You can download and print out this Public Servant Questionnaire PDF and keep it handy by your door, when the census worker knocks on your door hand the questionnaire to him or her. Be sure you have two witnesses when the census worker fills this out as the signatures of two witnesses are required. It is highly unlikely however, that the census worker is going to fill out your Public Servant Questionnaire. I suppose then, if you chose to, that it would be possible to say, “Turnabout is fair play, I guess I won’t be filling out your questionnaire either.”
The instructions for the public servant (in this case the census worker) are printed on the first page and are as follows:
“Public Law 93-579 states in part: “The purpose of this Act is to provide certain safeguards for an individual against invasion of personal privacy by requiring Federal agencies to permit an individual to determine what records pertaining to him are collected, maintained, used, or disseminated by such agencies.” The following questions are based upon that act and are necessary in order that this individual may make a reasonable determination concerning divulgence of information to this agency.
Fill out the form completely. If any question does not apply, mark the answer with N/A or Not applicable. Do not leave any question blank.”
Reprinted from CensusThis.
June 23, 2010
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