2017 Census Test - Self Response

Draft 7 (9-27-2016)

OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

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

April 10, 2017

Important Note:
You are receiving this
notice because we did not
receive your response by
April 4, 2017.

Dear Resident:
A few weeks ago, the U.S. Census Bureau sent instructions for completing the 2017 Census Test
online. If you have already completed the survey, you do not need to take any further action. If you have
not already responded to this important 10-minute survey, please do so now.
Complete the survey using ONLY ONE of the following options:
• Respond online at survey.census.gov
You will need to provide your 12-digit User ID, which is printed just below the barcode on the
front of the enclosed questionnaire.
• If you are unable to respond online, fill out and mail back the enclosed questionnaire in the postage
paid envelope provided.
Your response is important to your community.
You are required by U.S. law to respond to this survey. It is vital that you complete this survey to help
meet critical needs in your area – including helping to put roads, parks, and hospitals where they are
needed most.
If you do not respond promptly, a Census Bureau interviewer may contact you to complete the survey.
Your answers are completely confidential.
By law, the Census Bureau cannot publish or release information that would identify you or your
household to anyone, including other government agencies. If you need help completing the survey or
have questions, please call our toll-free number 1–844–330–2020.
Thank you for your prompt response.
Sincerely,

John H. Thompson
Director

Mensaje importante: Para completar la Prueba del Censo del 2017, por favor, visite
survey.census.gov o llame sin costo al 1–844–468–2020.
census.gov
DG-17(L1) (9-2016)

Base prints black 100%
Overlay prints pantone cyan #6 (10%)

FREQUENTLY ASKED QUESTIONS

How do I respond?
Go online at survey.census.gov to complete the 2017 Census Test online. You will need the 12-digit
User ID found below the barcode on the address label.
Are my answers confidential?
Yes. The Census Bureau is required by U.S. law to keep your answers confidential (Title 13, United
States Code, Sections 9 and 214). This means that the Census Bureau cannot give out information that
identifies you or your household. The Census Bureau chose your address, not you personally, as part of
a randomly selected sample.
For more information about how we protect your information, please visit our website at www.census.gov
and click on “Data Protection and Privacy Policy” at the bottom of the homepage.
Am I required to fill out this survey?
Yes. We are conducting this survey under the authority of Title 13, United States Code, Sections 141
and 193. This survey has been approved by the Office of Management and Budget (OMB). For this
survey, the OMB approval number is xxxx-xxxx.
What is the 2017 Census Test?
The 2017 Census Test is a survey that the U.S. Census Bureau is conducting in preparation for the
2020 Census. The goal of this survey is to develop new methods that will make the next census easier,
more convenient, and less costly for taxpayers.
How will the Census Bureau use the information I provide?
Your information will be combined with the information provided by other sampled households to help
determine the content and design of the 2020 Census.
How long will this survey take?
The U.S. Census Bureau estimates that, for the average household, this survey will take about 10
minutes to complete, including the time for reviewing the instructions and answers.
Send comments regarding this burden estimate or any other aspect of this burden to: Paperwork
Reduction Project xxxx-xxxx, U.S. Census Bureau, DCMD-2H174, 4600 Silver Hill Road,
Washington, DC 20233. You may e-mail comments to <[email protected]>; use
"Paperwork Reduction Project xxxx-xxxx" as the subject.
You are not required to respond to this collection of information if it does not display a valid approval
number from the Office of Management and Budget (OMB). The eight-digit OMB number is xxxx-xxxx.

DG-17(L1) (9-2016)