Letter&Info_Flyer 102214

Draft 1 (9-30-2014)

To Your Household:

DC
UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
OFFICE OF THE DIRECTOR

Washington, DC 20233-0001

The U.S. Census Bureau is conducting the 2015 Census Test in your community. An accurate
census test will help in our efforts to develop new methods that will make the next census easier,
more convenient, and less costly for taxpayers. Results from the next census will be used to
help each communities get their fair share of federal funding for many programs that you and
your neighbors need.

As part of the 2015 Census Test, we need to determine how well we counted the people in your
community. We may have recently visited your household, but we now have a few additional
questions to ask you. Your participation is very important and the information you provide will
help determine the accuracy of the 2015 Census Test count.
Your response is required by law (Title 13 of the United States Code). This same law also
protects your information, keeping your answers strictly confidential. This requirement means
the Census Bureau cannot give out information that identifies you or your household. Your
survey answers will be used only for statistical purposes. Any Census Bureau employee who
violates these provisions is subject to a fine up to $250,000 or a prison sentence up to five
years, or both. This survey has been approved by the Office of Management and Budget and
given approval number XXXX-XXXX. This approval and Title 13, United States Code, allow us
to conduct these interviews.
The interview will take about 10 to 15 minutes, on average. If you have any questions
or comments about this interview, please send them to the following address:
Paperwork Project XXXX-XXXX
U.S. Census Bureau
4600 Silver Hill Road, AMSD-3K138
Washington, DC 20233-1500

overlay prints in blue #281 ink.

www.census.gov

You may also send comments by e-mail to . Please use “Paperwork
Project XXXX-XXXX” as the subject on the e-mail message. Thank you for your help.
Sincerely,

John H. Thompson
Director

USCENSUSBUREAU
Helping You Make Informed Decisions

base prints in black ink.

INFORMATION SHEET 2015
Evaluation Follow-up
List A - Vacancy Status List
For Rent
Rented, not occupied
For sale only
Sold, not occupied

For seasonal, recreational, or occasional use
For migrant workers

Other, please specify

List B - Type of Place List
House/Apartment/Mobile home/Condo/Townhouse
College dorm/Residence Hall/Sorority/Fraternity House
Military barracks
Nursing home

Skilled nursing unit in AL
Independent/Assisted Living
Correctional Facility
Group Home
Other, please specify

Page 2

Base prints Black ink (10% and 100%)

Circle prints in Pantone red# 199 (100%)

Overlay prints in Cyan (10% and 20%)