Form QID 2006 Integrated Screening Survey

6

Project 905			OMB No. 0535-0218 Approval Expires 9/30/2008
	2006 INTEGRATED SCREENING SURVEY				NATIONAL AGRICULTURAL STATISTICS SERVICE

		National U.S. Department of Agriculture, Rm 5030, South Building 1400 Independence Ave., S.W. Washington, DC 20250-2000 Phone: 1-800-727-9540 Fax: 202-690-2090 Email: [email protected]
		Information requested on this report will be used to select a sample of growers to obtain agricultural data on resource management practices. Your voluntary cooperation is needed to ensure that all producers are represented in this state and national survey. As always, your response to this survey is confidential. Please return your report in the enclosed postage paid envelope. Thank you for your help.

1. Please make any needed corrections to the name, including the correct operation name, and mailing address on the label.

2. During 2006, will this operation grow crops, including field crops, fruits, vegetables,
nursery/greenhouse, or other specialty crops, cut hay, have any livestock or poultry, sell agricultural
products, receive government payments (CRP, WRP, etc.), have more than 19 acres of
idle cropland, or have more than 99 acres of pastureland?

	YES - Go to 2006 Total Acres Operated, below.
	NO – Complete items 2a and 2b; then go to Conclusion on back.
	2a. Has the operation name on the label been sold, rented, or turned over to someone else?
	YES	NO				Will the land be used for any agricultural purpose by you (the individual listed on the label), or anyone else in the next year?
						YES NO DON’T KNOW Please explain, then go to Conclusion on back page.
	2b. What is the name and address of the new operator?
	Operation Name_________________________________________				_________________________________________________________
	Operator Name__________________________________________				_________________________________________________________
	Address_________________________________________________				_________________________________________________________
	City____________________		State____________	Zip__________	_________________________________________________________
	Phone(___________________________________) _______________________________				_________________________________________________________

SECTION 1 - 2006 TOTAL ACRES OPERATED

(Complete section, then go to 2006 Value of Sales, next page.)

3. Considering the farmstead, all cropland, pastureland, wasteland, wetland, woodland and government program land, how many Total Acres does this operation---
	ACRES
a. Own?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +	901
b. Rent or Lease from others, including for Cash, Shares or Rent Free?. . . . . . . . . . . . . . . . . . . . +	902
c. Rent to others, including for Cash, Shares or Rent Free?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .–	905
4. Total Acres Operated: [item 3a +3b -3c]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =	900
5. Of the total [item 4] acres operated, how many acres are considered Cropland? (Include hay land, summer fallow, idle cropland, cropland pasture, and cropland in government programs.). . . . . . . . .	802

SECTION 5 - 2005 VALUE OF SALES

15. Considering

►Sales of all crops, livestock, poultry, and livestock products (milk, eggs, etc.) sold in 2005. ►The value of product removed for all crops, livestock, and poultry produced under contract in 2005. ►Sales of all miscellaneous agricultural products in 2005. ►All government agricultural payments received in 2005. ►Landlord’s share of government payments and crops sold in 2005.
Was the Gross Value of Sales for this farm or ranch in 2005: [Check box and enter code.] $1,000 or more [Enter code “2” in box 860, and go to Operation Type.] Between $1 - $999 [Enter code “1” in box 860, and complete table.] NONE [Enter code “99” in box 860, and complete table.]	GVS CODE	(Complete these items if the 2005 Gross Value of Sales was less than $1000.)
	860	Record all crops and other land uses, including cropland and pasture, on this operation in 2006.		Acres	Record all livestock and poultry that are NOW on this operation				Number
		________________________		________	_________________				___________
		________________________		________	_________________				___________
		________________________		________	_________________				___________

SECTION 6 - OPERATION TYPE

16. Are the day-to-day decisions for this operation made by one individual, a hired manager, or partners? [Check one] One individual - [Go to Conclusion, on back page.] A hired manager - [Go to Conclusion, on back page.] Partners – [Complete items 16a and 16b, then go to Conclusion, on back page.]
		Number
a. How many individuals, including the operator, are involved in the day-to-day decisions for this operation?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Please record partners’ names and addresses, then go to Conclusion, on back page. [Enter names and address of partners not already listed. Include partners who jointly operate land and share in decision making. Do not include landlords and tenants as partners.]
PARTNER 1				PARTNER 2
Partner name:_______________________________________________				Partner name:______________________________________________
Address____________________________________________________				Address:___________________________________________________
City:______________________	State:____________		Zip:__________	City:_____________________	State:____________		Zip:__________
Phone: (______)_____________				Phone: (______)_____________
PARTNER 3				PARTNER 4
Partner name:_______________________________________________				Partner name:______________________________________________
Address:____________________________________________________				Address:___________________________________________________
City:______________________	State:___________	Zip:____________		City:_____________________	State:___________	Zip:____________
Phone: (______)_____________				Phone: (______)_____________

Continue on Back Page

COMMENTS

SECTION 7 - CONCLUSION

17. Do you (the operator named on the label) make any day to day decisions for another farm or ranch?

YES –Please list the other operations(s):____________________________________________________________________________

[Complete a separate questionnaire for each additional operation]

NO – [Continue.]

18. To assist in identifying duplication in our list of farm operators, please report the operator’s Social Security Number. If this operation has a Federal Employer Identification Number, this would also be helpful. Reporting your SSN and EIN is voluntary.
This information is collected under the general authority of Title 7, Section 2204, of the U.S. Code

	OPERATOR’S SSN		FEDERAL EIN
	470 ___ ___ - ___ ___ ___ ___ ___ ___ ___		466 ___ ___ - ___ ___ ___ ___ ___ ___ ___
	This completes the survey. Thank you for your help.

Reported by:_____________________________________	Telephone:(_______)	_______________________	Date:___________________

OFFICE USE
R. Unit	Ptr 1 Str	Ptr 2 Str	Ptr 3 Str	Ptr 4 Str		Pasture Points	OPS	SSO 1	ADJ
921	925	926	927	928		869	923	407	922
Response	Respondent	Mode	Enum.	Eval.	MM DD YY	GVS Points	POID
9901	9902	9903	0098	100	9910	861	789 ___ ___ ___ ___ ___ ___ ___ ___ ___
					__ __ __ __ 06
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