Decennial Census Temporary, Intermittent Applicant Information (Supervisory)

Decennial Census Temporary, Intermittent Applicant Information Collection

Attachment E - Self Response Interview Questionnaires

Decennial Census Temporary, Intermittent Applicant Information (Supervisory)

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Self-Response Interview
Questionnaires
Decennial Census Temporary, Intermittent Applicant Information
Collection
3/6/2025

This slide deck contains wireframe mock-ups of screens as they are being
programmed to appear in the Decennial Administrative, Recruiting, Hiring, and
Training System (DARHTS), to be used to recruit and hire temporary, intermittent
decennial census applicants.
The DARHTS will collect the information electronically. The DARHTS could have a
slightly different look and feel than the mock-ups. For example, the font used or
placement of text on the screen could change, or colors or other cosmetic changes
could be made. The questions could also be presented in a slightly different order
than they are presented here. However, the data collected will not change.

Universal Interview Questionnaire

If the applicant clicks on the “Privacy Act and Burden Statement, then the
statements on the following slide appear. If the applicant clicks “here” it will
link them to information about the job on www.census.gov/2026jobs.

OMB Number 0607-XX, Expires XX/XX/XXXX
Thank you for your interest in Census jobs. You are being considered for a/an [insert position name] position.
The following is an interview questionnaire, all your answers must be truthful and complete. A false statement on any part of this declaration may be grounds for not hiring you, or for firing you after
you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, Title 18, section 1001). Your responses to the questions for this position will remain in our system and will be
used for future considerations.
Privacy Act and Burden Statement
Click here to get details about the position.
Are you still available and interested in working for the Census?

o
o
o
o

Yes
No - I do not want ANY Census position, please remove my application from future consideration
No - I do not want this position at this time, but may be interested in the future
No - I do not want this position, but I may be interested in other positions

If the applicant responds “No – I do not want this position, but I may be interested in other
positions” he/she will not be able to continue with the questionnaire and will receive the
following message “Thank you for your interest in Census jobs. Since you are not
interested in this position, we will remove you from consideration only for this position.
Your application will remain on file for future Census opportunities.”

Privacy Act and Burden Statement
Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II, Section 23(a) and 23(c); Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III,
Chapter 33, Subchapter 1.
The purpose of collecting this information is primarily to determine your qualifications for employment and may also be used to identify you to other sources asked to comment on your
qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a court during legal proceedings.
Disclosure of the information provided to us may be shared with other Census Bureau staff for the work-related purposes identified in this statement as permitted under the Privacy Act of
1974 (5 U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice OPM/GOVT-5,
Recruiting, Examining, and Placement Records.
Furnishing this information is voluntary, but failure to provide any part or all of the data requested will result in you receiving no further consideration for employment.
Public reporting burden for this collection of information is estimated to average 7 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: Paperwork Reduction Project 0607-XXXX, Field Division Correspondence Liaison, U.S. Census Bureau, 4600 Silver Hill
Road, 4th Floor, Washington DC 20233-1500. You may e-mail comments to [email protected]; use "Paperwork Reduction Project 0607-XXXX" as the subject.
Disclosure of protected medical information will be subject to the confidentiality provisions of the Rehabilitation Act of 1973. The eight digit OMB number confirms our authority to collect
this information.

* Before we can consider your application for the position, we must verify your home address. Please review the information below.

101 Main St., Apt. B
Anytown, MI 49843

o
o

Information needs updates
I certify that the information on this screen in accurate

If the applicant chooses “Information needs updates”, then the following message appears and
he/she cannot move forward: “Since your home address needs to be updated you are unable to
proceed with the questionnaire until this information is current. Please update your home
address in your account profile to ensure your application reflects the current details.”

Next, we have a series of questions that will help us determine if you meet the specific requirements for the position. Depending on your responses, it may take
up to 7 minutes to answer the questions. We are quickly filling positions. Please respond as soon as possible as your responses to the questions are time
sensitive.

* Are you currently employed or doing volunteer work?

o
o

Yes
No

We need to determine if working for the Census Bureau might create a conflict of interest with any current employment or volunteer work. Due to the schedule
flexibility and temporary/short-term nature of the position, most employees continue working in their current job or doing their volunteer work while working for the
Census Bureau. Therefore, the next series of questions are about that work.
* In your current job or volunteer work, are you required to act in instances where a law or regulation may have been violated, even when not on duty?

o
o

Yes
No

Please provide some details of the position where you are required to act in instances where a law or regulation may have been violated, even when you are not on duty.
* Job Title

* Agency/Organization

* Brief Description of your Position

* Are you currently employed by a law enforcement agency?

o
o

Yes

* As part of the duties of your job do you interact with the public to enforce laws? For example, do you issue citations, make arrests or make decisions
that would impact whether someone could be arrested, fined or otherwise penalized or held.

o
o

Yes
No

Please provide some details about your position at the law enforcement agency.

 Provide details from my previous response

* Job Title

* Agency/Organization

* Brief Description of your Position

* Are you currently employed by a state, local or tribal government agency?

o
o

Yes
No

* Does your current job for the state, local or tribal government involve planning, zoning decisions, issuing building permits, conducting inspections, assessing or
collecting taxes?

o
o

Yes
No

* Does your current job for the state, local, or tribal government involve using the results of the census to work on congressional or state legislative redistricting or
distribution of federal funds?

o
o

Yes
No

Please provide some information about your position.
* Job Title

 Provide details from my previous response

* Agency/Organization

* Brief Description of your Position

* Are you currently an elected official? (e.g., council member, mayor, judge, school board etc.)

o
o

Yes
No

Please provide some details about your elected office/position.
* Job Title

 Provide details from my previous response

* Agency/Organization

* Brief Description of your Position

* Do any of your relatives currently work for the Census Bureau? Relatives include – Parents, spouse, children, grandparents, siblings (include half), aunts,
uncles, first cousins, nephews, nieces, in-laws, and step relatives.

o
o

Yes
No

Please provide information about those relatives who currently work for the Census Bureau. Knowingly NOT providing information about your relatives
who work for the Census Bureau could be a reason for termination if you are hired. Include – Parents, spouse, children, grandparents, siblings (include half),
aunts, uncles, first cousins, nephews, nieces, in-laws, and step relatives.
* Relationship

Current Job Title

* First Name

* Last Name

In what city does your relative live?

In what state does your relative live?

If selected, you will need to be ﬁngerprinted. If hired, you may be reimbursed for the cost of being fingerprinted; however, you will not
be paid for the time and mileage.
* Are you available to get fingerprinted?

o
o

Yes
No - I do not want to be fingerprinted and understand that this disqualifies me from all jobs

Census Bureau employees are data stewards with a lifelong responsibility to protect the confidentiality and privacy of information that is entrusted to
them. It is vital that Census Bureau staff understand the principles and practices of good data stewardship to maintain public trust. Gaining and
maintaining public trust is essential to the Census Bureau mission. As such, all new Census Bureau employees, contractors, and other Special Sworn
Status individuals must undergo training and take a lifelong oath to protect this data, pursuant to Title 13 and Title 26.
* Are you willing to follow Census Bureau policies and procedures related to safeguarding this sensitive, confidential information?

o
o

Yes
No - I am not willing to follow policies and procedures to safeguard information and understand that this disqualifies me from all jobs

The Census Bureau is committed to producing data that depicts an accurate portrait of the nation's people and economy. To accomplish this mission, your
position may require you to engage with people from different backgrounds, neighborhoods, and communities.
* Are you willing to engage with people from different backgrounds, neighborhoods, and communities?

o
o

Yes
No - I do not want to engage with people from a different neighborhoods or communities and understand that this disqualifies me from all jobs

If the applicant responds “No”, to any of the above questions then he/she will be unable to continue through the
questionnaire and will see a message that reads “Thank your interest in Census jobs. We will remove your application from
consideration for all Census jobs.”

Depending on which position the applicant is being considered
for, he/she will then skip to one of the following:
Position Specific Self-Response Interview Questionnaires (SRIQ)
1)
2)
3)
4)

Enumerator SRIQ – slides 16 to 23
Outreach Assistant SRIQ – slides 25 to 31
Census Trainer SRIQ – slides 33 - 38
Census Field Supervisor SRIQ – slides 40 to 47

1) Enumerator Self-Response Interview
Questionnaire

Enumerator Interview Questionnaire
OMB Number 0607-XX, Expires XX/XX/XXXX

If the applicant clicks on the “Privacy Act and Burden Statement”, then the
statements on the following slide appear. If the applicant clicks “here” he/she
will be taken to information about the job on www.census.gov/2026jobs.

Next, we have a series of questions that will help us determine if you meet the specific requirements for the enumerator position. Depending on your responses, it may take up to 4 minutes to answer
the questions. We are quickly filling positions. You must answer all the questions within 48 hours of receiving the notification to remain under consideration.
The following is an interview questionnaire, all your answers must be truthful and complete. A false statement on any part of this declaration may be grounds for not hiring you, or for firing you after
you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, Title 18, section 1001). Your responses to the questions for this position will remain in our system and will be
used for future considerations.
Privacy Act and Burden Statement

This job requires extensive travel in and around your local area. Although the typical appointment lasts approximately 12 weeks, the length of employment is
subject to the availability of work. Your employment may end at any time based on the operational needs of the agency.
This position requires that you make yourself available to work at least 20 hours per week. Depending on the type of work, you may need to work weekend and
evening hours. Actual work hours and scheduling are subject to the availability of work and operational needs of the agency.
Hourly pay and mileage reimbursement, for official business, can be found here. Ofﬁcial pay begins after you are sworn in as an employee.
* Are you still interested in the position?

o
o
o
o

If the applicant responds “No – I do not want ANY Census position …” he/she will not be
able to continue with the questionnaire and will receive the following message “Thank you
for interest in Census jobs. We will remove your application from consideration for all
Census jobs.”
If the applicant responds “No – I do not want this position at this time, …” he/she will not
be able to continue with the questionnaire and will receive the following message “Thank
you for your interest in Census jobs. Although you are not interested in this position at this
time, we will keep your application on file for future Census opportunities.”
If the applicant responds “No – I do not want this position, but I may be interested in other
positions” he/she will not be able to continue with the questionnaire and will receive the
following message “Thank you for your interest in Census jobs. Since you are not
interested in this position, we will remove you from consideration only for this position.
16
Your application will remain on file for future Census opportunities.”

Privacy Act and Burden Statement
Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II, Section 23(a) and 23(c); Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III,
Chapter 33, Subchapter 1.
The purpose of collecting this information is primarily to determine your qualifications for employment and may also be used to identify you to other sources asked to comment on your
qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a court during legal proceedings.
Disclosure of the information provided to us may be shared with other Census Bureau staff for the work-related purposes identified in this statement as permitted under the Privacy Act of
1974 (5 U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice OPM/GOVT-5,
Recruiting, Examining, and Placement Records.
Furnishing this information is voluntary, but failure to provide any part or all of the data requested will result in you receiving no further consideration for employment.
Public reporting burden for this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: Paperwork Reduction Project 0607-XXXX, Field Division Correspondence Liaison, U.S. Census Bureau, 4600 Silver Hill
Road, 4th Floor, Washington DC 20233-1500. You may e-mail comments to [email protected]; use "Paperwork Reduction Project 0607-XXXX" as the subject.
Disclosure of protected medical information will be subject to the confidentiality provisions of the Rehabilitation Act of 1973. The eight digit OMB number confirms our authority to collect
this information.

This job requires you to communicate with the public in both English and [insert language]. Therefore, we are interested in hiring bilingual candidates.
* Are you fluent in [insert language] where you can hold a conversation, record responses, and respond to questions in that language?

o
o

Yes
No

If the applicant responds “No” to this question he/she will see the following message and will not
be able to continue with the questionnaire: “Thank you for your interest in Census jobs. Although
you do not meet the criteria for this position, at this time, we will keep your application on file for
future Census opportunities.”

* Do you have access to the type(s) of transportation listed below?
[insert transportation type(s)]

o
o

Yes
No - I no longer have access to this type of transportation and understand that I do not meet the criteria for this position at this time

* Does this vehicle have 4-wheel drive (4WD)?

o
o

Yes
No

* If your state requires you to have an operator's license for this transportation type, do you have a valid operator’s license?

o
o
o

Yes
No
I am not required to have an operator’s license

If the applicant responds “No” to any of these questions he/she will see the following message
and will not be able to continue with the questionnaire: “Thank you for your interest in Census
jobs. Although you do not meet the criteria for this position, at this time, we will keep your
application on file for future Census opportunities.”

Most positions require our employees to travel from housing unit to housing unit locally (up to 50 miles in some rural or suburban areas) to verify address lists
or ask interview questions to members of households.
* Are you willing to travel from housing unit to housing unit within your community and neighboring communities to conduct your work?

o
o

Yes
No

This job requires carrying materials and knocking on the doors of housing units, not all of which will be easily accessible. Examples could include, housing
units located on rough terrain, multi-level buildings without elevators, etc.
* Are you able and willing to walk up and down stairs and walk in areas with uneven surfaces to locate housing units and interview respondents?

o
o
o

Yes
No
No – but I would like to explain

* Please explain your response.

If the applicant responds “No” to either of these questions he/she will see the following message
and will not be able to continue with the questionnaire: “Thank you for your interest in Census
jobs. Although you do not meet the criteria for this position, at this time, we will keep your
application on file for future Census opportunities.”

This job requires traveling from housing unit to housing unit, including at night.
* Are you able and willing to travel from housing unit to housing unit either on foot or via some form of transportation?

o
o
o

Yes
No
No – but I would like to explain

* Please explain your response.

Working in bad, but NOT dangerous, weather is an essential function of the job. Work is adjusted to follow local public safety guidelines.
* Are you able and willing to work in bad (rainy, hot, cold, etc.) weather?

o
o

Yes
No

Working in bad, but NOT dangerous, weather is an essential function of the job. You must be willing to work in these conditions.
* Do you want to change your answer?

o
o

Yes – I agree to work in bad weather
No – I do not want this position

If the applicant responds “No” to this question he/she will see the following message and will not
be able to continue with the questionnaire: “Thank you for your interest in Census jobs. Since you
are not interested in this position, we will remove you from consideration only for this position.
Your application will remain on file for future Census opportunities. ”

Thank you for your time, a supervisor will review your answers to determine if you have
been selected for the position. You can log back into your account to check your status.
For more information on the hiring process click here.

2) Outreach Assistant Self-Response
Questionnaire

Outreach Assistant Interview Questionnaire

OMB Number 0607-XX, Expires XX/XX/XXXX
Next, we have a series of questions that will help us determine if you meet the specific requirements for the outreach assistant position. Depending on your responses, it may take up to 4 minutes to
answer the questions. We are quickly filling positions. You must answer all the questions within 48 hours of receiving the notification to remain under consideration.

The following is an interview questionnaire, all your answers must be truthful and complete. A false statement on any part of this declaration may be grounds for not hiring you, or for firing you after
you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, Title 18, section 1001). Your responses to the questions for this position will remain in our system and will be
used for future considerations.
Privacy Act and Burden Statement

This job requires extensive travel in and around your local area. Although the typical appointment lasts approximately 12 weeks, the length of employment is subject to the
availability of work. Your employment may end at any time based on the operational needs of the agency.
This position requires that you make yourself available to work at least 20 hours per week. Depending on the type of work, you may need to work weekend and evening hours.
Actual work hours and scheduling are subject to the availability of work and operational needs of the agency.
Hourly pay and mileage reimbursement, for official business, can be found here. Ofﬁcial pay begins after you are sworn in as an employee.
* Are you still interested in the position?

o
o
o
o

If the applicant responds “No – I do not want ANY Census position …” he/she will not be
able to continue with the questionnaire and will receive the following message “Thank you
for interest in Census jobs. We will remove your application from consideration for all
Census jobs.”
If the applicant responds “No – I do not want this position at this time, …” he/she will not
be able to continue with the questionnaire and will receive the following message “Thank
you for your interest in Census jobs. Although you are not interested in this position at this
time, we will keep your application on file for future Census opportunities.”
If the applicant responds “No – I do not want this position, but I may be interested in other
positions” he/she will not be able to continue with the questionnaire and will receive the
following message “Thank you for your interest in Census jobs. Since you are not
interested in this position, we will remove you from consideration only for this position.
25
Your application will remain on file for future Census opportunities.”

Privacy Act and Burden Statement
Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II, Section 23(a) and 23(c); Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III,
Chapter 33, Subchapter 1.
The purpose of collecting this information is primarily to determine your qualifications for employment and may also be used to identify you to other sources asked to comment on your
qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a court during legal proceedings.
Disclosure of the information provided to us may be shared with other Census Bureau staff for the work-related purposes identified in this statement as permitted under the Privacy Act of
1974 (5 U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice OPM/GOVT-5,
Recruiting, Examining, and Placement Records.
Furnishing this information is voluntary, but failure to provide any part or all of the data requested will result in you receiving no further consideration for employment.
Public reporting burden for this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: Paperwork Reduction Project 0607-XXXX, Field Division Correspondence Liaison, U.S. Census Bureau, 4600 Silver Hill
Road, 4th Floor, Washington DC 20233-1500. You may e-mail comments to [email protected]; use "Paperwork Reduction Project 0607-XXXX" as the subject.
Disclosure of protected medical information will be subject to the confidentiality provisions of the Rehabilitation Act of 1973. The eight digit OMB number confirms our authority to collect
this information.

o
o

Yes
No

* Do you have access to the type(s) of transportation listed below?
[insert transportation type(s)]

o
o

Yes
No - I no longer have access to this type of transportation and understand that I do not meet the criteria for this position at this time

* Does this vehicle have 4-wheel drive (4WD)?

o
o

Yes
No

* If your state requires you to have an operator's license for this transportation type, do you have a valid operator’s license?

o
o
o

Yes
No
I am not required to have an operator’s license

Outreach Assistant positions require extensive travel that may mean traveling over 50 miles in some rural or suburban areas. In city/urban areas traveling should
not be more than 50 miles.
* Are you willing to travel?

o
o

Yes
No

Part of the Outreach Assistant job is to speak and interact with the public and/or organizations to promote available jobs, educate on the importance of Census
participation and/or to conduct an interview using the Census questionnaire at response events.
* Are you willing and able to perform these tasks?

o
o
o

Yes

No
No – but I would like to explain

* Please explain your response.

3) Census Trainer Self-Response
Questionnaire

Census Trainer Interview Questionnaire
OMB Number 0607-XX, Expires XX/XX/XXXX

Next, we have a series of questions that will help us determine if you meet the specific requirements for the census trainer position. Depending on your responses, it may take up to 3 minutes to
answer the questions. We are quickly filling positions. You must answer all the questions within 48 hours of receiving the notification to remain under consideration.
The following is an interview questionnaire, all your answers must be truthful and complete. A false statement on any part of this declaration may be grounds for not hiring you, or for firing you after
you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, Title 18, section 1001). Your responses to the questions for this position will remain in our system and will be
used for future considerations.
Privacy Act and Burden Statement

Although the typical appointment lasts approximately 12 weeks, the length of employment is subject to the availability of work. Your employment may end at any time based on
the operational needs of the agency.
This position requires that you make yourself available to work 30-40 hours per week. Depending on the type of work, you may need to work weekend and evening hours. Actual
work hours and scheduling are subject to the availability of work and operational needs of the agency.
Hourly pay can be found here. Ofﬁcial pay begins after you are sworn in as an employee.

* Are you still interested in the position?

o
o
o
o

Yes

No - I do not want ANY Census position, please remove my application from future consideration
No - I do not want this position at this time, but may be interested in the future
No - I do not want this position, but I may be interested in other positions

If the applicant responds “No – I do not want this position at this time, …” he/she will not
be able to continue with the questionnaire and will receive the following message “Thank
you for your interest in Census jobs. Although you are not interested in this position at this
time, we will keep your application on file for future Census opportunities.”
If the applicant responds “No – I do not want this position, but I may be interested in other
positions” he/she will not be able to continue with the questionnaire and will receive the
following message “Thank you for your interest in Census jobs. Since you are not
interested in this position, we will remove you from consideration only for this position.
33
Your application will remain on file for future Census opportunities.”

Privacy Act and Burden Statement
Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II, Section 23a and c; Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III, Chapter 33,
Subchapter 1.
The purpose of collecting this information is primarily to determine your qualifications for employment and may also be used to identify you to other sources asked to comment on your
qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a court during legal proceedings.
Disclosure of the information provided to us may be shared with other Census Bureau staff for the work-related purposes identified in this statement as permitted under the Privacy Act of
1974 (5 U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice OPM/GOVT-5,
Recruiting, Examining, and Placement Records.
Furnishing this information is voluntary, but failure to provide any part or all of the data requested will result in you receiving no further consideration for employment.
Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: Paperwork Reduction Project 0607-XXXX, Field Division Correspondence Liaison, U.S. Census Bureau, 4600 Silver Hill
Road, 4th Floor, Washington DC 20233-1500. You may e-mail comments to [email protected]; use "Paperwork Reduction Project 0607-XXXX" as the subject.
Disclosure of protected medical information will be subject to the confidentiality provisions of the Rehabilitation Act of 1973. The eight digit OMB number confirms our authority to collect
this information.

o
o

Yes

Census Trainers must have professional experience training or teaching in a work or school setting and performing instructional tasks to different types of
audiences.
*Do you have this type of experience?

o
o

Yes
No

Census Trainers will provide small group and one-on-one coaching and instructional support to assist employees in comprehending difficult concepts and
applying newly acquired knowledge and skills.
*Do you have this type of experience?

o
o

Yes
No

4) Census Field Supervisor Self-Response
Questionnaire

Census Field Supervisor Interview Questionnaire
OMB Number 0607-XX, Expires XX/XX/XXXX

Next, we have a series of questions that will help us determine if you meet the specific requirements for the census field supervisor position. Depending on your responses, it may take up to 4
minutes to answer the questions. We are quickly filling positions. You must answer all the questions within 48 hours of receiving the notification to remain under consideration.

The following is an interview questionnaire, all your answers must be truthful and complete. A false statement on any part of this declaration may be grounds for not hiring you, or for firing you
after you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, Title 18, section 1001). Your responses to the questions for this position will remain in our system and
will be used for future considerations.
Privacy Act and Burden Statement

This job requires extensive travel in and around your local area. Although the typical appointment lasts approximately 12 weeks, the length of employment is subject to the
availability of work. Your employment may end at any time based on the operational needs of the agency.
This position requires that you make yourself available to work at least 20-30 hours per week. Depending on the type of work, you may need to work weekend and evening hours.
Actual work hours and scheduling are subject to the availability of work and operational needs of the agency.
Hourly pay and mileage reimbursement, for official business, can be found here. Ofﬁcial pay begins after you are sworn in as an employee.
* Are you still interested in the position?

o
o
o
o

Yes
No - I do not want ANY Census position, please remove my application from future consideration
No - I do not want this position at this time, but may be interested in the future

No - I do not want this position, but I may be interested in other positions

If the applicant responds “No – I do not want ANY Census position …” he/she will not be
able to continue with the questionnaire and will receive the following message “Thank you
for interest in Census jobs. We will remove your application from consideration for all
Census jobs.”
If the applicant responds “No – I do not want this position at this time, …” he/she will not
be able to continue with the questionnaire and will receive the following message “Thank
you for your interest in Census jobs. Although you are not interested in this position at this
time, we will keep your application on file for future Census opportunities.”
If the applicant responds “No – I do not want this position, but I may be interested in other
positions” he/she will not be able to continue with the questionnaire and will receive the
following message “Thank you for your interest in Census jobs. Since you are not
interested in this position, we will remove you from consideration only for this position.
40
Your application will remain on file for future Census opportunities.”

Privacy Act and Burden Statement
Solicitation of your personal information is authorized by Title 13 U.S.C., Chapter 1, Subchapter II, Section 23a and c; Title 5 U.S.C., Part II, Chapter 13; Title 5 U.S.C., Part III, Chapter 33,
Subchapter 1, Section 1 and 20.
The purpose of collecting this information is primarily to determine your qualifications for employment and may also be used to identify you to other sources asked to comment on your
qualifications, e.g. educational institutions, former employers, and enforcement agencies, or to a court during legal proceedings.
Disclosure of the information provided to us may be shared with other Census Bureau staff for the work-related purposes identified in this statement as permitted under the Privacy Act of
1974 (5 U.S.C. Section 552a). Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice OPM/GOVT-5,
Recruiting, Examining, and Placement Records.
Furnishing this information is voluntary, but failure to provide any part or all of the data requested will result in you receiving no further consideration for employment.
Public reporting burden for this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: Paperwork Reduction Project 0607-XXXX, Field Division Correspondence Liaison, U.S. Census Bureau, 4600 Silver Hill
Road, 4th Floor, Washington DC 20233-1500. You may e-mail comments to [email protected]; use "Paperwork Reduction Project 0607-XXXX" as the subject.
Disclosure of protected medical information will be subject to the confidentiality provisions of the Rehabilitation Act of 1973. The eight digit OMB number confirms our authority to collect
this information.

o
o

Yes
No

* Do you have access to the type(s) of transportation listed below?
[insert transportation type(s)]

o
o

Yes
No - I no longer have access to this type of transportation and understand that I do not meet the criteria for this position at this time

* Does this vehicle have 4-wheel drive (4WD)?

o
o

Yes
No

* If your state requires you to have an operator's license for this transportation type, do you have a valid operator’s license?

o
o
o

Yes
No
I am not required to have an operator’s license

Census Field Supervisor positions may require traveling over 50 miles in some rural or suburban areas. In city/urban areas traveling should not be more than 50
miles.
* Are you willing to travel?

o
o

Yes
No

Your application indicated that you have supervisory experience. Should you be selected for the Census Field Supervisor position, you may be required to:
•
•
•
•
•
•

Train and mentor team members remotely to encourage them to perform in a timely manner according to the amount of work assigned.
Use internal computer software system to assign work and monitor your team’s progress
Review your team’s work to determine if it meets job standards
If the applicant responds “No” to either of these questions he/she will see the following message
Review and certify staff’s payroll
and will not be able to continue with the questionnaire: “Thank you for your interest in Census
Communicate and meet with team members on an ongoing basis
Occasionally conduct household interviews to obtain address or household data jobs. Although you do not meet the criteria for this position, at this time, we will keep your
application on file for future Census opportunities.”

* Are you willing and able to perform the duties mentioned above?

o
o

Yes
No - I am not interested in the Census Field Supervisor job, but please keep my application on file for other positions

Enumerators locate households and conduct interviews with respondents, explaining the purpose of the Census, asking questions to validate addresses, and recording data.
Enumerators go to specific addresses to interview people to complete a questionnaire or to verify the status of addresses. They travel from housing unit to housing unit,
carrying materials, climbing stairs, working in bad weather and having to deal with reluctant households.
Census Field Supervisors may work in similar situations to ensure that workloads are completed on time or when follow up is needed.
*Are you willing and able to perform the duties mentioned above?

o
o
o

Yes
No
No – but I would like to explain

* Please explain your response.

File Type	application/pdf
Author	Anna Parikos (CENSUS/FLD FED)
File Modified	2025-04-17
File Created	2025-04-17