Return_of_Materials0503
D- 1778(BO)
(4-2010)
PL2546330
125000463300
225379
June 2010
James Thompson
GIS Coordinator
Office of Planning and Development
210 Main Street, Room 11
Northampton MA 01060
UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
Regional Census Center
BOSTON, MA 02108 -3107
JUN 7 2010
DEPT OF PLANNING
NORTHAMPTON, MA 01060
Dear James Thompson,
Thank you for participating in the 2010 Decennial Census Local Update of Census Addresses
(WCA) Program. Your government's participation in the WCA Program is now complete. You
are now required to complete, sign, and return the "Return or Destruction of Title 13, U.S.C.
Materials" form to our office within the next two weeks. Enclosed is a blank copy of this
form and a postage -paid envelope to use to return your form. If you prefer, you may fax the
form to us. Our fax number is 1- 617 223 -3674.
Please ensure that all reviewers and anyone with access to the Title 13 WCA materials sign
this form in accordance with the "Confidentiality and Security Guidelines" described in the
2010 Decennial Census Local Update of Census Addresses (WCA) Program User Guide.
'A copy of the Security Guidelines is available on the WCA website at www.census.gov.
If anyone with access to Title 13 materials is no longer available to sign and date this form, the
current liaison can sign -out on their behalf. If the liaison is no longer available, the Highest
Elected Official will need to designate a new liaison. Please contact my Geography staff for
further instructions. They can be reached toll -free at 1- 866 511 —WCA (5822).
At this time you must also destroy, or return to us, your WCA Title 13 materials, which include
WCA Feedback materials, as well as the original WCA materials. Please mark the appropriate
box on the "Return or Destruction of Title 13, U.S.C. Materials "form to indicate if you choose
to destroy or to return your WCA Title 13 materials. If you choose to destroy the materials,
please follow the destruction requirements in the "Confidentiality and Security Guidelines."
If you choose to return the materials to the Census Bureau, double -wrap the materials and
use the FedEx label that was included with your WCA materials. If you have misplaced the
FedEx label, please contact your RCC for a replacement. Please be sure to include the
"Return. or Destruction of Title 13, U.S.C. Materials "form with the materials. (Note that the
Census Bureau uses FedEx service for your return of the materials because tracking is
required and this service would be more expensive from the United States Postal Service). The
white portion of the label is the receipt for your records, and contains the tracking number
(12 -digit number on the bottom right corner) needed for you to confirm that the package was
received by the Census Bureau. If you do not know a location for a FedEx drop off, please call
1- 800 GOFEDEX.
USCENSUSBUREAU
Helping You Make Informed Decisions www.census.gov
If you have any questions, please contact my Geography staff for assistance. Thank you for
your cooperation.
Sincerely,
Kathleen Ludgate
Regional Director
Enclosures
cc: Ms. Mary C Higgins
D-1778(80) (4-2010)
0503
FORM D -1674
(5.31.2007)
U.S. DEPARTMENT OF. COMMERCE
c
Eonomic
s and Statistics Administration
U.S. CENSUS BUREAU
RETURN OR DESTRUCTION OF TITLE 13, U.S.C. MATERIALS
LOCAL UPDATE OF CENSUS ADDRESSES (LUCA) PROGRAM
2010 Decennial Census
Government name Please Print:
C I 1 o f o R. Tv\ M A
PL 2S tb33o
2. 2010 Decennial Census LUCA Program Liaison.
Please print name
c\ A M,cS 1 1-1 of -L.PS o l-1-
Signature
has properly destroyed or returned to the`U.S. Census. Bureau, the original 2010 Decennial Census
Local Update of Census Addresses (LUCA) Program Title. 13, U.S.C. materials and any copies using
the security requirements provided to us::by the ;U.S. Census. Bureau:
Mark (X) one.
Returned Title 13, U.S.C. materials
Destroyed Title 13,: U.S.0 'materials
2010 DECENNIAL CENSUS LUCA PROGRAM REVIEWERS
Signature
Date
Month Day Year
Date
Month :Day
Program Reviewer
1. Please print name
c T 4 C\, c�.� IA
M
1(
i!
2.: Please prink name V
3. Please print name.
Signature
4. Please print .name.:
Signature
C
If you require more signature °.blocks, ;.you may duplicate this form.
Date
Month Day Year
2
O
1
CD
All LUCA :Program liaisons; reviewers, and anyone with access toTitle 13 .materials are required to sign
and date this form at the conclusion of the appeals process. ::Should any liaison:, reviewer,::: or anyone
with access to Title 13 materials leave before the completion Of the Program, they are required to
sigh-out of the program by signing and dating this form: if any liaison, reviewer, or anyone With access
to Title 13 materials fails :to:.. sign:: and. date this form, current liaison:: can sign out on their behalf.....::
USCENSUSBUREAU
OMB No. 0607 -0795
06/22/2010 14:31 6172233675
USCENSUSBUREAU
Helping You Make Informed Decisions
TO:
Jim Thompson
COMPANY:
Northampton city
FAX NUMann:
413-587-1264
SENDER'S PHONE NUMBER:
617- 223 -3623
LUCA
US Census Bureau
Boston Regional. Census Centex
1 l3ea.con St 7th Floor
Boston, MA 02108
Phone: (617) 223 -3623
Fax: (617) 223 -3674
Email. malianne.p.salami
FACSIMILE TRANSMITTAL SHEET
NOTES/COMMENTS:
census.gov
BOSTON RCC PAGE 01/03
FROM;
Maliant),e Skl tmi.
lA're:
6/22/10
TOTAL NO. OF VAGES INCLUDING C:oVF•.R:
3
SENDER'S FAX NUMBERI
617 223 -3674
YOUR IU:FIiIU:NC :R NUMMIR:
El [AGENT Cl FOR Rr vrrrW lI P.I,I;ASE. COMMJ N'1' 0 ISLEASE REPLY 0 FLFASS ?tLLC'YCL.
Hi f irn,
Thanks for sending your destruction form back but 1 need 2 mote signatures Andrew Kucthcr
and Wendy Mazza. If they are no longer there please print there name and sign for them,
Thank you,
Marianne Salami
Geographic Clerk
Contact Name i
Telephone Number
LUCA Liaison
Former
LUCA
Liaison
Title 13
Signature
Former Title 13
Signature
Non -Title 13
Contact
Thompson, James
413- 587 -1285
Et
thi
F
r
IS
Feiden, Wayne
413- 587 -1266
8
Era
;v
TM
r
Higgins, Mary C
413 -587 -1249
{t
ii1i
riii
Kuether, Andrew
413.587.1570
INTI
ilk
rg
4 7 1
eZ
Mazza, Wendy
413-587-1224
Kt
ijlj
r
r
(fit
Entity ID
Entity Name
PIPS
RO
P12546330
Northampton city
A
26-Massachusetts
46330
21-Boston, MA
06/22/2010 14:31 6172233675
2010 Census LUCA
Advance Notice Sent Date (NPC):
First Response Received Date
(RO):
Updates? (RO):
Invitation Sent Date (NPC): 1042
New Letter Sent Date (NPC):
Date Registration Form Received
(R0):
Participation Option(RO):
tf "No ",why ?(RO):
Initial Participation Option (HQ):
Signed LUCA Title 13
Confidentiality Agreement? (R0):
Signed LUCA Self-Assessment
Checklist(R0):
Option Change Date (R0):
Program Dropout Date (RO):
Title 13 Materials Returned(RO):
Program Dropout Letter Sent Date
(RO):
BOSTON RCC
2010 Census LUCA Report
FS State
Entity Contacts
101/31/2007 1
104/05/2007
IYos
112
(Full Address list Review
(Yes
fr
1
1
Number of Addresses (HQ):
Address List Pages (HO):
Advance Notice
Invitation /Participation
Postmaster Return Resent Date (R0):
Date: 112/26/20071
Date:
112/26/2007 1
Program Dropout
Program Dropout, why? (R0):
Date Materials Destruction
Form Returned(RO):
Outgoing Media Requested
1112437 1
2073
Postmaster Return Resent Date (RO):
Follow -up Telephone Data (R0):
If "No ",why Other ?(RO):
PAGE 02/03
Page 1 of 5
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