BASSC-4L Discrepancy Form- Boundary Changes Marked For Removal

FORM

BASSC-4L (06-2021)

OMB Control No.: 0607-0151 Expiration Date: 11/30/2023

BOUNDARY AND ANNEXATION SURVEY (BAS) STATE CERTIFICATION DISCREPANCY FORM
BOUNDARY CHANGES MARKED FOR REMOVAL FROM CENSUS BUREAU RECORDS
BAS ID: ,

Activation Type

Authorization Type

Local Authorization Number

Local Effective Date

Estimated Acres

We estimate that participating in the Boundary and Annexation Survey State Certification Program will take 7.5
hours on average. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, using Paperwork Reduction Project 0607-0151 as the
subject, to . 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 conduct this survey. The Census Bureau conducts this program under
the legal authority of the Title 13 United States Code, Section 6.