What is your name? Please PRINT the name of the person who
is filling out this form. Include the telephone number so we can
contact you if there is a question, and today’s date.
If you need help or have questions
about completing this form, please call
1-800-354-7271. The telephone call is free.
¿NECESITA AYUDA? Si usted habla español
y necesita ayuda para completar su cuestionario,
llame sin cargo alguno al 1–877–833–5625.
Telephone Device for the Deaf (TDD):
Call 1–800–582–8330. The telephone call is free.
OMB No. 0607-0810
ACS-1(INFO)(2005), Page 1, Base (Black)
ACS-1(INFO)(2005), Page 1, GREEN Pantone 354 (20% and 100%)
• basic information about the people who are living or staying at
the address on the mailing label above
• specific information about this house, apartment, or mobile
• more detailed information about each person living or staying
People are our most important resource.
This Census Bureau survey collects
information about education,
employment, income, and housing—
information your community uses to
This form asks for three types of information:
Area Code + Number
Number of people
How many people are living or staying at this address?
Please turn to the next page to continue.
THE American Community Survey
For more information about the American
Community Survey, visit our web site at:
U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU
Economics and Statistics Administration
plan and fund programs. Your
response is important, and we
keep your answers confidential.
This booklet shows the
content of the
American Community Survey
U S C E N S U S B U R E A U
ACS-1(INFO)(2005), Page 2, Base (Black)
ACS-1(INFO)(2005), Page 2, GREEN Pantone 354 (10%, 20% and 100%)
IF YOU ARE NOT SURE
WHOM TO LIST, CALL
If there are more than
five people, list them
here. We may call you
for more information