ACS Custom Tabulation Request Form

To Activate the ACS Custom Tabulation Request Form

Please confirm your understanding of the minimum costs ($4,000) and the minimum timeframe (8 weeks).

Authority for the collection of information using the Custom Tables Request Form for the American Community Survey (ACS) is provided under 13 U.S.C. 8.

The purpose for collecting this information is to gather information from users who want to request a custom table using ACS data. The form will provide users a way to request help for data needs that cannot be met with the data sources from data.census.gov or through the Public Use Microdata Sample File. Information collected includes name, telephone number, email address, organization, organization address, and job title.

Disclosure of the information provided to us is permitted under the Privacy Act of 1974 (5 U.S.C. § 552a) and may be shared with other Census Bureau staff for the work-related purposes identified in this statement. Disclosure of this information is also subject to the published routine uses as identified in the Privacy Act System of Record Notice COMMERCE/DEPT-5, Decennial Census Programs.

Providing this information is voluntary. Failure to provide this information may affect the Department of Commerce's ability to provide some custom tabulations using ACS data.

OMB Control NO: 0690-0030

Expiration Date: 07/31/2026

Please provide information about you, your organization, and your data requests in the form below.

Note: * indicates a required field

*First Name:

*Last Name:

Title:

*Phone Number:

Format: 555-555-5555

*Email:

*Organization Name:

*Address1:

Address2:

*City:

*State:

*Zip Code:

US or Canada zip/postal code format only: 12345, 12345-1234, A1A 1A1

Data Request:

Purpose of Request:

Specify Dataset:

ACS 5-Year Estimates

ACS 1-Year Estimates (Limited to geographic areas with a population of 65,000 or more.)

Data Year(s):

Format: YYYY, YYYY, YYYY - use ending year for 5-year estimates

Geography Type(s):

For explanations on the Geographies used in the ACS go to geography concepts and definitions.

Nation

State

County

Census Tracts (only 5-year)

Zip Code Tabulation Areas (2007-2011 ACS 5-year estimates and later.)

Other - Please specify:

Type of Estimate:

Tally Count

Percentage

Median

Mean

Aggregate

Other - Please specify:

Product Description:

Please specify ACS variables, categories of these variables, and other details:

Data Format:

CSV
EXCEL
SAS
Other - Please specify:

*Requested Delivery Date:

Month:

Day:

Year:

Note: Assume a minimum of 8 weeks

Additional Information:

Please check required fields:

Please check fields for errors