QID Broilers/Starter Pullets Contractor Expense Survey

Project 143			OMB No. 0535-0218 Approval Expires 9/30/2008
	20xx Broilers / Starter Pullets Contractor Expense Survey					NATIONAL AGRICULTURAL STATISTICS SERVICE
				U.S. Department of Agriculture, xx Field Office Field Office Street address xxxx City, State zip-xxxx 1-800-xxx-xxxx Fax: 1-xxx-xxx-xxxx e-mail: [email protected]

YOUR REPORT IS CONFIDENTIAL and it will only be used for statistical purposes.

Your report CANNOT be used for purposes of taxation, investigation, or regulation. The law also provides that copies retained in your files are immune from legal processes.

Results from this important data collection will be mailed to all respondents in August 2009

http://www.usda.gov/nass/ and http://www.ers.usda.gov/

For 20xx, please report production cost PER HEAD.	Starter Pullets		Broilers
TOTAL COST PER HEAD	$	. __ __	$	. __ __
Of this total, how much was for?
a. Grower Pay	$	. __ __	$	. __ __
b. Marketing Charges	$	. __ __	$	. __ __
c. Disinfectants & Insecticides	$	. __ __	$	. __ __
d. Chicks placed on the operation	$	. __ __	$	. __ __
e. Feed	$	. __ __	$	. __ __
f. Litter	$	. __ __	$	. __ __
g. Medication, Vaccination, Debeaking, Veterinary, & Custom Services	$	. __ __	$	. __ __
h. Fuel
1. Diesel Fuel	$	. __ __	$	. __ __
2. Gasoline	$	. __ __	$	. __ __
3. Natural Gas	$	. __ __	$	. __ __
4. LP Gas	$	. __ __	$	. __ __
5. Other (Specify:___________)	$	. __ __	$	. __ __

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For 20xx, please report production cost PER HEAD.	Starter Pullets		Broilers
TOTAL COST PER HEAD	$	. __ __	$	. __ __
Of this total, how much was for?

i. Utilities
1. Electricity	$	. __ __	$	. __ __
2. Water / Other	$	. __ __	$	. __ __
j. Supplies	$	. __ __	$	. __ __
k. Taxes	$	. __ __	$	. __ __
l. Hauling	$	. __ __	$	. __ __
m. Other Expenses (Include admin. costs, depreciation, technical services & other) (Specify:______________ )	$	. __ __	$	. __ __

Reported by: ______________________________ Telephone: __________________

We are collecting information on cost and returns and need your help to make the information as accurate as possible. Authority for collection of information on the Costs and Returns report is Title 7, Section 2204 of the U.S. Code. This information will be used for economic analysis and to compile and publish estimates for your region and the United States. Response to this survey is confidential and voluntary.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The time required to complete this information collection is estimated to average 45 minutes per response.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The time required to complete this information collection is estimated to average 60 minutes per response.