Form F-500 2020 PSAP State Recognized Tribes Update Form

Form F-500 [State Recognized Tribes Update Form] (XX-XX-XXXX) OMB Control No. XXXX-XXXX

U.S. DEPARTMENT OF COMMERCE ECONOMICS AND STATISTICS ADMINSTRATION U.S. CENSUS BUREAU

2020 Census Participant Statistical Areas Program (PSAP)

State Recognized Tribes Update Form

Entity ID <Entity ID>		Government Name <Government Name>
Provide names of State Recognized Tribes that should be added to the enclosed U.S. Census Bureau (Census Bureau) list of State Recognized Tribes in Box 1.				Box 1
Provide names of State Recognized Tribes that should be removed from the enclosed Census Bureau list of State Recognized Tribes in Box 2.				Box 2
Provide name corrections to the enclosed Census Bureau list of State Recognized Tribes in Box 3.				Box 3
Are you interested in 2020 Census PSAP specific training provided by the Census Bureau?				☐Yes ☐No
Do you have high-speed internet access?				☐Yes ☐No
Person Completing This Form
Title	First Name & Middle Initial (MI)		Last Name & Name Suffix			Professional Suffix
Dept. Name				Position
Contact Information
Phone Number (xxx-xxx-xxxx)					Extension (xxxx)
Email Address ([email protected])					Date (DD/MM/YYYY)

Please see the back of this form for additional information.

We estimate that completing this form will take 10 minutes on average. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to [email protected]. This collection has been approved by the Office of Management and Budget (OMB). The eight digit OMB approval number that appears at the upper left of the form confirms this approval. If this number were not displayed, we could not conduct this survey.

Return this form by mail, using the enclosed postage-paid envelope, or scan and e-mail the form to [email protected], within two weeks of receipt. If you have questions, you may contact the Geographic Partnership Support Desk at 1-844-788-4921 from 8 a.m. to 8 p.m. EST Monday through Friday or send an e-mail to [email protected].