Self Response -Internet/Telephone/Paper

Draft 7 (5-5-2017)

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

Important Note:
You are receiving this
notice because we did not
receive your response by
April 2, 2018.

April 9, 2018
Dear Resident:

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A few weeks ago, the U.S. Census Bureau sent instructions for completing the 2018 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:

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• 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 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.

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Your answers are completely confidential.
By law, the Census Bureau is required to protect your information. 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
Enclosures

census.gov
DH-17(L1) (5-2017)

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 2018 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 law to protect your information. The Census Bureau is not
permitted to publicly release your responses in a way that could identify you or your household. Per the
Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data.

Am I required to fill out this survey?

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For more information about how we protect your information, please visit our website at census.gov and
click on “Data Protection and Privacy Policy” at the bottom of the home page.

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Yes. We are conducting this survey under the authority of Title 13, U.S. Code, Sections 141 and 193.
This collection of information has been approved by the Office of Management and Budget (OMB). You
are not required to respond to this survey if it does not display a valid approval number. The eight-digit
OMB number is xxxx-xxxx.
This collection of information has been approved by the Office of Management and Budget (OMB). 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.
What is the 2018 Census Test?

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The Census Bureau is researching modern and cost-efficient methods for the population to exercise its
civic obligation to be counted in the 2020 Census. By completing this survey, you help prepare for a
more accurate count of all populations in the 2020 Census.
How will the Census Bureau use the information I provide?
By law, the Census Bureau can only use your responses to produce statistics.
How long will this survey take?
The Census Bureau estimates that completing the questionnaire will take 10 minutes on average.
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 email comments to <[email protected]>; use "Paperwork
Reduction Project xxxx-xxxx" as the subject.

DH-17(L1) (5-2017)