Form Attachment V Attachment V Screening Questionnaire

United States Department of Labor Bureau of Labor Statistics Housing Survey

July 22, 2020

We plan to place a label with the address here.

We are conducting a brief survey about housing in your area.

The Bureau of Labor Statistics needs your help. We are collecting a few facts to help us identify homes in your area as owner or renter occupied. We are specifically interested in collecting data for your residence. Please complete the question below. This survey should take less than two minutes of your time.

1. This house/apartment is occupied by the: (Please check all boxes that apply)

 Owner  Renter  Relative of the Landlord

 None of the above → Some arrangement exists other than owning or renting.

Please describe here:

Why are we collecting this information?

We conduct this survey to help us better identify rented and owned housing across the country as the first step in the Consumer Price Index (CPI) Housing Survey. In a later step, we collect information about the costs of housing. This information plays a critical role in helping us update the CPI. The CPI is the most widely used measure of inflation, and has many uses, including:

• The cost of living adjustments for over 50 million Social Security beneficiaries.

• The cost of lunches for millions of school children.

• Federal income tax brackets, so you don’t pay higher taxes because of inflation.

• Payments in collective bargaining agreements.

To learn more, please visit our website: www.bls.gov/cpi/.

Your answers will be kept confidential.

Maintaining your confidentiality is our primary concern. Information about you is not disclosed to anyone and is used for statistical purposes only. The Bureau of Labor Statistics holds the information in confidence to the full extent permitted by law. Our representatives carry official government IDs and their email addresses always end with @bls.gov which is the exclusive domain of the Bureau of Labor Statistics, US Department of Labor.

Although your participation is voluntary, this information is very important and will lead to a more accurate CPI that directly benefits you and all of us. For more information about the legal requirement for us to keep your information confidential, please visit our website: https://www.bls.gov/bls/confidentiality.htm

Completing this form by mail saves money. It reduces the amount of information we need to collect in person or over the phone. If you have any questions about the survey, please call 404-555-1213, or send email to [email protected], and reference the “BLS Housing Survey.”

Thank you for your help!

Please fold this page and return it in the enclosed stamped envelope.

Confidentiality Pledge

*The Bureau of Labor Statistics, its employees, agents and partner statistical agencies will use the information you provide for statistical purposes only, and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3572) and other applicable Federal Laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.

Paperwork Reduction Act Notice

The time needed to complete this survey is estimated to be less than 2 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making the survey simpler, you can write to: Office of Prices and Living Conditions, 2 Massachusetts Ave., NE, Rm. 3655, Washington, DC 20212. The OMB control number for this voluntary survey is 1220-0163. Without a currently valid number BLS would not be able to conduct this survey.