Citizen Response to Census and Surveys

[Date]  January 18, 2008

[Agency] USDA

[Agency Address]1201 E. 10th St

Jefferson, IN 47133

[Insert your name]

[Insert your address]

[Address the Agency] Dear United States Department of Agriculture,

This is my Citizen Response which I just received.In this day of privacy theft I am sure that you can understand that a citizen needs to be pro-active in ensuring their data is safe and secure. For this reason insert your surname family policy clearly states that the enclosed Public Servant Questionnaire must be fully filled out by:

• Each person who will see the [insert what Census or survey you are responding to] Year  Census of Agriculture (or other Agency)
• Each person who will have access either to the hard copy, database, data aggregate information, or any and all GPS units

Policy for Public Servant Questionaire

*Please ensure that all sections of the Public Servant Questionnaire are

filled out by all persons seeing the hardcopy, data, or database so that I may promptly fill out my Census.
* Provide 2 pieces of photo identification for each person who has access to any part of the [insert Census or Survey you are addressing] Census of Agriculture hard copy, database, or data aggregate.
* Include for each person having access to this hard-copy, database, or aggragate data a sworn and notarized oath that the information filled out by insert your name will be used exclusively for purposes within the United States of America and will not be used for any statistical purposes outside of the Republic of the United States of America. This statement must INCLUDE that in no way will information provided by insert your name to the [insert Agency] USDA be for used for determining assets of insert your name or assets of the United States of America.

Legal Fees:FINES & Penalties for failure to secure the private and personal data of insert your name is subject to prosecution within this country and international tribunal if any data (in any form including aggregate) goes outside the original 50 States of America.

Your response must be postmarked no later than [insert the date you want them to respond ']  for insert your name to respond. Please return the portion of the Census that you would like me to Constitutionally fill out.

Your prompt attention to this matter is requested.

Sign your name