NATCHEZ — The 10-form questionnaire that will soon appear in your mailbox has dollar signs attached.

Filling out the 2010 U.S. Census form won’t cost you anything, but a form left blank could cost the Miss-Lou, officials said.

Federal cash appropriations for roadwork, schools and community services are based on population tallies gathered by the U.S. Census Bureau.

Representation in local and state government bodies also depends on the census.

A low count could mean Mississippi and Louisiana lose money and representatives and senators in state and national congresses.

And so it’s especially important for Concordia Parish residents to fill out their census form, as Louisiana is expected to reflect a declining population, Vidalia Mayor Hyram Copeland said.

“We could lose a congressman in this census,” Copeland said. “If we lose population in the north part of the state, we could have one congressman instead of two, and we don’t want that to happen.”

Adams County and Southwest Mississippi have already been down that road, Rep. Robert Johnson, D-Natchez, pointed out. The state lost a congressional seat in the last census.

But Johnson said he hopes enough people fill out and return their census forms so the state can reclaim its fifth congressional seat.

Johnson said if residents want more money or jobs in the area or want a better way of life in Adams County, they should make themselves counted in the census.

This year’s census is one of the shortest ever, containing only 10 questions. The questions are all basic questions about demographical information including age, race and gender.

“(The census) does a lot of surveys, how many women you have in your parish, how many men, how many people are younger than 18, what is the per capita income, and those factors are weighed when we sit down and talk to industries and businesses, and those are all information we get from these census counts,” Copeland said.

The federal government allocates $400 billion based on census counts.

Johnson said the federal money goes where the people are.

“Look at the fastest growing counties, DeSoto and Madison, that is where the money for roads is,” he said. “The government sends money where the need is and where the population is rising.

“Everybody needs to be counted so we can keep our numbers up, so we can keep our foot in the door as far as what is given to us.”

Vidalia City Coordinator Larry Chauvin said that every person who is not counted in the census could cost the area $1,200 a year in federal funding for 10 years.

“That kind of money adds up very quickly,” he said.

Former Natchez Mayor Phillip West, who has joined forces with others to promote the census, said the count also determines the number of supervisors and aldermen for each area.

Forms will be mailed out Wednesday, and must be returned by April.

Residences from which a form is not returned will be visited in person by a census worker in April.

Residences with no clear address or those in rural areas that may have unknown addresses will be visited by census workers.

Nursing homes, colleges and other group living areas will be visited by census workers in April.

Returning a completed census form is required by law.

Census worker Kelvin Rankin stressed that the government is not trying to simply be nosy nor will it share private information with anyone.

“If I give out somebody’s information, that is a $250,000 fine and potential prison time,” he said.

After 72 and a half years, Rankin said the U.S. Census Bureau releases the information to the national museum for genealogy purposes, but no individual information is released prior to that point.

Information is not shared with law enforcement, immigration agents or welfare agencies, Rankin said.

“We are just looking to get the number of residents in the county.”

West said the process should be completed by July.

“I don’t know of any downside in participating myself,” he said. “There is no part of the census that will adversely impact anybody.”

To learn more about the census, visit the official 2010 census Web site at 2010.census.gov.