Att H - CPS-580(ASEC)(L), ASEC Respondent Letter

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

A Message from the Director, U.S. Census Bureau...
Thank you for your past cooperation in the U.S. Census Bureau’s Current Population Survey (CPS).
Your participation in this study continues to play a major role in the development of the employment
and unemployment data, which are so important to understanding our Nation’s economic situation.
One of our field representatives or telephone center interviewers will call on your household soon to
update the regular labor force information. He or she also will ask questions about other subjects that
will provide government and private organizations the information needed to understand the economic
situation of our population. These questions will concern work experience, income from various
sources, and health insurance coverage during the year 2024. Personally identifiable information
collected includes name, address, telephone/cell phone number, and date of birth or age. The average
time for each interview is 25 minutes, in addition to the time needed for the regular labor force
information. To explain the need for this information and how these data are used, we have enclosed a
fact sheet about this survey that may answer some of the questions you might have.
We are conducting this survey under the authority of Title 13, United States Code
Sections 141 and
182, and Title 29 U.S.C. Sections 1m9. The Office of Management and Budget control number for the
CPS is 0607-0354, and the expiration date is December 31, 2024. Without this number, we would not
be able to conduct this survey.
Some income sources, and medical out-of-pocket expenditures, that the field representative will be
asking about appear on the back of this letter. Space is provided for you to enter the income amounts
received, and medical expenditures paid, by members of your household who are 15 years old or over.
Although the income sources mentioned are not all-inclusive and some may not have been received by
anyone in your household, we request that you look up the 2023 income records for yourself and the
rest of your household before the representative calls on you. This will ensure the accuracy of the
statistics collected and will also serve to minimize the time required for the interview.
Information provided to us may only be shared with other Census Bureau staff for work-related
purposes as identified in the Privacy Act System of Records Notice COMMERCE/CensusCOMMERCE/Census-3, Demographic Survey Collection (Census Bureau Sampling Frame).
Census Bureau staff have received training on privacy and confidentiality policies and practices.
Access to PII/BII is restricted to authorized personnel only. Access to PII/BII is being monitored,
tracked, or recorded on Census Bureau IT systems.
Furnishing this information is voluntary. There are no consequences for not providing the requested
information. However, your cooperation in obtaining this much needed information is extremely
important to ensure complete and accurate results.
If you have any questions, please visit census.gov/cps, or call your Census Bureau Regional Office at
1–800–424–6974, #53939.
Send comments regarding the time estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, by email to: [email protected]; use "Demo Survey
Comments 0607-0354" as the subject.
Thank you for your continued cooperation.
Enclosure

CPS-580(ASEC)(L)ATLANTA
(10-2023)

census.gov

HOLD FOR REFERENCE
A Census Bureau field representative or telephone center interviewer will be calling on your household soon to ask about income
received for everyone over 15 years of age and medical expenditures paid for all household members. Consult your records and
enter the amounts received or spent during 2024, as applicable, in the columns provided for each person in your household. Then,
refer to this form when the field representative calls on you. It is important to note that this is not comprehensive but just a tool to
aid with the interview. This form should not be delivered or mailed in lieu of an actual interview.

Income (All Persons 15+)
Wages or salary before taxes
and deductions
Income from his/her own nonfarm
business, partnership, or
professional practice after expenses
Income from his/her own farm after
expenses
Social Security or Supplemental
Security Income (SSI)
Unemployment Compensation
Interest on savings, CD’s, bonds,
retirement accounts, and so on
Dividends on stocks, mutual funds,
and so on
Pensions and Company retirement
Withdrawals from retirement
accounts (401K, IRA, KEOGH,
SEP, and so on)
Public assistance or welfare
Rental properties, estates, or trusts
Medical Expenditures (All Persons)
Out-of-pocket premiums paid for all
health insurance policies except
Medicare deductions from Social
Security benefits; assign premium
payments to policyholder.

Medical care and equipment
expenses, not reimbursed; e.g.,
copayments for Dr. visits, prescription
medication, hearing/vision aids, etc.
Over-the-counter expenses on
health-related products, not
reimbursed (e.g., aspirin, cold
remedies, etc.)

FORM CPS-580(ASEC)(L) (10-2023)

$

Name

Name

Name

Name

Amount

Amount

Amount

Amount

$

$

$