U.S. Department of Commerce
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Geographically Updated Population Certification Program
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Instructions for Completing Section I of Form BC-1869(EF)

Note:  These instructions are also on page 2 of the PDF version of the form.

Please answer every question in Section I.

  1. Today’s Date: The date you are filling out this form.
  2. Number of Certificates requested: If more than one copy is needed, indicate how many, and, on a separate piece of paper, provide addressee name, title, office, and mailing address for each additional certificate. There is a $35 fee for each additional copy.
  3. a. Governmental Unit or Entity Name: The name of the governmental unit or entity name for which you are requesting certification.
  4. b. County or Counties: Provide the county or counties in which this governmental unit or entity is in.
  5. c. Name of highest elected official for this Governmental Unit or Entity.
  6. a. Contact Name: The name of the person filling out this form, i.e., requestor.
    b.-i. self explanatory.
    Note:  No P.O. box addresses are accepted.
  7. a. Type of action precipitating need for certification: Choose one.
    b. Effective date of action (mm/dd/yy): The effective date of the action checked in question 5a.
  8. a. Type of certification requested:
        Annual:  Certificate received after October 1 of calendar year. Available only if boundaries included in the population certification were effective as of January 1 of the current calendar year and reported by April. Please call 800-923-8282 for additional information.
        Expedited:  We will send your certificate within 3 months of request. Provide the date the certificate is needed by. Please call 800-923-8282 for additional information.
    b. If expedited, date certification needed (mm/dd/yy). Please allow 3 (three) months for processing from the time you place your request.
  9. Were the boundaries included in the requested population certification reported in the current or previous year’s Boundary and Annexation Survey?:
    Please call 800-923-8282 for assistance in answering this question.

If you need further assistance to complete Section I of this form, please contact the Census Bureau’s Geographically Updated Population Certification Program staff on 301-763-2419, or the Customer Services Center staff on 1-800 923-8282 or 301-763-INFO (4636).

NOTE: Failure to meet deadlines may result in increased costs to customer.

 

Source: U.S. Census Bureau,
Customer Liaison and Marketing Services Office, Customer Services Center

Created: July 9, 2002
Last Revised: Friday, 01-Nov-2013 13:02:36 EDT