 40 minutes to complete, including the time
for reviewing the instructions and answers. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: Paperwork Project 0607-0810 and 0607-0936,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD – 3K138,
Washington, D.C. 20233. You may e-mail comments to
[email protected]; use "Paperwork Project
0607-0810 and 0607-0936" as the subject. Please
DO NOT RETURN your questionnaire to this address. Use the
enclosed preaddressed envelope to return your completed
questionnaire.
Respondents are not required to respond to any information
collection unless it displays a valid approval number from the
Office of Management and Budget. This 8-digit number
appears in the bottom right on the front cover of this form.
Form ACS-1(2017) (03-14-2016)

28

§.4iq¤
ACS-1(2017), Page 28, Base (Black)

ACS-1(2017), Page 28, Green Pantone 354 (18, 50, 100%)

Version B
13197280

Mailing
Instructions

➜

Then...
• put the completed questionnaire into the postagepaid return envelope. If the envelope has been
misplaced, please mail the questionnaire to:
U.S. Census Bureau
P.O. Box 5240
Jeffersonville, IN
47199-5240

➜ Please make sure you have...

• listed all names and answered the
questions on pages 2, 3, and 4
• answered all Housing questions

• make sure the barcode above your address
shows in the window of the return envelope.

• answered all Person questions for
each person.

Thank you for participating in the
American Community Survey.

You may use the space below to share any comments about your experience
with the American Community Survey.

For Census Bureau Use
POP

EDIT

EDIT CLERK

PHONE

TELEPHONE CLERK

JIC1

JIC2

JIC3

JIC4

The Census Bureau estimates that, for the average household,
this form will take 40 minutes to complete, including the time
for reviewing the instructions and answers. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: Paperwork Project 0607-0810 and 0607-0936,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD – 3K138,
Washington, D.C. 20233. You may e-mail comments to
[email protected]; use "Paperwork Project
0607-0810 and 0607-0936" as the subject. Please
DO NOT RETURN your questionnaire to this address. Use the
enclosed preaddressed envelope to return your completed
questionnaire.
Respondents are not required to respond to any information
collection unless it displays a valid approval number from the
Office of Management and Budget. This 8-digit number
appears in the bottom right on the front cover of this form.
Form ACS-1(2017) (03-14-2016)

28

§.4iq¤
ACS-1(2017), Page 28, Base (Black)

ACS-1(2017), Page 28, Green Pantone 354 (18, 50, 100%)

Version C

Mailing
Instructions

➜

13197280

Then...
• put the completed questionnaire into the postagepaid return envelope. If the envelope has been
misplaced, please mail the questionnaire to:
U.S. Census Bureau
P.O. Box 5240
Jeffersonville, IN
47199-5240

➜ Please make sure you have...

• listed all names and answered the
questions on pages 2, 3, and 4

• make sure the barcode above your address
shows in the window of the return envelope.

• answered all Housing questions

Thank you for participating in the
American Community Survey.

• answered all Person questions for
each person.

Thank You

You may use the space below to share any comments about your experience with the survey.

For Census Bureau Use
POP

EDIT

EDIT CLERK

PHONE

TELEPHONE CLERK

JIC1

JIC2

JIC3

JIC4

The Census Bureau estimates that, for the average household,
this form will take 40 minutes to complete, including the time
for reviewing the instructions and answers. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: Paperwork Project 0607-0810 and 0607-0936,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD – 3K138,
Washington, D.C. 20233. You may e-mail comments to
[email protected]; use "Paperwork Project
0607-0810 and 0607-0936" as the subject. Please
DO NOT RETURN your questionnaire to this address. Use the
enclosed preaddressed envelope to return your completed
questionnaire.
Respondents are not required to respond to any information
collection unless it displays a valid approval number from the
Office of Management and Budget. This 8-digit number
appears in the bottom right on the front cover of this form.
Form ACS-1(2017) (03-14-2016)

28

§.4iq¤
ACS-1(2017), Page 28, Base (Black)

ACS-1(2017), Page 28, Green Pantone 354 (18, 50, 100%)

ACS‐400C (January 2017)  finalize - FEEDBACK QUESTION DRAFT

You may use the space below to share any comments.

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 ACS Internet Screen Capture Guide 

Version D

ACS‐400C (January 2017)  finalize - FEEDBACK QUESTION DRAFT

 ACS Internet Screen Capture Guide 

Version E

You may use the space below to share any comments about your experience
with the American Community Survey.

Return to Top