2017 Census Test - Self Response

Draft 6 (10-3-2016)

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

March 20, 2017
Dear Resident:
Your address has been randomly selected by the U.S. Census Bureau to participate in the
2017 Census Test. The Census Bureau conducts this important, 10-minute survey to help
make the 2020 Census easier, more convenient, and less costly.
Results from the 2020 Census will be used to:
• Allocate resources for schools, health services, and new business development
• Prepare your community to meet transportation and emergency readiness needs
• Help ensure the political representation of your community
Respond by April 1 at:
survey.census.gov

Your USER ID is:

The Census Bureau is using the Internet instead of paper forms mailed to you to securely collect this
information, to conserve natural resources, save taxpayer money, and process data more efficiently. If
you are unable to complete the survey online, we will send you a paper questionnaire in a few weeks
for you to complete and mail back.
The census is so important that your response is required by U.S. law, and your answers are kept
completely confidential. If you don’t respond, we will need to send a Census Bureau interviewer to
your home to collect your answers in person. If you need help completing the survey, please call
1–844–330–2020 toll-free.
Thank you in advance for your prompt response.
Sincerely,

John H. Thompson
Director
Enclosure

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-16(L1) (10-2016)

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 home page.
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-16(L1) (10-2016)