OMB Control No. 3265-0006 1 Expiration Date 5/31/2013 

U.S. ELECTION ASSISTANCE COMMISSION 

2012 Election Administration & Voting Survey 

The ongoing process of improving America’s election systems relies in part on having accurate data about the way 

Americans cast their ballots. In 2002, Congress chartered the U.S. Election Assistance Commission (EAC) to collect 

information on the state of American elections and make it widely available to policy makers, advocates, scholars, 

journalists and the general public. Since 2004, the Commission has sponsored a biennial survey as its primary tool 

for fulfilling that mission. We are pleased to present the 2012 Election Administration and Voting Survey, and we ask 

for your help in making it the most complete and accurate survey in its history. 

The questions below ask for information about ballots cast; voter registration; overseas and military voting; Election 

Day activities; voting technology; and other important issues. The section concerning the Uniformed and Overseas 

Citizens Voting Act (UOCAVA) serves as the EAC’s standardized format for state reporting of UOCAVA voting 

information as required by 42 U.S.C. §1973ff-1. States that complete and timely submit this section to the EAC will 

fulfill their UOCAVA reporting requirement under 42 U.S.C. §1973ff-1(c). Additionally, EAC is mandated by the 

National Voter Registration Act (NVRA) to collection information from states concerning the impact of that statute on 

the administration of Federal elections. With this information EAC is required to make a report to Congress and 

provide recommendations for the improvement of Federal and State procedures, forms, and other NVRA matters. 

States that timely respond to all questions in this survey concerning voter registration related matters will meet their 

NVRA reporting requirements under 42 U.S.C. § 1973gg-7 and EAC regulations. 

The EAC recognizes the burden that asking for this data places on state and local election officials, and we have 

worked to minimize that burden as much as possible. 

In advance, we thank you for your cooperation and look forward to answering any questions you might have. 

Information supplied by: 

Name Title 

Office/Agency name 

Address 1 

Address 2 

City State Zip Code 

E-mail address 

Telephone (area code and number) Extension Fax number (area code and number) 
OMB Control No. 3265-0006 2 Expiration Date 5/31/2013 

Instructions for Completing the 2012 Election Administration & Voting Survey 

1. This survey collects information on election administration issues in local election offices (typically counties or townships) 

that are responsible for the administration of the November 2012 general election. As such, all data should be reported at the 

level of the local jurisdiction. However, the State or Territorial level election office may fill out any or all of the information on 

behalf of the local election offices under its jurisdiction. 

2. Do not leave items blank - always provide an answer to the question asked using the “Data not available” or “Other” 

categories discussed below, if needed. 

3. Use the “Data not available” box if the question asks for details that are not required by your state law or the question asks 

for information that is not currently collected. 

4. You may find it helpful to read an entire section before answering any of the questions in that section. 

5. Please attempt to record data according to the categories as they are defined in the question. If your jurisdiction uses a 

different data classification scheme (for instance, collects data in such a way that combines two or more categories listed in a 

question), you can use the space provided for “Other” to provide numbers and details on these categories. Use as many 

“Other” categories as you need to adequately report the relevant statistics for your jurisdiction. If you enter information into the 

“Other” field, please use the comments field to provide an explanation for the answer. 

In the example below, the jurisdiction does not collect separate statistics on the number of duplicate and rejected registration 

forms, but instead has only one number that represents the total number of registration forms that are either duplicated/or 

rejected. 

EXAMPLE: 

A5. In order to evaluate the workflow of your office over the last election cycle, enter the total number of registration 

forms your jurisdiction received from all sources during the period from the close of registration for the November 

2010 general election until the close of registration for the November 2012 general election. Include here any Election 

Day or Same Day registrations, if applicable. Also include any special categories of voters who may have extended 

deadlines, such as returning military personnel, if applicable. 

A5a. Total .......................................................................................... 5000 Data not 

available 

 Next, divide the total number of registration application forms received (as entered in A5a) into the following categories. 

The amounts should sum to the total provided in A4a. 

Data not 

available 

▼

 A5b. New registrations ................................................................................................. 4000 ............ 

 A5c. Invalid or rejected (other than duplicates) ............................................................. ............ 

 A5d. Duplicate of existing registration .......................................................................... ............ 

 A5e. Changes to name, party or within-jurisdiction address change ............................. 500 ............ 

 A5f. Moved into jurisdiction but was registered elsewhere in the state .......................... 200 ............ 

 A5g. Other→ comments: duplicate and invalid registrations combined ........................ 300 

 A5h. Other→ comments: _ .................................................. 

 TOTAL .......................................................................................................................... 5000 
OMB Control No. 3265-0006 3 Expiration Date 5/31/2013 

SECTION A VOTER REGISTRATION

EAC is mandated by the National Voter Registration Act (NVRA) to collect information from states concerning the 

impact of that statute on the administration of Federal elections. With this information EAC is required to make a 

report to Congress and provide recommendations for the improvement of Federal and State procedures, forms, and 

other NVRA matters. States that timely respond to all questions in this survey concerning voter registration related 

matters will meet their NVRA reporting requirements under 42 U.S.C. § 1973gg-7 and EAC regulations. 

Roadmap to Section A: 

• A1, A2 and A3 ask for information about the number of registered voters in your jurisdiction and how you calculate 

those statistics. 

• A4 asks for information about registration activity on days in which it was possible for a person to both register and 

vote on the same day. 

• A5 asks for information on all registration forms for all types of registration transactions (successful and 

unsuccessful) received by your office. 

• A6 asks for the sources of all registration forms (both successful and unsuccessful). 

• A7 asks for the sources of new registrations. 

• A8 asks for the sources of duplicate registrations. 

• A9 asks for the sources of invalid or rejected registrations. 

• A10 asks for information on removal notices sent under NVRA Section 8(d) 2. 

• A11 asks for the number of voters removed from the voter registration rolls and the reason for their removal. 

A1. Enter the total number of persons in your jurisdiction who were registered and eligible to vote in the November 

2012 general election. Include all persons eligible to vote in the election including special categories of voters with 

extended deadlines (such as returning military). Do not include any persons under the age of 18 who may be registered 

under a “pre-registration” program.

 A1a. Total ....................... Data not available 

A1 Comments 

A2. When you report the number of registered voters in your jurisdiction for the November 2012 general election (as in 

A1a) do you include both active and inactive voters in the count, or does your jurisdiction only include active

voters? (Select only one) 

 A2a. Jurisdiction uses both active and inactive registered voters .............................................................. 

 A2b. Jurisdiction only uses active registered voters ................................................................................... 

 A2c. Other → comments: ____________________ ................................................................................... 

 

A2 Comments 

 

 
OMB Control No. 3265-0006 4 Expiration Date 5/31/2013 

A3. Enter the total number of persons who were registered and eligible to vote in the November 2012 general election 

into the following categories. Do not include any persons under the age of 18 who may be registered under a “pre-registration” 

program. 

Data not 

available 

▼

A3a. Active ....................................................................................... .......................................... 

A3b. Inactive .................................................................................... .......................................... 

A3 Comments 

A4. If your state’s laws allowed any voters to register and then to vote on the same day, enter the total number of 

registration forms received on those days in which it was possible to both register for and vote in the November 

2012 general election on the same day. This question includes jurisdictions in states that have formal Election Day 

Registration or Same Day Registration and those states that have other situations that provide Election Day Registration or 

Same Day Registration. This question includes jurisdictions in states that permit Election Day Registration for voting for 

office of President, such as Connecticut and Rhode Island.

A4a. Total new Same Day registrations... ........................... Data not available 

 ................................................................................................................................... Not applicable 

A4b. Are the numbers you provided for question A4a because your state allows Election Day Registration or Same 

Day Registration for all voters, or does your answer come from a different circumstance? 

 .....Yes, our state has Election Day Registration or Same Day Registration. 

 

.... No, our state does not have formal Election Day Registration or Same Day Registration, but some voters were able to 

 register and vote on the same day for the 2012 election. 

 

.... Other  comments: ________________________________ 

.... Not applicable. 

A4 Comments 

 

 
OMB Control No. 3265-0006 5 Expiration Date 5/31/2013 

A5. In order to evaluate the workflow of your office over the last election cycle, enter the total number of forms your 

jurisdiction received from all sources during the period from the close of registration for the November 2010 general 

election until the close of registration for the November 2012 general election. Include any forms that were processed, 

such as changes to name, party or address, duplicates, or pre-registrations. Include here any Election Day or Same Day 

registrations, if applicable. Also include any special categories of voters who may have extended deadlines such as returning 

military personnel, if applicable. 

A5a. Total ........................................................................................ Data not 

available 

 Next, divide the total number of registration application forms received (as entered in A5a) into the following 

categories. The amounts should sum to the total provided in A5a. 

Data not available 

▼

A5b. New valid registrations (excluding pre-registrations of persons under 18) ... .................. 

A5c. New “pre” registrations of persons under age 18 ........................................ .................. 

 A5d. Duplicate of existing valid registration .......................................................... .................. 

A5e. Invalid or rejected (other than duplicates) .................................................... .................. 

A5f. Changes to name, party or within-jurisdiction address change .................... .................. 

A5g. Address changes that cross jurisdiction borders .......................................... .................. 

A5h. Other → comments: ____________________ ............................................ 

A5i. Other → comments: ____________________ ............................................ 

A5j. Other → comments: ____________________ ............................................ 

A5k. Other → comments: ____________________ ............................................ 

A5l. Other → comments: ____________________ ............................................ 

TOTAL ............................................................................................................. A5a 

A5 Comments 

 
OMB Control No. 3265-0006 6 Expiration Date 5/31/2013 

A6a through A6o: Divide the total number of all registration forms received (as entered in A5a) into the following sour

A7a through A7o: Divide the total number of new registration forms received (as entered in A5b) into the following sou

A8a through A8o: Divide the total number of duplicate registration forms received (as entered in A5d) into the followin

A9a through A9o: Divide the total number of invalid or rejected registration forms (as entered in A5e) received into the 

 (from A5a) (from A5b) (from A5d) 

*Sub-question “e” should include all forms handled through the public assistance agency process (i.e., paper, online). A6. Total forms 

received 

A7. New 

registrations 

A8. Duplicate o

existing 

registrations 

NA NA NA 

▼ ▼ ▼ 

a. Individual voters submitting applications by mail, fax, or email ................b. Individual voters registering in person at the election/registrar’s office ................................c. Individual voters submitting registration forms via the Internet .................d. Motor vehicle offices or other offices that issue drivers licenses ................................e.

*

 Public assistance offices mandated as registration sites under NVRA ................................

f. State funded agencies primarily serving persons with disabilities ................................g. Armed forces recruitment offices ..............................................................h. Other agencies designated by the State not mandated by NVRA ................................i. Registration drives from advocacy groups or political parties ..................j. Other → comments: _______________________________ .................k. Other → comments: _______________________________ ...............l. Other → comments: ______________________________ ...............m. Other → comments: _______________________________ ...............n. Other → comments: ______________________________ ...............o. Other → comments: _______________________________ ...............TOTAL ............................................................................................................. A5a A5b A5d 
OMB Control No. 3265-0006 7 Expiration Date 5/31/2013

 A6, A7, A8, and A9 Comments 

A10. Enter the total number of confirmation notices sent to voters in the period between the close of registration for the 

 November 2010 general election and the close of registration for the November 2012 general election, because the 

 person had not voted or appeared to vote in the two previous federal elections (per NVRA Section 8 (d) (2)). 

 

A10a. Total ................. ... Data not available 

 Next, divide the total number of confirmation notices mailed (as entered in A10a) into the following categories. The 

amounts should sum to the total provided in A10a. 

Data not available 

▼

A10b. Received back from voters confirming registration ............................................... ....... 

 A10c. Received back confirming registration should be invalidated ................................ ....... 

A10d. Returned back as undeliverable ............................................................................ ....... 

A10e. Status unknown (neither received confirmation nor returned undeliverable) ......... ....... 

A10f. Other → comments: ____________________ ..................................................... 

A10g. Other → comments: ____________________ ..................................................... 

A10h. Other → comments: ____________________ ..................................................... 

TOTAL ........................................................................................................................ A10a 

A10 Comments 

 

 
OMB Control No. 3265-0006 8 Expiration Date 5/31/2013

A11. Enter the total number of voters removed from the voter registration rolls in your jurisdiction in the period between 

the close of registration for the November 2010 general election and the close of registration for the November 2012 

general election. Note this question asks for those ineligible to vote, not merely those moved into an “inactive” status. 

A11a. Total ........... .... Data not available 

 Next, divide the total number of voters removed (as entered in A11a) into the following categories. The amounts 

should sum to the total provided in A11a. 

Data not available 

▼

A11b. Moved outside jurisdiction .......................................................................... .................. 

A11c. Death.......................................................................................................... .................. 

A11d. Disqualifying felony conviction ................................................................... .................. 

A11e. Failure to respond to notice sent and failure to vote in the two most recent 

 federal elections ......................................................................................... .................. 

 A11f. Declared mentally incompetent ................................................................... .................. 

A11g. Voter requested to be removed for reasons other than felony conviction, 

 mental status, or moved outside jurisdiction .............................................. .................. 

A11h. Other → comments: ____________________ .......................................... 

A11i. Other → comments: ____________________ .......................................... 

A11j. Other → comments: ____________________ .......................................... 

A11k. Other → comments: ____________________ .......................................... 

TOTAL ............................................................................................................. A11a 

A11 Comments 

 
OMB Control No. 3265-0006 9 Expiration Date 5/31/2013

SECTION B UNIFORMED & OVERSEAS CITIZENS ABSENTEE VOTING ACT (UOCAVA)

Section B serves as the EAC’s standardized format for the state reporting of UOCAVA voting information as 

required by 42 U.S.C. §1973ff-1. States that complete and timely submit this section to the EAC will fulfill their 

UOCAVA reporting requirement under 42 U.S.C §1973ff-1(c). 

Pursuant UOCAVA, this section collects various data elements needed to determine: (1) the combined number of 

absentee ballots transmitted to UOCAVA voters; (2) the combined number of ballots returned by UOCAVA voters; 

and (3) the combined number of returned ballots cast by UOCAVA voters (the number of cast ballots is practically 

determined by collecting data concerning the total votes counted and rejected). 

Roadmap to Section B: 

• B1 and B2 ask for information about the number and type of UOCAVA absentee ballots transmitted. 

• B3 asks for the number and type of all UOCAVA ballots returned and submitted for counting.

• B4, B5, B6, and B7 asks for information on the type of UOCAVA ballot returned by type of UOCAVA voter. 

• B8 asks for the number and type of all UOCAVA ballots counted.

• B9, B10, B11, and B12 asks for information on the type of UOCAVA ballot counted by type of UOCAVA voter. 

• B13 asks for the number and type of all UOCAVA ballots rejected.

• B14 asks for information on reasons why UOCAVA ballots were rejected. 

• B15, B16, B17, and B18 asks for information on the type of UOCAVA ballot rejected by type of UOCAVA voter. 

B1. Enter the total number of absentee ballots transmitted to UOCAVA voters for the November 2012 general election. 

 B1a. Total ................... ... Data not available 

 Next, divide the total number of absentee ballots transmitted to UOCAVA voters (as entered in B1a) into the 

following categories. The amounts should sum to the total provided in B1a. 

Data not available 

▼

B1b. Uniformed services voters – domestic or foreign ......................................... .................. 

B1c. Non-military/civilian overseas voters ............................................................ .................. 

B1d. Other → comments: ____________________ ........................................... 

B1e. Other → comments: ____________________ ........................................... 

TOTAL ............................................................................................................. B1a 

B1 Comments 

 
OMB Control No. 3265-0006 10 Expiration Date 5/31/2013

B2. Of the UOCAVA absentee ballots transmitted (as entered in B1a) how many were: 

 

Data not available 

▼

B2a. Returned by voter and submitted for counting (include both those that 

 were counted and those that were rejected) ........................................................ .................. 

 B2b. Returned as undeliverable .......................................................................... .................. 

B2c. Spoiled or replaced ballots ........................................................................... .................. 

B2d. Status unknown (neither returned undeliverable nor returned from voter) ... .................. 

 B2e. Other → comments: ____________________ ........................................... 

B2f. Other → comments: ____________________ ............................................ 

 B2g. Other → comments: ____________________ ........................................... 

 TOTAL ............................................................................................................. B1a 

B2 Comments 

B3. Enter the total number of all UOCAVA ballots (including regular UOCAVA absentee ballots and Federal Write-in 

Absentee Ballots (FWAB)) returned by UOCAVA voters and submitted for counting for the November 2012 general 

election. Please include both those ballots that were later counted and those that were rejected. Do not include ballots that 

were returned undeliverable.

 B3a. Total .................... ..... Data not available 

B3 Comments 

 

 
OMB Control No. 3265-0006 11 Expiration Date 5/31/2013

B4a through B4c. Divide the total number of UOCAVA ballots returned by UOCAVA voters and submitted for counting

(as entered in B3) into each category of UOCAVA voter below. 

Next, for each type of UOCAVA voter, enter the number of: 

• B5a through B5c: Regular UOCAVA absentee ballots returned and submitted for counting. 

• B6a through B6c: FWAB returned and submitted for counting. 

• B7a through B7c: Other type of ballots returned and submitted for counting. 

Of the total UOCAVA ballots returned (as entered in B3), 

how many were ballots of each of the following ballot types: 

B4. All UOCAVA 

ballots 

B5. Absentee 

ballots 

B6. FWAB B7. Other type of 

ballot → 

NA NA NA NA 

▼ ▼ ▼ ▼

Type of UOCAVA voter: 

a. Uniformed services voters – domestic or 

foreign 

 

b. Non-military/civilian overseas voters ................................ 

 

c. Other type of voter→ ................................................................ 

comments: 

TOTAL B3 

B4, B5, B6, and B7 Comments 

B8. Enter the total number of all UOCAVA ballots (including regular UOCAVA absentee ballots and FWAB) counted in 

the November 2012 general election. 

B8a. Total ....................... Data not available 

B8 Comments 

 

 
OMB Control No. 3265-0006 12 Expiration Date 5/31/2013

B9a through B9c. Divide the total number of UOCAVA ballots counted (as entered in B8) into each category of 

UOCAVA voter below. 

Next, for each type of UOCAVA voter, enter the number of: 

• B10a through B10c: Regular UOCAVA absentee ballots counted. 

• B11a through B11c: FWAB counted. 

• B12a through B12c: Other type of ballots counted. 

 

Of the total UOCAVA ballots counted (as entered in B8), 

how many were ballots of each of the following ballot types: 

B9. All 

UOCAVA 

ballots 

B10. Absentee 

ballots 

B11. FWAB B12. Other type 

of ballot →

NA NA NA NA 

▼ ▼ ▼ ▼

Type of UOCAVA voter:

 

a. Uniformed services voters – domestic or 

foreign ................................................................

 

b. Non-military/civilian overseas voters ................................

 

c. Other type of voter → ...............................................................

 comments: _________________________ 

 TOTAL .........................................................................................

B8 

B9, B10, B11 and B12 Comments 

B13. Enter the total number of UOCAVA ballots (including regular UOCAVA absentee ballots and FWAB) rejected in 

 the November 2012 general election. 

B13a. Total .......................... Data not available 

B13 Comments 

 

 
OMB Control No. 3265-0006 13 Expiration Date 5/31/2013

B14. Please divide the total number of all UOCAVA ballots rejected (as entered in B13a) into the following 

categories indicating the reason the absentee ballots were rejected. The amounts should sum to the total provided in 

B13a. 

Data not available 

▼

B14a. Ballot not received on time/missed deadline. .............................................. ................. 

B14b. Problem with voter signature....................................................................... ................. 

B14c. Ballot lacked a postmark ............................................................................. ................. 

 B14d. Other → comments: ________________________________ .................. 

B14e. Other → comments: ________________________________ ................... 

B14f. Other → comments: ________________________________ .................. 

TOTAL ................................................................................................................... B13a 

B14 Comments 

B15a through B15c. Divide the total number of UOCAVA ballots rejected (as entered in B13) into each category of 

UOCAVA voter below. 

Next, for each type of UOCAVA voter, enter the number of: 

• B16a through B16c: Regular UOCAVA absentee ballots rejected. 

• B17a through B17c: FWAB rejected. 

• B18a through B18c: Other type of ballots rejected. 

Of the total UOCAVA ballots rejected (as entered in B13), 

how many were ballots of each of the following ballot types: 

B15. All 

UOCAVA 

ballots 

B16. Absentee 

ballots 

B17. FWAB B18. Other type of 

ballot → 

NA NA NA NA 

▼ ▼ ▼ ▼

Type of UOCAVA voter:

 

a. Uniformed services voters – domestic or 

foreign ................................................................

 

 

b. Non-military/civilian overseas voters ................................

 

 

c. Other type of voter → ................................................................ 

comments ____________________________ 

TOTAL ................................................................................................ B13 

 

B15, B16, B17, and B18 Comments 

 

 

 
OMB Control No. 3265-0006 14 Expiration Date 5/31/2013

SECTION C Domestic Civilian Absentee Ballots

Roadmap to Section C. 

• C1 asks for information about absentee ballots transmitted and the status of the transmitted ballots.

• C2 and C3 ask for information on any voters who may be registered as permanent absentee voters.

• C4 asks for information on the status of absentee ballots returned and submitted for counting. 

• C5 asks for information on the reasons absentee ballots were rejected.

C1. Enter the total number of domestic civilian absentee ballots transmitted to voters for the November 2012 general 

election. Do not include absentee ballots transmitted to UOCAVA voters 

 C1a. Total .................... .... Data not available 

 Next, divide the total number of absentee ballots transmitted to voters (as entered in C1a) into the following 

categories. The amounts should sum to the total provided in C1a. 

Data not available 

▼

C1b. Returned by voters and submitted for counting (include both 

 those that were later counted and those that were rejected) ........................ ................. 

 C1c. Returned as undeliverable ........................................................................... ................. 

C1d. Spoiled or replaced ballots ........................................................................... ................. 

 C1e. Status unknown (neither returned undeliverable nor returned from voter) .... ................. 

C1f. Other → comments: ____________________ ............................................ 

C1g. Other → comments: ____________________ ............................................ 

C1h. Other → comments: ____________________ ............................................ 

 TOTAL ............................................................................................................. C1a 

C1 Comments 

C2. Does your jurisdiction have a permanent absentee voter registration list in which voters may apply to receive an 

absentee (or mail) ballot for subsequent elections without further application? Do not include UOCAVA voters. 

 ....... Yes → Continue to question C3. 

 ....... No → Skip to question C4. 

C2 Comments 

 

 
OMB Control No. 3265-0006 15 Expiration Date 5/31/2013

C3. Of the total number of domestic civilian absentee ballots transmitted (as entered in C1) how many ballots were 

sent to voters in your jurisdiction because they appear on a permanent absentee (or mail) ballot voter

registration list? 

Total ............................. ..... Data not available 

C3 Comments 

C4. Of the total number of absentee ballots returned by voters and submitted for counting (as entered in C1b) how 

many ballots were: 

Data not available 

▼

C4a. Counted in the November 2012 general election .......................................... ................. 

 C4b. Rejected in the November 2012 general election ......................................... ................. 

C4c. Other → comments: ____________________ ............................................ 

C4d. Other → comments: ____________________ ............................................ 

TOTAL ............................................................................................................. C1b 

C4 Comments 

 

 
OMB Control No. 3265-0006 16 Expiration Date 5/31/2013

C5. Please divide the total number of domestic civilian absentee ballots rejected (as entered in C4b) into the following 

categories indicating the reason why the absentee ballots were rejected. The amounts should sum to the total 

provided in C4b. 

Data not available 

▼

C5a. Ballot not received on time/missed deadline. ................................................ ................. 

C5b. No voter signature ......................................................................................... ................. 

C5c. No witness signature ..................................................................................... ................. 

C5d. Non-matching signature ................................................................................ ................. 

C5e. No election official’s signature on ballot ........................................................ ................. 

C5f. Ballot returned in an unofficial envelope ........................................................ ................. 

C5g. Ballot missing from envelope ........................................................................ ................. 

C5h. Envelope not sealed ..................................................................................... ................. 

C5i. No resident address on envelope ................................................................... ................. 

C5j. Multiple ballots returned in one envelope. ...................................................... ................. 

C5k. Voter deceased. ............................................................................................ ................. 

C5l. Voter already voted in person ........................................................................ ................. 

C5m. First-time voter without proper identification ................................................ ................. 

C5n. No ballot application on record...................................................................... ................. 

C5o. Other → comments: ________________________________ .................... 

C5p. Other → comments: ________________________________ .................... 

C5q. Other → comments: ________________________________ .................... 

C5r. Other → comments: ________________________________ .................... 

C5s. Other → comments: ________________________________..................... 

C5t. Other → comments: ________________________________ .................... 

C5u. Other → comments: ________________________________ .................... 

C5v. Other → comments: ________________________________..................... 

TOTAL ............................................................................................................. C4b 

C5 Comments 

 
OMB Control No. 3265-0006 17 Expiration Date 5/31/2013

SECTION D Election Administration

• D1 asks for information on the number of precincts in your jurisdiction 

• D2 asks for information on the number and type of polling places in your jurisdiction 

• D3, D4, and D5 ask for information on poll workers utilized in the November 2012 general election. 

D1. Enter the total number of precincts in your jurisdictions for the November 2012 general election. 

D1a. Total ...................... ..... Data not available 

D1 Comments 

D2. Enter the total number of physical polling places in your jurisdiction for the November 2012 general election. 

Please include physical polling places in operation on Election Day and physical polling places in operation before 

Election Day (such as early vote centers). 

D2a. Total ...................... .... Data not available 

 Next, divide the total physical polling places in your jurisdiction (as entered in D2a) into the following categories. 

The amounts should sum to the total provided in D2a. If you do not include election offices in your count of polling places, 

enter 0. 

Data not available 

▼

Election Day voting

D2b. Physical polling places other than election offices ........................................ ................. 

D2c. Election offices .............................................................................................. ................. 

 D2d. Other → comments: ________________________________ .................... 

Early voting

D2e. Physical polling places other than election offices ........................................ ................. 

D2f. Election offices .............................................................................................. ................. 

D2g. Other → comments: ________________________________ .................... 

 TOTAL .......................................................................................................................... D2a 

D2 Comments 

 

 
OMB Control No. 3265-0006 18 Expiration Date 5/31/2013

D3. Enter the total number of poll workers used in your jurisdiction for the November 2012 general election. 

• Poll workers may include election judges, booth workers, wardens, commissioners, or other similar terms that refer to 

persons who verify the identity of a voter; assist the voter with signing the register, affidavits or other documents 

required to cast a ballot; assist the voter by providing the voter with a ballot or setting up the voting machine for the 

voter; and serving other functions as dictated by State law. 

• Include all people recruited specifically for the purposes of working at physical polling places in operation on and/or 

before Election Day, but, do not include observers stationed at the polling places or regular office staff. 

D3a. Total ................... .... Data not available 

D3 Comments 

D4. If your jurisdiction has data on the ages of its poll workers (for example, from voter registration records, payroll 

records or from poll worker applications), enter the total number of poll workers in each age category. 

 D4a. Under 18 years old ....................................................................................... 

 D4b. 18 to 25 ........................................................................................................ 

D4c. 26 to 40 ......................................................................................................... 

 D4d. 41 to 60......................................................................................................... 

D4e. 61 to 70 ......................................................................................................... 

D4f. 71 years old and over .................................................................................... 

 Data not available 

D4 Comments 

D5. How difficult or easy was it for your jurisdiction to obtain a sufficient number of poll workers for the November 

2012 general election? 

....... Very difficult 

....... Somewhat difficult 

....... Neither difficult nor easy 

....... Somewhat easy 

....... Very easy 

....... Not enough information to answer 

D5 Comments 

 

 

 
OMB Control No. 3265-0006 19 Expiration Date 5/31/2013

SECTION E Provisional Ballots

• E1 asks for the information on the number and status of provisional ballots submitted. 

• E2 asks for the information on reasons why provisional ballots were rejected.

E1. Enter the total number of voters who submitted provisional ballots in the November 2012 general election. 

E1a.Total ....................... .... Data not available 

Next, divide the total number of voters who submitted provisional ballots in the November 2012 general election (as 

entered in E1) into the following categories. 

Data not available 

▼

E1b. Counted the full ballot ................................................................................... 

 E1c. Counted part of the ballot .............................................................................. 

 E1d. Rejected ballot .............................................................................................. 

E1e. Other → comments: ____________________ ............................................. 

E1f. Other → comments: ____________________ ............................................. 

TOTAL ............................................................................................................. E1a 

E1 Comments 

 
OMB Control No. 3265-0006 20 Expiration Date 5/31/2013

E2. Please divide the total number of provisional ballots rejected (as entered in E1d) into the following categories 

indicating the reason the provisional ballots were rejected. The amounts should sum to the total provided in E1d. 

Data not available 

▼

 E2a. Voter not registered in the state .................................................................... 

E2b. Voter registered in state but attempted to vote in the wrong jurisdiction ....... 

E2c. Voter registered in state but attempted to vote in the wrong precinct ............ 

E2d. Failure to provide sufficient identification ...................................................... 

E2e. Envelop and/or ballot was incomplete and/or illegible ................................... 

E2f. Ballot missing from envelope ......................................................................... 

E2g. No signature .................................................................................................. 

E2h. Non-matching signature ................................................................................ 

E2i. Voter already voted ........................................................................................ 

E2j. Other → comments: ________________________________ ................... 

E2k. Other → comments: ________________________________ ................... 

E2l. Other → comments: ________________________________ ................... 

E2m. Other → comments: ________________________________ ................... 

E2n. Other → comments: ________________________________ ................... 

E2o. Other → comments: ________________________________ ................... 

E2p. Other → comments: ________________________________ ................... 

 

 TOTAL ................................................................................................................... 

E2 Comments 

 E1d

 
OMB Control No. 3265-0006 21 Expiration Date 5/31/2013

SECTION F Election Day Activities

• F1 and F2 ask for turnout figures for the November 2012 general election and the source used to arrive at this 

number. 

• F3 asks for the number of first time voters who registered to vote by mail and, under HAVA 303(b), were required to 

provide identification in order to vote. 

• F4 asks for information on electronic poll books or electronic lists of voters that may have been used. 

• F5 and F6 ask for information on printed poll books or printed lists of voters that may have been used. 

• F7 asks for the type of primary voting equipment used. 

• F8 solicits any additional comments jurisdictions may wish to share regarding their Election Day experiences. 

F1. Enter the total number of people in your jurisdiction who participated in the November 2012 general election. 

Include all type of voters (civilian and military) by all types of ballots. Include rejected provisional ballots only if your 

jurisdiction credits the person’s vote history even though the provisional ballot was rejected. 

F1a. Total ........................ .... Data not available 

 Next, divide the total number people who participated in the November 2012 general election (as entered in F1a) 

into the following categories. The amounts should sum to the total provided in F1a. 

Data not available 

▼

F1b. Voted at a physical polling place on Election Day (not including provisional ballots 

or absentee ballots dropped off at the polls). ......................................................... 

F1c. UOCAVA voters who voted via absentee or FWAB (as in B2a) .................... 

 F1d. Voted using a domestic civilian absentee ballot (as in C1b) .......................... 

F1e. Voted using a provisional ballot (as in E1) ..................................................... 

 F1f. Voted at an early vote center (as in D2e,f,g)........................................... 

F1g. Voted by mail in a vote by mail jurisdiction .................................................... 

F1h. Other → comments: ____________________ ............................................. 

F1i. Other → comments: ____________________ ............................................. 

F1j. Other → comments: ____________________ ............................................. 

TOTAL ............................................................................................................. F1a 

F1 Comments 

 
OMB Control No. 3265-0006 22 Expiration Date 5/31/2013

F2. Indicate the source used to arrive at the total number of voters entered in F1a. (Select only one source.) 

....... Number of voters checked off by poll workers or who signed poll books at physical polling places plus the 

number of UOCAVA and other absentee or early voters. 

....... Number of ballots counted at precincts and/or at a central location (including UOCAVA and other absentee or 

early vote ballots) 

....... Number of voters generated after "vote history" has been added. 

....... Number of votes cast for the highest office on the ballot. 

....... Other:→ comments: ________________________________ 

F2 Comments 

F3. HAVA 303(b) states that all first-time voters in a State who registered to vote by mail are required to provide 

identification in order to vote and have their ballot counted. Enter the number of first-time voters who provided 

identification and were able to vote in the November 2012 general election in your jurisdiction. 

Total ........... Data not available ........... Not applicable 

F3 Comments 

F4. Were electronic poll books or electronic lists of voters used at the polling place for the November 2012 general 

election in your jurisdiction to (select either Yes or No for each item): 

 Yes No

 a. Sign voters in ....................................................................... 

b. Update voter history ............................................................. 

c. Look up polling places .......................................................... 

d. Other → comments: _____________________________ . 

e. Information unavailable ........................................................ 

 

F4 Comments 

 

 

 
OMB Control No. 3265-0006 23 Expiration Date 5/31/2013

F5. Did your jurisdiction use printed lists of registered voters at the polls in the November 2012 Federal general 

election? 

Yes ............................................ → Continue to F6 

 No .............................................. → Skip to F7 

 Information unavailable .............. → Skip to F7 

F5 Comments 

F6. Did your state print and ship the printed poll books to your local jurisdiction or did your jurisdiction arrange for 

the printing of the poll books? (Select only one.) 

State printed poll books and shipped to jurisdiction ......................................

 Jurisdiction arranged for printing of poll books .............................................

 Combination of printing by the state and local jurisdiction ...........................

 Information unavailable ................................................................................ 

F6 Comments

 

 
OMB Control No. 3265-0006 24 Expiration Date 5/31/2013 

F7. Enter information on the number and type of voting equipment used for the 2012 November general election. Then, for each typ

please identify how the machines were used in the voting process and where the ballots from that machine type were tallied. D

that were not actually used.

Type of Equipment Number used Make Model Version Vendor Machine use (select all that apply) F7a. Direct Recording Electronic (DRE) (Not Equipped with Voter 

Verified Paper Audit Trail (VVPAT))

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Not Available 

F7b. Direct Recording Electronic (DRE) (Equipped with VVPAT) 

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting Early Vote Site voting  Not Available 
OMB Control No. 3265-0006 25 Expiration Date 5/31/2013 

Type of Equipment Number used Make Model Version Vendor Machine use (select all that apply) F7c. Electronic system 

that prints voter choices on an optical scan ballot (hybrid of a DRE and an optical scan system) 

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Not Available 

F7d. Optical/Digital Scan

Number of counters: ______ Number of booths: ______ 

 Not 

Available Not Available Not Available Not Available Not Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Absentee  Not Available 
OMB Control No. 3265-0006 26 Expiration Date 5/31/2013 

Type of Equipment Number 

used 

Make Model Version Vendor Machine use 

(select all that apply)

F7e. Punch Card

Number of counters: ______ Number of booths: ______ 

 Not 

Available Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Absentee  Not Available 

F7f. Lever

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Early Vote Site voting  Not Available 
OMB Control No. 3265-0006 27 Expiration Date 5/31/2013 

Type of Equipment Number 

used 

Make Model Version Vendor Machine use 

(select all that apply)

F7g. Hand-counted paper ballots (not optical scan system)

Number of 

booths: 

______ 

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Absentee  Not Available 

F7h. Other

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Absentee  Not Available 
OMB Control No. 3265-0006 28 Expiration Date 5/31/2013 

F8. The U.S. Election Assistance Commission welcomes any general comments the jurisdiction may wish to share regarding it(e.g., problems with voting system anomalies*, recounts, staffing, challenges to eligibility, long lines, etc.), or note worthy succNovember 2012 general election. Please feel free to attach additional pages as necessary. 

 * An anomaly is defined as an irregular or inconsistent action or response from the voting system or system component resulting in some 

process. Incidents resulting from administrator error or procedural deficiencies are not considered anomalies for purposes of this survey 

Testing and Certification Program Manual). 

Type of Equipment Number 

used 

Make Model Version Vendor Machine use 

(select all that apply)

F7i. Other

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 Not 

Available

 In-Precinct regular ballot voting  Special Device accessible to disabled vo Provisional Ballot voting  Early Vote Site voting  Absentee  Not Available 
OMB Control No. 3265-0006 29 Expiration Date 5/31/2013 

END OF SURVEY 

THANK YOU FOR RESPONDING TO THIS SURVEY 

* This information collection is required for the U.S. Election Assistance Commission (EAC) to meet its statutory requirements under the H

(HAVA) of 2002 (42 U.S.C. 15301), the National Voter Registration Act (NVRA) (42 U.S.C. 1973gg-1 et seq.), and the Uniformed and Ov

Voters Act (UOCAVA) (42 U.S.C. 1973ff-1). Respondent’s obligation to reply to this information collection is mandatory as required undeet seq.) and UOCAVA (42 U.S.C. 1973ff-1); respondents include the 50 States, the District of Columbia, and the U.S. Territories. This infoavailable on the EAC Web site (http://www.eac.gov). According to the Paperwork Reduction Act of 1995, an agency may not conduct or sp

required to respond to, a collection of information unless it displays a valid Office of Management and Budget (OMB) control number. The for this information collection is OMB Control No. 3265-0006 (expires 5/31/2013). The time required to complete this information collectiohours per State response. This estimate includes the time for reviewing the instructions, gathering information, and completing the form. Coestimate should be sent the U.S. Election Assistance Commission – 2012 Election Administration and Voting Survey, 1201 New York AvenDC 20005.