Form D-2001 Contact Information Update Form

2020 Census Local Update of Census Addresses Operation (LUCA)

D-2001 2020 LUCA Contact Information Update Form DRAFT_10_28_2016

2020 Census LUCA

OMB: 0607-0994

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Form D-2001

(XX-XX-XXXX)

OMB Control No. XXXX-XXXX

U.S. DEPARTMENT OF COMMERCE

ECONOMICS AND STATISTICS ADMINSTRATION

U.S. CENSUS BUREAU

CONTACT INFORMATION UPDATE FORM

2020 CENSUS LOCAL UPDATE OF CENSUS ADDRESSES OPERATION (LUCA)


ENITIY ID:

Government Name:


Contact ID:

The person listed in Section A is associated by the Census Bureau as an organizational or program contact for the government listed above, as indicated by the mark in box or boxes below:


 Highest Elected/Appointed Official Appointed Regional Agency Planner

 Tribal Chair 2010 LUCA Liaison

 Governor’s Liaison Geographic Support System Contact

 Census Contact Liaison Federal State Cooperative for Population Estimates Contact

 State Data Center Contact National States Geographic Information Council Contact

 GIS Contact Addressing Authority Contact

 Boundary and Annexation Survey Contact

Shape1

Please indicate the status of the information in Section A by checking the appropriate box:


 Section A is CORRECT. (Return the form, even if the information is correct.)

 Section A is INCORRECT. (Update Section B and return the form.)

  1. Contact Information

  1. New Contact and/or Updated Information (Please Print)

Title


Title – Mark (X) one

___ Mr. ___ Mrs. ___Miss ___ Ms. ___ Dr. ___ The Honorable

First Name

MI

First Name


MI


Last Name


Last Name


Name Suffix


Name Suffix – (Jr., Sr., II, III, etc.)

Department Name


Department Name – (e.g., Board of Commissioners, Planning and Development)


Position

Position – (e.g., Chairman, Supervisor, Mayor)


Term Expiration Date

Term

Term Expiration Date – (mm/dd/yyyy)


Term (e.g., 2 years,4 years)


Preferred Address


Preferred Address – (Number and street name or P.O. Box)


City

State


City

State


ZIP


ZIP+4


ZIP

ZIP+4


Alternate Address


Alternate Address – (Number and street name)


City

State

City

State


ZIP Code

ZIP+4


ZIP Code

ZIP+4


Phone

Ext


Phone

Ext


Alternate Phone


FAX


Alternate Phone (includes cell)


FAX


Email


Email


Name and Position of Person Completing This Form (Please print)

Name ________________________________________________________ Telephone Number ( )________________ Ext_________

Position________________________________________________________________________________________________________

Email Address _________________________________________________________________ Date _____________________________


Complete this form, return it using the enclosed postage-paid envelope, and address it to ATTN: Geography LUCA Materials 63-E, National Processing Center, 1201 East 10th St, Jeffersonville, IN 47132. Rather than mailing, you may scan your completed form and email it to [email protected].








File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorRebecca S Swartz
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File Created2021-01-21

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