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Phase 4 Certification Form (Multiple CD States)
ICR 202608-0607-005 · OMB 0607-0988 · Object 172047200.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Phase 4 Certification Form (Multiple CD States) |
| Author | U.S. Census Bureau |
| Last Modified By | Acrobat PDFMaker 24 for Word |
| File Modified | 2024-08-26 |
| File Created | 2024-08-16 |
| Conversion State | complete |
Extracted Text
OMB Control No.: 0607-0988 Expiration Date: 11/30/2024 Form: Phase 4 Certification Form Multiple CD States (2026) 120 th Phase 4 Certification Form (States with Multiple Congressional Districts) Congressional District (CD) Boundaries and State Legislative District (SLD) Boundaries I certify there have been no changes to the geographic areas selected below since they were last submitted and/or verified through the Redistricting Data Program in 2024. 120th CD SLDU (Upper House) SLDL (Lower House) There have been changes to the CD and/or SLD boundaries selected below since they were last submitted and/or verified through the Redistricting Data Program in 2024. Select the option(s) below that identify the district type and whether the changes involve whole or split blocks. 120th CD Whole Block SLDU (Upper House) Whole Block SLDL (Lower House) Whole Block 120th CD Split Block SLDU (Upper House) Split Blocks SLDL (Lower House) Split Blocks Name: ________________________________________________________________________________ Title: __________________________________________________________________________________ Address: _______________________________________________________________________________ Email: _________________________________________________________________________________ Phone: ________________________________________________________________________________ Fax: ___________________________________________________________________________________ Signature: _____________________________________________ Date: ___________________________ For questions about completing this form or any other questions on the redistricting topic, contact the Redistricting & Voting rights Data Office at 301-763-4039 or at <[email protected]>. We estimate that participating in the Redistricting Data Program will take eight hours 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 on this form confirms this approval. If this number were not displayed, we could not conduct this program. The Census Bureau conducts this program under the legal authority of Public Law 94-171, as amended (Title 13 United States Code (U.S.C.), Section 141(c)).