State & Local Government Finance Forms

February 27, 2017

NAME
Title
Office
Address 1
Address 2
City, ST ZIP

Dear NAME:
We are writing to request information for our 2017 Census of Governments, Survey of Local
Government Finances. This survey provides the only source of nationwide, comprehensive
information on state and local government finances. Results of this survey are used by the U.S.
Congress, federal agencies, state governments, and other local governments, educational and
research organizations and the general public.
Title 13 United States Code (U.S.C.), Sections 161 and 182 authorize the U.S. Census Bureau to
conduct this collection and to request your voluntary assistance and has been approved by the
U.S. Office of Management and Budget number 0607-0585. These data are subject to provisions
of Title 13 U.S.C., Section 9(b) exempting data that are customarily provided in public records
from rules of confidentiality.
As in previous survey years, we would like to obtain copies of the reports specified below. The
data we are requesting is for your government’s fiscal year that ended December 30, 2016.
•
•
•

Name of report requested 1
Name of report requested 2
Name of report requested 3

Please send the reports via e-mail to [email protected]. If the requested reports are
not available electronically, or if you need further assistance, please call our customer help line
at 1-800-832-2839, Monday through Friday, 8 AM to 5 PM Eastern Time or via the e-mail
address above.

Thank you in advance for your time and cooperation, and for helping the U.S. Census Bureau
measure America’s people, places, and our economy. Your response makes a difference.

Sincerely,

Randy A. Moore
Branch Chief, Local Finance Statistics Branch
International Trade Management Division
U.S. Census Bureau

OMB Number
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit
OMB approval number is 0607-0585 and appears at the upper right of the login screen. Without
this approval, we could not conduct this survey.
Authority and Confidentiality
Title 13 United States Code, Sections 161 and 182, authorizes the Census Bureau to conduct this
collection and request your voluntary assistance. These data are subject to provisions of Title 13
United States Code, Section 9(b), exempting data that are customarily provided in public records
from rules of confidentiality.
Burden Estimate Statement
We estimate this survey will take an average of 1.5 to 6 hours to complete, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining 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:
ITMD Survey Comments 0607-0585
U.S. Census Bureau
4600 Silver Hill Road
Room ITMD-5K158
Washington, DC 20233
You may email comments to [email protected]. Be sure to use “ITMD Survey Comments
0607-0585” as the subject.

Subject: 2017 Census of Governments Annual Survey of Local Government Finances

Dear NAME:
We are writing to request information for our 2017 Census of Governments, Survey of Local
Government Finances. This survey provides the only source of nationwide, comprehensive
information on state and local government finances. Results of this survey are used by the U.S.
Congress, federal agencies, state governments, and other local governments, educational and
research organizations and the general public.
Title 13 United States Code (U.S.C.), Sections 161 and 182 authorize the U.S. Census Bureau to
conduct this collection and to request your voluntary assistance and has been approved by the
U.S. Office of Management and Budget number 0607-0585. These data are subject to provisions
of Title 13 U.S.C., Section 9(b) exempting data that are customarily provided in public records
from rules of confidentiality.
As in previous survey years, we would like to obtain copies of the reports specified below. The
data we are requesting is for your government’s fiscal year that ended December 30, 2016.
•
•
•

Name of report requested 1 (Look up in spreadsheet)
Name of report requested 2 (Look up in spreadsheet)
Name of report requested 3 (Look up in spreadsheet)

Please send the reports via e-mail to [email protected]. If the requested reports are
not available electronically, or if you need further assistance, please call our customer help line
at 1-800-832-2839, Monday through Friday, 8 AM to 5 PM Eastern Time or via the e-mail
address above.
Thank you in advance for your time and cooperation, and for helping the U.S. Census Bureau
measure America’s people, places, and our economy. Your response makes a difference.

Sincerely,

OMB Number
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit
OMB approval number is 0607-0585 and appears at the upper right of the login screen. Without
this approval, we could not conduct this survey.
Authority and Confidentiality
Title 13 United States Code, Sections 161 and 182, authorizes the Census Bureau to conduct this
collection and request your voluntary assistance. These data are subject to provisions of Title 13
United States Code, Section 9(b), exempting data that are customarily provided in public records
from rules of confidentiality.
Burden Estimate Statement
We estimate this survey will take an average of 1.5 to 6 hours to complete, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining 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:
ITMD Survey Comments 0607-0585
U.S. Census Bureau
4600 Silver Hill Road
Room ITMD-5K158
Washington, DC 20233
You may email comments to [email protected]. Be sure to use “ITMD Survey Comments
0607-0585” as the subject.

Subject: PAST DUE NOTICE: 2017 Census of Governments, Survey of Local Government Finances

Dear NAME:
PAST DUE NOTICE

Recently, you should have received an email following up with you about the 2017 Census of
Governments, Survey of Local Government Finances.
As in previous survey years, we would like to obtain copies of the reports specified below. The
data we are requesting is for your government’s fiscal year that ended December 30, 2016.
•
•
•

Name of report requested 1 (Look up in spreadsheet)
Name of report requested 2 (Look up in spreadsheet)
Name of report requested 3 (Look up in spreadsheet)

If you recently submitted your response, please accept our sincere thanks.
Please send the reports via e-mail to [email protected]. If the requested reports are
not available electronically, or if you need further assistance, please call our customer help line
at 1-800-832-2839, Monday through Friday, 8 AM to 5 PM Eastern Time or via the e-mail
address above.
Thank you in advance for your time and cooperation, and for helping the U.S. Census Bureau
measure America’s people, places, and our economy. Your response makes a difference.

Sincerely,

2/3/17

Dear Public Official:
I am writing to request information for our Annual Survey of State Government Finances. This annual
survey enables the Census Bureau to develop statistical estimates of government revenue, expenditure,
debt, and assets. We publish these estimates in summarized format, by Census Bureau category, for all
states. The statistics are used by the Bureau of Economic Analysis in that agency’s mission to develop
the National Income and Product Accounts – Gross Domestic Product (GDP), national income, and the
like. The statistics also are used by other Federal agencies, states and policy makers to develop a variety
of important economic measures. The voluntary survey is authorized by Title 13, United States Code,
Section 161 and 182. Due to its public nature, information provided from this request are exempt from
confidential treatment as cited in Title 13, United States Code, Section 9. On the back of this letter, you
will find disclosure descriptions regarding Office of Management and Budget number, authority and
confidentiality, and burden estimate statement.
As in previous years, we would like to obtain copies of the report(s) specified below. The data
requested are for your government’s fiscal year that ended June 30, 2016:
Annual Report and Financial Statements
Please verify, correct, or add to the following information:
1.
2.
3.
4.

Mailing address:
Telephone Number:
Fax Number:
E-mail address:

Official mailing labels are enclosed for your convenience in sending the materials to us. If you have any
questions about this request, the survey, or the transmission of the files, please contact me at 1-866820-7210, or via e-mail at: [email protected].
We request a variety of reports for this annual survey. Some are specialized, while others are standard
(such as annual financial reports). If any of the standard reports we request from your agency are
available from an internet site, you may direct us to the web pages in lieu of providing a hard copy. For
any reports so available, we shall eliminate this request for future surveys.
We appreciate your continued cooperation in this important annual survey.
Sincerely,
Melissa L. Therrien
Assistant Division Chief for Public Sector
International Trade Management Division
Enclosures
CC

OMB Number
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit
OMB approval number is 0607-0585 and appears at the upper right of the login screen. Without
this approval, we could not conduct this survey.
Authority and Confidentiality
Title 13 United States Code, Sections 161 and 182, authorizes the Census Bureau to conduct this
collection and request your voluntary assistance. These data are subject to provisions of Title 13
United States Code, Section 9(b), exempting data that are customarily provided in public records
from rules of confidentiality.
Burden Estimate Statement
We estimate this survey will take an average of 1 hour to complete, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining 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:
ITMD Survey Comments 0607-0585
U.S. Census Bureau
4600 Silver Hill Road
Room ITMD-5K158
Washington, DC 20233
You may email comments to [email protected]. Be sure to use ‘‘ITMD Survey Comments
0607-0585’’ as the subject.