BAS-ARF BAS Annual Response Form

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

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2019
BOUNDARY AND ANNEXATION SURVEY
ANNUAL RESPONSE AND CONTACT UPDATE FORM

BAS-ARF

FORM
(2-21-2018)

OMB No. 0607-0151 Approval Expires: 03/31/2021

Please respond to the BAS using this form or online at https://www.census.gov/geo/partnerships/bas/bas_ar_form.html
For more information on the BAS, visit the BAS website at https://www.census.gov/programs-surveys/bas.html
Mark (X) one box.
Our government does not have boundary changes to report.

Our government HAS boundary changes to report OR I would like to use one of the following options to review and
update my government’s boundaries. Please mark one of the next three boxes.
We will download the Geographic Update Partnership Software (GUPS) OR we will download
shapefiles only.
Please send the Geographic Update Partnership Software (GUPS) and shapefiles on DVD.
Please send Paper Maps.
CONTACT INFORMATION: BAS materials will be mailed to the Highest Elected Official (HEO) or Tribal
Chair (TC) if there is no BAS contact information printed below. If you prefer to have your BAS materials shipped
directly to a person responsible for updating your boundaries, provide the contact information in the space
below. Please use black ink to correct any preprinted information.
Our records indicate the HEO/TC contact is:

Name of person filling out this form

To save nonresponse follow-up
costs, respond online, email,
mail, or fax the form to the
U.S. Census Bureau within 10
calendar days.

Our records indicate the BAS contact is:

Position

U.S. Census Bureau
National Processing Center
1201 East 10th Street, BLDG 63E
Jeffersonville, IN 47132-0001
Fax Number: 1–800–972–5652

Date

E-mail questions/comments to:
[email protected];
use "BAS-ARF" as the subject.
Phone: 1–800–972–5651

We estimate that completing this form will take 30 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. The Census
Bureau conducts this program under the legal authority of the Title 13 U.S. Code, Section 6.