NCS_2017AdaptiveStrategyTest_AttachmentB_AdaptiveStrategyMailMaterials

Attachment B
Treatment 02. Adaptive Strategy
I.
II.
III.
IV.
V.

Mailing 1: Prenotice
Mailing 2: Questionnaire Package
Mailing 3: First Reminder
Mailing 4: Replacement Package
Mailing 5: Final Reminder

Pieces in Mailing 1: Prenotice
Envelope:

ACS-40

Letter:

ACS-12(LX)AS(2017)(3-2017)

Multilingual Brochure:

ACS-9 (2014)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
ACS-40(2012) (6-2011)

AN EQUAL OPPORTUNITY EMPLOYER

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-12(LX)AS(2017)
(3-2017)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau...
In a few days your household will receive instructions in the mail on how to complete a very
important national survey, the American Community Survey. Please follow the instructions to
complete the survey promptly. The U.S. Census Bureau is conducting this survey and chose
your address, not you personally, as part of a randomly selected sample.
The American Community Survey collects information about various topics like education,
housing, and jobs. Information from this survey is used by federal, state, local, and tribal
governments to meet the needs of communities across America. For example, community
leaders use this information to decide where schools, highways, hospitals, and other services
are needed. The survey also is used to develop programs to reduce traffic congestion, provide
job training, and plan for the health care needs of the elderly.
If you have access to the Internet and want to learn more about the American Community
Survey, please visit the Census Bureau’s Web site: www.census.gov/acs.
Thank you in advance for your help.
Sincerely,

John H. Thompson
Director
Enclosures

census.gov

Important
Information From the
U.S. Census Bureau

La Oficina del Censo de los Estados
Unidos está realizando la Encuesta
sobre la Comunidad Estadounidense
En unos días, recibirá por correo un
cuestionario de la Encuesta sobre la
Comunidad Estadounidense. Como usted
esta viviendo en los Estados Unidos, la ley
exige que usted responda a esta encuesta.
Si tiene preguntas sobre el cuestionario,
llámenos al 1-877-833-5625 para hablar
con uno de nuestros empleados que habla
español. La llamada es gratis. El empleado
podrá contestar sus preguntas o usted
podrá completar la encuesta por teléfono.

Así es. Toda información que la Oficina
del Censo de los Estados Unidos
obtenga durante esta encuesta sobre
usted y su vivienda es confidencial
según la ley (Título 13, Código de los
Estados Unidos).
U.S. Department of Commerce
Economics and Statistics Administration

Issued August 2013
ACS-9 (2014)

U.S. CENSUS BUREAU

census.gov

ACS-9_4panel_August2013(2014)_REPRINT_VP.indd 1

8/1/2013 12:27:35 PM

ACS-9_4panel_August2013(2014)_REPRINT_VP.indd 2

8/1/2013 12:27:37 PM

Attachment B
Treatment 02. Adaptive Strategy
I.
II.
III.
IV.
V.

Mailing 1: Prenotice
Mailing 2: Questionnaire Package
Mailing 3: First Reminder
Mailing 4: Replacement Package
Mailing 5: Final Reminder

Pieces in Mailing 2: Questionnaire Package
Envelope:

ACS-46 (2012)(5-2011)

Instruction Card:

ACS-34RM (11/15/2016)

Letter:

ACS-13 (LX)(2017)(3-2017)

Survey Form:

ACS-1 (2017) - First two pages

FAQ:

ACS-10SM(2016)

Return Envelope

6385-47 (2014)(10-2013)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
ACS-46(2012) (5-2011)

The American Community Survey
Form Enclosed

YOUR RESPONSE IS
REQUIRED BY LAW

AN EQUAL OPPORTUNITY EMPLOYER

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

American Community Survey
U.S. Department of Commerce | Economics and Statistics Administration

Two Ways to Complete the American Community Survey:
Option 1 – Go to https://respond.census.gov/acs to complete the survey online.
IMPORTANT: You will need information from the address label on the enclosed

questionnaire to log in.
Option 2 – Fill out the enclosed questionnaire and mail it back in the postage-paid envelope.

Please choose ONLY one way to respond. If you need help or have questions about the
American Community Survey, call the toll-free number 1–800–354–7271.
Vea el otro lado para español.
ACS-34RM (11/15/2016)

ACS-34 RM (11_15_2016)_11_2016.indd 2

11/16/2016 2:48:06 PM

American Community Survey
U.S. Department of Commerce | Economics and Statistics Administration

Hay dos maneras para completar la Encuesta sobre la Comunidad
Estadounidense:
Opción 1 – Vaya a https://respond.census.gov/acs para completar la encuesta por

Internet en español. ATENCIÓN: Necesitará información que aparece en la etiqueta

del cuestionario adjunto para iniciar la sesión.

Opción 2 – Llene y devuelva por correo el cuestionario adjunto en el sobre de envío incluido.
Por favor, escoja SOLAMENTE una manera de responder. Si usted necesita ayuda para llenar la
encuesta o tiene preguntas acerca de la Encuesta sobre la Comunidad Estadounidense, llame sin
cargo al 1-877-833-5625.
See other side for English.
ACS-34RM (11/15/2016)

ACS-34 RM (11_15_2016)_11_2016.indd 1

11/16/2016 2:48:06 PM

ACS-13(LX)AS(2017)
(3-2017)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau...
Your household has been randomly selected to complete a very important national survey, the
American Community Survey. The U.S. Census Bureau conducts this survey to give our country
an up-to-date picture of how we live—our education, employment, housing, and more.
Please complete the survey as soon as possible using ONE of the following two options.
Option 1: Go to https://respond.census.gov/acs to complete the survey online. You
will need information from the address label on the enclosed questionnaire to log in.
Option 2: Fill out and mail back the enclosed questionnaire.
This survey collects critical information used to meet the needs of communities across the United
States. For example, results from this survey are used to decide where new schools, hospitals,
and fire stations are needed. This information also helps communities plan for the kinds of
emergency situations that might affect you and your neighbors, such as floods and other natural
disasters.
The Census Bureau chose your address, not you personally, as part of a randomly selected
sample. You are required by U.S. law to respond to this survey. The Census Bureau is required by
U.S. law to keep your answers confidential. The enclosed brochure answers frequently asked
questions about the survey.
If you need help completing the survey, please call our toll–free number (1–800–354–7271).
Thank you.
Sincerely,

John H. Thompson
Director
Enclosures

census.gov

13197017

DC

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

THE

American Community Survey

Start Here
Respond online today at:
https://respond.census.gov/acs
OR
Complete this form and mail it
back as soon as possible.

➜

Please print today’s date.
Month

➜

Day

Year

Please print the name and telephone number of the person who is
filling out this form. We will only contact you if needed for official
Census Bureau business.
Last Name

This form asks for information about the
people who are living or staying at the
address on the mailing label and about the
house, apartment, or mobile home located
at the address on the mailing label.

First Name

MI

Area Code + Number

If you need help or have questions
about completing this form, please call
1-800-354-7271. The telephone call is free.
Telephone Device for the Deaf (TDD):
Call 1–800–582–8330. The telephone call is free.

—

➜

How many people are living or staying at this address?
• INCLUDE everyone who is living or staying here for more than 2 months.
• INCLUDE yourself if you are living here for more than 2 months.
• INCLUDE anyone else staying here who does not have another place to
stay, even if they are here for 2 months or less.
• DO NOT INCLUDE anyone who is living somewhere else for more than
2 months, such as a college student living away or someone in the
Armed Forces on deployment.
Number of people

➜

Fill out pages 2, 3, and 4 for everyone, including yourself, who is
living or staying at this address for more than 2 months. Then
complete the rest of the form.

¿NECESITA AYUDA? Si usted habla español y
necesita ayuda para completar su cuestionario,
llame sin cargo alguno al 1-877-833-5625.
Usted también puede completar su entrevista
por teléfono con un entrevistador que habla
español. O puede responder por Internet en:
https://respond.census.gov/acs
For more information about the American
Community Survey, visit our web site at:
http://www.census.gov/acs

ACS-1(2017)

FORM
(03-14-2016)

§.4g2¤
ACS-1(2017), Page 1, Base (Black)

ACS-1(2017), Page 1, Green Pantone 354 (18, 100%)

OMB No. 0607-0810
OMB No. 0607-0936

13197025

Person 1

Person 2
1 What is Person 2’s name?

(Person 1 is the person living or staying here in whose name this house
or apartment is owned, being bought, or rented. If there is no such
person, start with the name of any adult living or staying here.)

Last Name (Please print)

First Name

MI

2 How is this person related to Person 1? Mark (X) ONE box.

1

What is Person 1’s name?
Last Name (Please print)

2

First Name

MI

How is this person related to Person 1?
X

3

Person 1

4

Female

Month

Day

Housemate or roommate

Brother or sister

Unmarried partner

Father or mother

Foster child

Grandchild

Other nonrelative

Female

Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

Year of birth

Age (in years)

Month

Day

Year of birth

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Question 6 about race. For this survey, Hispanic origins are not races.

5 Is Person 2 of Hispanic, Latino, or Spanish origin?

Is Person 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

No, not of Hispanic, Latino, or Spanish origin

Yes, Mexican, Mexican Am., Chicano

Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Puerto Rican

Yes, Cuban

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on. C

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on. C

6 What is Person 2’s race? Mark (X) one or more boxes.

What is Person 1’s race? Mark (X) one or more boxes.
White

White

Black or African Am.

Black or African Am.

American Indian or Alaska Native — Print name of enrolled or principal tribe. C

American Indian or Alaska Native — Print name of enrolled or principal tribe. C

Asian Indian

Japanese

Native Hawaiian

Asian Indian

Japanese

Native Hawaiian

Chinese

Korean

Guamanian or Chamorro

Chinese

Korean

Guamanian or Chamorro

Filipino

Vietnamese

Samoan

Filipino

Vietnamese

Samoan

Other Pacific Islander –
Print race, for example,
Fijian, Tongan, and
so on. C

Other Asian – Print race,
for example, Hmong,
Laotian, Thai, Pakistani,
Cambodian, and so on. C

Other Asian – Print race,
for example, Hmong,
Laotian, Thai, Pakistani,
Cambodian, and so on. C

Some other race – Print race. C

2

Roomer or boarder

Stepson or stepdaughter

4 What is Person 2’s age and what is Person 2’s date of birth?

Question 6 about race. For this survey, Hispanic origins are not races.

6

Adopted son or daughter

Male

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and
5

Other relative

3 What is Person 2’s sex? Mark (X) ONE box.

What is Person 1’s age and what is Person 1’s date of birth?
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.
Age (in years)

Son-in-law or daughter-in-law

Biological son or daughter

Parent-in-law

What is Person 1’s sex? Mark (X) ONE box.
Male

Husband or wife

Some other race – Print race. C

§.4g:¤
ACS-1(2017), Page 2, Base (Black)

ACS-1(2017), Page 2, Green Pantone 354 (18, 100%)

Other Pacific Islander –
Print race, for example,
Fijian, Tongan, and
so on. C

ACS-10SM(2016)(January 2015).pdf 1 8/14/2015 2:57:03 PM

Frequently Asked
Questions

census.gov/acs
1-800-354-7271

AMERICAN
COMMUNITY
SURVEY

C

M

Y

CM

MY

CY

CMY

K

American
Community
Survey
Si necesita ayuda para completar su cuestionario,
llame sin cargo alguno al: 1-877-833-5625.

Issued January 2015
ACS-10SM(2016)

U.S. Department of Commerce
Economics and Statistics Administration
U.S. CENSUS BUREAU

census.gov

ACS-10SM(2016)(January 2015).pdf 2 8/14/2015 2:57:04 PM

Frequently Asked Questions
What is the American Community Survey?
The American Community Survey collects information
about population and housing characteristics for the
nation, states, cities, counties, metropolitan areas, and
communities on a continuous basis. Based on the
American Community Survey, the Census Bureau can
provide up-to-date data about our rapidly changing
country more often than once every 10 years when the
census is conducted.

C

M

How do I benefit by answering the
American Community Survey?

Y

CM

MY

CY

CMY

K

Communities need data about the well-being of children,
families, and the older population to provide services to
them. By responding to the American Community Survey
questionnaire, you are helping your community to
establish goals, identify problems and solutions, and
measure the performance of programs.
The data are also used to decide where to locate new
highways, schools, hospitals, and community centers; to
show a large corporation that a town has the workforce
the company needs; and in many other ways.

Do I have to answer the questions on the
American Community Survey?
Yes. Your response to this survey is required by law
(Title 13, U.S. Code, Sections 141,193, and 221). Title 13,
as changed by Title 18, imposes a penalty for not
responding. We estimate this survey will take about 40
minutes to complete.

How will the Census Bureau use the
information that I provide?
The Census Bureau can use the information you provide
for statistical purposes only and cannot publish or release
information that would identify you and your household.
Your information will be used in combination with
information from other households to produce data for
your community. Similar data will be produced for
communities across the United States.
We may combine your answers with information that
you gave to other agencies to enhance the statistical
uses of these data. This information will be given the
same protections as your survey information. Based on
the information that you provide, you may be asked to
participate in other Census Bureau surveys that are
voluntary.

Will the Census Bureau keep my
information confidential?
Yes. All of the information the Census Bureau collects
for this survey about you and your household is
confidential by law (Title 13, U.S. Code, Section 9). By
law, every Census Bureau employee—including the
Director as well as every field representative—has taken
an oath and is subject to a jail term, a fine, or both if he
or she discloses ANY information that could identify you
or your household.

Where can I find more information about
the American Community Survey or get
assistance?
You may visit our Web site census.gov/acs
or call 1-800-354-7271 if you need assistance or more
information.

C

AN EQUAL OPPORTUNITY EMPLOYER

OFFICIAL BUSINESS
Penalty for Private Use $300

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

6385-47(2014) (10-2013)

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 16081

WASHINGTON DC

POSTAGE WILL BE PAID BY THE U.S. CENSUS BUREAU

DIRECTOR
US CENSUS BUREAU
PO BOX 5240
JEFFERSONVILLE IN 47199-5240

FFATTFADDDTAADTFADDFAFTDFFAADFFFAFDTFDTAFATFDFATADTTFDFDTFFFFATTF

Attachment B
Treatment 02. Adaptive Strategy
I.
II.
III.
IV.
V.

Mailing 1: Prenotice
Mailing 2: Questionnaire Package
Mailing 3: First Reminder
Mailing 4: Replacement Package
Mailing 5: Final Reminder

Pieces in Mailing 3: First Reminder
Postcard:

ACS-20 (X)AS(2017) (3-2017)

U.S. DEPARTMENT OF COMMERCE
Economic and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. DEPARTMENT OF COMMERCE
Economic and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

ACS-20(X)AS(2017) (3-2017)

ACS-20(X)AS(2017) (3-2017)

U.S. DEPARTMENT OF COMMERCE
Economic and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. DEPARTMENT OF COMMERCE
Economic and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

ACS-20(X)AS(2017) (3-2017)

ACS-20(X)AS(2017) (3-2017)

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-20(X)AS(2017) (3-2017)

DC

UNITED STATES DEPARTMENT OF COMMERCE

ACS-20(X)AS(2017) (3-2017)

Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau...

A message from the Director, U.S. Census Bureau...

A few days ago, you should have received a request to complete the American Community
Survey. If you have already responded, thank you. If you have not, please complete the
survey online at https://respond.census.gov/acs or mail the questionnaire back soon.

A few days ago, you should have received a request to complete the American Community
Survey. If you have already responded, thank you. If you have not, please complete the
survey online at https://respond.census.gov/acs or mail the questionnaire back soon.

Local and national leaders use the information from this survey for planning schools,
hospitals, roads, and other community needs.

Local and national leaders use the information from this survey for planning schools,
hospitals, roads, and other community needs.

If you need help completing the survey or have questions, please call our toll-free number
(1–800–354–7271).

If you need help completing the survey or have questions, please call our toll-free number
(1–800–354–7271).

Thank you.

Thank you.

John H. Thompson

John H. Thompson

ACS-20(X)AS(2017) (3-2017)

DC

UNITED STATES DEPARTMENT OF COMMERCE

ACS-20(X)AS(2017) (3-2017)

Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau...

A message from the Director, U.S. Census Bureau...

A few days ago, you should have received a request to complete the American Community
Survey. If you have already responded, thank you. If you have not, please complete the
survey online at https://respond.census.gov/acs or mail the questionnaire back soon.

A few days ago, you should have received a request to complete the American Community
Survey. If you have already responded, thank you. If you have not, please complete the
survey online at https://respond.census.gov/acs or mail the questionnaire back soon.

Local and national leaders use the information from this survey for planning schools,
hospitals, roads, and other community needs.

Local and national leaders use the information from this survey for planning schools,
hospitals, roads, and other community needs.

If you need help completing the survey or have questions, please call our toll-free number
(1–800–354–7271).

If you need help completing the survey or have questions, please call our toll-free number
(1–800–354–7271).

Thank you.

Thank you.

John H. Thompson

John H. Thompson

Attachment B
Treatment 02. Adaptive Strategy
I.
II.
III.
IV.
V.

Mailing 1: Prenotice
Mailing 2: Questionnaire Package
Mailing 3: First Reminder
Mailing 4: Replacement Package
Mailing 5: Final Reminder

Pieces in Mailing 4: Replacement Package
Envelope:

ACS-46 (2012)(5-2011)

Instruction Card:

ACS-34RM (11/15/2016)

Letter:

ACS-13 (LX)(2017)(3-2017)

Survey Form:

ACS-1 (2017) - First two pages

FAQ:

ACS-10SM(2016)

Return Envelope

6385-47 (2014)(10-2013)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
ACS-46(2012) (5-2011)

The American Community Survey
Form Enclosed

YOUR RESPONSE IS
REQUIRED BY LAW

AN EQUAL OPPORTUNITY EMPLOYER

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

American Community Survey
U.S. Department of Commerce | Economics and Statistics Administration

Two Ways to Complete the American Community Survey:
Option 1 – Go to https://respond.census.gov/acs to complete the survey online.
IMPORTANT: You will need information from the address label on the enclosed

questionnaire to log in.
Option 2 – Fill out the enclosed questionnaire and mail it back in the postage-paid envelope.

Please choose ONLY one way to respond. If you need help or have questions about the
American Community Survey, call the toll-free number 1–800–354–7271.
Vea el otro lado para español.
ACS-34RM (11/15/2016)

ACS-34 RM (11_15_2016)_11_2016.indd 2

11/16/2016 2:48:06 PM

American Community Survey
U.S. Department of Commerce | Economics and Statistics Administration

Hay dos maneras para completar la Encuesta sobre la Comunidad
Estadounidense:
Opción 1 – Vaya a https://respond.census.gov/acs para completar la encuesta por

Internet en español. ATENCIÓN: Necesitará información que aparece en la etiqueta

del cuestionario adjunto para iniciar la sesión.

Opción 2 – Llene y devuelva por correo el cuestionario adjunto en el sobre de envío incluido.
Por favor, escoja SOLAMENTE una manera de responder. Si usted necesita ayuda para llenar la
encuesta o tiene preguntas acerca de la Encuesta sobre la Comunidad Estadounidense, llame sin
cargo al 1-877-833-5625.
See other side for English.
ACS-34RM (11/15/2016)

ACS-34 RM (11_15_2016)_11_2016.indd 1

11/16/2016 2:48:06 PM

ACS-14(LX)AS(2017)
(3-2017)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau...
About three weeks ago, the U.S. Census Bureau sent instructions for completing the American
Community Survey to your address. We asked you to help us with this very important survey by
completing it and mailing back the questionnaire or providing your information online. But we have
not received your response yet.
If you have already completed the survey, thank you very much. If you have not, please complete
the survey soon using ONE of the following two options.
Option 1: Go to https://respond.census.gov/acs to complete the survey online.
Option 2: Fill out and mail back the enclosed questionnaire.
This survey is so important that a Census Bureau representative may attempt to contact you by
telphone or personal visit if we do not receive your response.
The information collected in this survey will help decide where new schools, hospitals, and fire
stations are needed. The information also is used to develop programs to reduce traffic
congestion, provide job training, and plan for the health care needs of the elderly.
The Census Bureau chose your address, not you personally, as part of a randomly selected
sample. You are required by U.S. law to respond to this survey. The Census Bureau is required by
U.S. law to keep your answers confidential. The enclosed brochure answers frequently asked
questions about the survey.
If you need help completing the survey, please call our toll–free number (1–800–354–7271).
Thank you.
Sincerely,

John H. Thompson
Director
Enclosures

census.gov

13197017

DC

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

THE

American Community Survey

Start Here
Respond online today at:
https://respond.census.gov/acs
OR
Complete this form and mail it
back as soon as possible.

➜

Please print today’s date.
Month

➜

Day

Year

Please print the name and telephone number of the person who is
filling out this form. We will only contact you if needed for official
Census Bureau business.
Last Name

This form asks for information about the
people who are living or staying at the
address on the mailing label and about the
house, apartment, or mobile home located
at the address on the mailing label.

First Name

MI

Area Code + Number

If you need help or have questions
about completing this form, please call
1-800-354-7271. The telephone call is free.
Telephone Device for the Deaf (TDD):
Call 1–800–582–8330. The telephone call is free.

—

➜

How many people are living or staying at this address?
• INCLUDE everyone who is living or staying here for more than 2 months.
• INCLUDE yourself if you are living here for more than 2 months.
• INCLUDE anyone else staying here who does not have another place to
stay, even if they are here for 2 months or less.
• DO NOT INCLUDE anyone who is living somewhere else for more than
2 months, such as a college student living away or someone in the
Armed Forces on deployment.
Number of people

➜

Fill out pages 2, 3, and 4 for everyone, including yourself, who is
living or staying at this address for more than 2 months. Then
complete the rest of the form.

¿NECESITA AYUDA? Si usted habla español y
necesita ayuda para completar su cuestionario,
llame sin cargo alguno al 1-877-833-5625.
Usted también puede completar su entrevista
por teléfono con un entrevistador que habla
español. O puede responder por Internet en:
https://respond.census.gov/acs
For more information about the American
Community Survey, visit our web site at:
http://www.census.gov/acs

ACS-1(2017)

FORM
(03-14-2016)

§.4g2¤
ACS-1(2017), Page 1, Base (Black)

ACS-1(2017), Page 1, Green Pantone 354 (18, 100%)

OMB No. 0607-0810
OMB No. 0607-0936

13197025

Person 1

Person 2
1 What is Person 2’s name?

(Person 1 is the person living or staying here in whose name this house
or apartment is owned, being bought, or rented. If there is no such
person, start with the name of any adult living or staying here.)

Last Name (Please print)

First Name

MI

2 How is this person related to Person 1? Mark (X) ONE box.

1

What is Person 1’s name?
Last Name (Please print)

2

First Name

MI

How is this person related to Person 1?
X

3

Person 1

4

Female

Month

Day

Housemate or roommate

Brother or sister

Unmarried partner

Father or mother

Foster child

Grandchild

Other nonrelative

Female

Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

Year of birth

Age (in years)

Month

Day

Year of birth

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Question 6 about race. For this survey, Hispanic origins are not races.

5 Is Person 2 of Hispanic, Latino, or Spanish origin?

Is Person 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

No, not of Hispanic, Latino, or Spanish origin

Yes, Mexican, Mexican Am., Chicano

Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Puerto Rican

Yes, Cuban

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on. C

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on. C

6 What is Person 2’s race? Mark (X) one or more boxes.

What is Person 1’s race? Mark (X) one or more boxes.
White

White

Black or African Am.

Black or African Am.

American Indian or Alaska Native — Print name of enrolled or principal tribe. C

American Indian or Alaska Native — Print name of enrolled or principal tribe. C

Asian Indian

Japanese

Native Hawaiian

Asian Indian

Japanese

Native Hawaiian

Chinese

Korean

Guamanian or Chamorro

Chinese

Korean

Guamanian or Chamorro

Filipino

Vietnamese

Samoan

Filipino

Vietnamese

Samoan

Other Pacific Islander –
Print race, for example,
Fijian, Tongan, and
so on. C

Other Asian – Print race,
for example, Hmong,
Laotian, Thai, Pakistani,
Cambodian, and so on. C

Other Asian – Print race,
for example, Hmong,
Laotian, Thai, Pakistani,
Cambodian, and so on. C

Some other race – Print race. C

2

Roomer or boarder

Stepson or stepdaughter

4 What is Person 2’s age and what is Person 2’s date of birth?

Question 6 about race. For this survey, Hispanic origins are not races.

6

Adopted son or daughter

Male

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and
5

Other relative

3 What is Person 2’s sex? Mark (X) ONE box.

What is Person 1’s age and what is Person 1’s date of birth?
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.
Age (in years)

Son-in-law or daughter-in-law

Biological son or daughter

Parent-in-law

What is Person 1’s sex? Mark (X) ONE box.
Male

Husband or wife

Some other race – Print race. C

§.4g:¤
ACS-1(2017), Page 2, Base (Black)

ACS-1(2017), Page 2, Green Pantone 354 (18, 100%)

Other Pacific Islander –
Print race, for example,
Fijian, Tongan, and
so on. C

ACS-10SM(2016)(January 2015).pdf 1 8/14/2015 2:57:03 PM

Frequently Asked
Questions

census.gov/acs
1-800-354-7271

AMERICAN
COMMUNITY
SURVEY

C

M

Y

CM

MY

CY

CMY

K

American
Community
Survey
Si necesita ayuda para completar su cuestionario,
llame sin cargo alguno al: 1-877-833-5625.

Issued January 2015
ACS-10SM(2016)

U.S. Department of Commerce
Economics and Statistics Administration
U.S. CENSUS BUREAU

census.gov

ACS-10SM(2016)(January 2015).pdf 2 8/14/2015 2:57:04 PM

Frequently Asked Questions
What is the American Community Survey?
The American Community Survey collects information
about population and housing characteristics for the
nation, states, cities, counties, metropolitan areas, and
communities on a continuous basis. Based on the
American Community Survey, the Census Bureau can
provide up-to-date data about our rapidly changing
country more often than once every 10 years when the
census is conducted.

C

M

How do I benefit by answering the
American Community Survey?

Y

CM

MY

CY

CMY

K

Communities need data about the well-being of children,
families, and the older population to provide services to
them. By responding to the American Community Survey
questionnaire, you are helping your community to
establish goals, identify problems and solutions, and
measure the performance of programs.
The data are also used to decide where to locate new
highways, schools, hospitals, and community centers; to
show a large corporation that a town has the workforce
the company needs; and in many other ways.

Do I have to answer the questions on the
American Community Survey?
Yes. Your response to this survey is required by law
(Title 13, U.S. Code, Sections 141,193, and 221). Title 13,
as changed by Title 18, imposes a penalty for not
responding. We estimate this survey will take about 40
minutes to complete.

How will the Census Bureau use the
information that I provide?
The Census Bureau can use the information you provide
for statistical purposes only and cannot publish or release
information that would identify you and your household.
Your information will be used in combination with
information from other households to produce data for
your community. Similar data will be produced for
communities across the United States.
We may combine your answers with information that
you gave to other agencies to enhance the statistical
uses of these data. This information will be given the
same protections as your survey information. Based on
the information that you provide, you may be asked to
participate in other Census Bureau surveys that are
voluntary.

Will the Census Bureau keep my
information confidential?
Yes. All of the information the Census Bureau collects
for this survey about you and your household is
confidential by law (Title 13, U.S. Code, Section 9). By
law, every Census Bureau employee—including the
Director as well as every field representative—has taken
an oath and is subject to a jail term, a fine, or both if he
or she discloses ANY information that could identify you
or your household.

Where can I find more information about
the American Community Survey or get
assistance?
You may visit our Web site census.gov/acs
or call 1-800-354-7271 if you need assistance or more
information.

C

AN EQUAL OPPORTUNITY EMPLOYER

OFFICIAL BUSINESS
Penalty for Private Use $300

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

6385-47(2014) (10-2013)

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 16081

WASHINGTON DC

POSTAGE WILL BE PAID BY THE U.S. CENSUS BUREAU

DIRECTOR
US CENSUS BUREAU
PO BOX 5240
JEFFERSONVILLE IN 47199-5240

FFATTFADDDTAADTFADDFAFTDFFAADFFFAFDTFDTAFATFDFATADTTFDFDTFFFFATTF

Attachment B
Treatment 02. Adaptive Strategy
I.
II.
III.
IV.
V.

Mailing 1: Prenotice
Mailing 2: Questionnaire Package
Mailing 3: First Reminder
Mailing 4: Replacement Package
Mailing 5: Final Reminder

Pieces in Mailing 5: Final Reminder
Postcard:

ACS-23 (2015)(7-2015)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

OFFICIAL BUSINESS
Penalty for Private Use $300
ACS-23(2015) (7-2015)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
ACS-23(2015) (7-2015)

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

ACS-23(2015) (7-2015)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau . . .
Within the last few weeks, the U.S. Census Bureau mailed an American Community Survey
questionnaire package to your address. You are required by U.S. law to respond to
this survey. The Census Bureau is required by U.S. law to keep your answers confidential. If
you have already responded, thank you. If you have not, please complete the questionnaire and
send it now, or complete the survey online now at https://respond.census.gov/acs.
Your response is critically important to your local community and to your
country. If you do not respond, a Census Bureau interviewer may contact you by personal
visit to complete the survey.
If you would like to complete the survey by telephone or need assistance, please call our
toll-free number (1–800–354–7271).
Thank you.

John H. Thompson

ACS-23(2015) (7-2015)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A message from the Director, U.S. Census Bureau . . .
Within the last few weeks, the U.S. Census Bureau mailed an American Community Survey
questionnaire package to your address. You are required by U.S. law to respond to
this survey. The Census Bureau is required by U.S. law to keep your answers confidential. If
you have already responded, thank you. If you have not, please complete the questionnaire and
send it now, or complete the survey online now at https://respond.census.gov/acs.
Your response is critically important to your local community and to your
country. If you do not respond, a Census Bureau interviewer may contact you by personal
visit to complete the survey.
If you would like to complete the survey by telephone or need assistance, please call our
toll-free number (1–800–354–7271).
Thank you.

John H. Thompson