6 Researcher Contact Update

OMB No. 0607-XXXX
Researcher Semi-Annual Contact Information and Travel History Update - Due February 15 & August 15
First:

Last:

1. Name (Legal):
Nickname/Alias

2. RDC:

3. Affiliation:

4. Home
Address:

Apt./
Suite/
Unit

Street
City

State

ZIP Code

5. Email Address:

6. Citizenship:

Visa card holder

Legal Permanent Resident

7. Change in citizenship since last update?

Yes

U.S. Citizen

No

If change in status, please provide updated documentation (e.g. green card, passport/naturalization documentation).

If you marked U.S. Citizen in Question 6, skip questions 8 and 9.

8. New/updated visa since last update?

Yes

No

If yes, provide copy of new/updated visa(s), letter of extension, or I-20.

9. Foreign Travel History for previous 12 months (month/day/year) (legal permanent residents & visa card holders):

10. Are you employed outside the United States (or on leave from overseas employer)?
Yes, if yes, please explain below

No

The information I have provided is accurate.
Type Initials here:

Date:

Phone Number:

We are conducting the Data Security Requirements for Accessing Confidential Data collection under the authority of Title 13, U.S. Code,
Section 23c. Providing the requested information is required to obtain Special Sworn Status (SSS). Personally identifiable information
collected includes name, telephone number, age/date of birth, race, sex, travel records, work email and citizenship, etc.]. Title 13 of the
U.S. Code protects the confidentiality of all your information. Violating the confidentiality of a respondent is a federal crime with serious
penalties, including a federal prison sentence of up to five years, a fine of up to $250,000, or both. Only authorized individuals have access

to the stored data, and the information you provide to the Census Bureau may only be used by a restricted number of authorized
individuals who are sworn for life to protect the confidentiality of your individual responses. For more information about how we protect
your information, please visit our Web site at census.gov and click on "Data Protection and Privacy Policy" at the bottom of the home page.
This page also includes information about the collection, storage, and source, etc., of these records. Click on "System of Records Notices
(SORN)" and look for Privacy Act System of Records Notice COMMERCE/DEPT-13, Investigative and Security Records.
This is a voluntary collection, however, failure to provide the information may delay or prevent the individual from receiving approval to
access data. This collection has been approved by the Office of Management and Budget (OMB) The eight-digit OMB approval number that
appears at the upper right of the form confirms this approval. If this number were not displayed, we could not collect this information. We
estimate that completing this form will take 15 minutes on average. You may email comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing the burden, to [email protected]. Use “Paperwork
Reduction Project 0607-XXXX” as the subject.