QID Annual Floriculture & Nursery Survey

Floriculture Survey

0093 - Annual Floriculture and Nursery Survey - 09 - HI

Floriculture Survey

OMB: 0535-0093

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____________________________________________________________________________________________________________

Project Code 148 O.M.B Number 535-0093 Approval Expires 06/30/2009

In cooperation with:

Agricultural Development Division




Annual Floriculture &

Nursery Survey

January 1, 2009

1. Please make corrections to your name, address, and ZIP code. (Make corrections directly on name and address shown.)


2. Does this operation do business under any name other than shown on the mailing label?

  • No

  • Yes – Please enter name:


__________________________________________

Do you want this name to appear on the mailing label? Yes No















3. In 2008, did this operation produce and sell any floriculture and nursery products listed below?

Christmas trees, fruit trees, plant rental services, and out-of-State sales are included in this survey.

YES – Please check the box below and complete the appropriate section(s) that apply to your operation.


Cut flowers

Section 1



Cut cultivated greens

Section 7


Cut orchids and potted orchids

Section 2



Propagative floriculture material

Section 8


Lei flowers

Section 3



Landscape plant material

Section 9


Potted flowering plants & bulbs

Section 4



Sod

Section 9


Bedding/garden plants &

herbaceous perennials


Section 5



All other nursery products

Section 9



Plant rental services

Section 10


Potted foliage (indoor use)

Section 6



Out-of-State sales

Section 13


NO – Please check the box below that applies to you and complete Section 14. Conclusion


Engaged in agricultural operation other than floriculture and nursery products

If the farm was sold or taken over by another, please provide the new operator’s name and address if known:


Name of new operator:___________________________


Address:______________________________________


Phone: (______)________________________________


Shipper only (please complete Section 13)


Just started operation, no sales in 2008


Quit farming


Operator deceased


Sold operation


Retired from farming


Never farmed


Temporarily not farming


Other, please specify:__________________

What to Report………………………..


* Finished products - Report only flowers and plants finished by this operation in Sections 1 to 7 and 9.

* Unfinished products - Report only unfinished flower and plant material for the products listed in Section 8

(Propagative Floriculture Material). This material was produced and sold by this operation to other growers

for finishing.

* Value of sales - Report value of sales before deductions for commissions and transportation are made.

* Area - Report all production whether grown under glass, fiberglass and other rigid plastics, film plastic, shade cloth, natural shade, other shade, or outdoor in Section 11.


Section 1. Did this operation produce and sell any CUT FLOWERS during 2008?


Yes- Please report for your operation below. No- Go to the next section.

Cut Flowers

Code

Cut flower sales in 2008

Retail sales

Wholesale sales

Quantity grown

and sold

Total value of

retail sales (Dollars)

Quantity grown

and sold

Total value of

wholesale sales (Dollars)

Alstroemeria (Stems)

100

1

2

$

3

4

$

Anthurium (Dozens)

110

1

2

$

3

4

$

Bird of Paradise (Dozens)

120

1

2

$

3

4

$

Standard Carnation (Stems)

130

1

2

$

3

4

$

Pompon Chrysanthemum

(Bunch)

140

1

2

$

3

4

$

Delphinium and Larkspur

(Stems)

150

1

2

$

3

4

$

Gerbera Daisy (Stems)

160

1

2

$

3

4

$

Ginger, Pink (Dozens)

170

1

2

$

3

4

$

Ginger, Red (Dozens)

180

1

2

$

3

4

$

Gingers, Other (Dozens)

190

1

2

$

3

4

$

Gladioli (Spikes)

200

1

2

$

3

4

$

Heliconia (Dozens)

210

1

2

$

3

4

$

Iris (Stems)

220

1

2

$

3

4

$

All Lilies (Stems)

230

1

2

$

3

4

$

Lisianthus (Stems)

240

1

2

$

3

4

$

Protea (Stems)

250

1

2

$

3

4

$

All Roses (Stems)

260

1

2

$

3

4

$

Snapdragons (Spikes)

270

1

2

$

3

4

$

Tulip (Stems)

280

1

2

$

3

4

$

Other Cut Flowers Not

Reported Above*

(Report quantity of “other cut

flowers” as percent of total

quantity sold, cells 1+3=100%)

290

1





%

2





$

3





%

4





$

* Include dried flowers as other cut flowers. Cut orchids are to be included in Section 2. Lei or individual blooms are to be reported in Section 3.



Section 2. Did this operation produce and sell any CUT or POTTED ORCHIDS during 2008?


Yes- Please report for your operation below. No- Go to the next section.

A. Cut Orchids

Code

Cut orchid sales in 2008

Retail sales

Wholesale sales

Quantity grown

and sold

Total value of

retail sales (Dollars)

Quantity grown

and sold

Total value of

wholesale sales (Dollars)

Cattleya (Each)

300

1

2

$

3

4

$

Cymbidium (Cut flower)

310

1

2

$

3

4

$

Dendrobium (Cut flower)

320

1

2

$

3

4

$

Oncidiinae (Cut flower)

330

1

2

$

3

4

$

Vandaceous (Cut flower)

340

1

2

$

3

4

$

Other Cut Orchids Not

Reported Above

(Report quantity of “other cut

orchids” as percent of total

quantity sold, cells 1+3=100%)

350

1







%

2







$

3







%

4







$


B. Potted Orchids

Code

Type of container

Potted orchid sales in 2008

Retail sales

Wholesale sales

Quantity grown

and sold

Total value of

retail sales (Dollars)

Quantity grown

and sold

Total value of

wholesale sales (Dollars)

Dendrobium

(In bud/bloom)

550

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Dendrobium Seedlings

For cut flower

560


2

$


4

$

For potted plants

6

$

8

$

Oncidiinae

900

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Phalaenopsis

580

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

All Other Potted

Orchids Not

Reported Above

590

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

All Other Potted Orchid Seedlings (Liners, Tissue Culture Flasks, Plugs etc.)

640


2

$


4

$


Section 3. Did this operation produce and sell any LEI FLOWERS during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Lei Flowers

Code

Lei flower sales in 2008

Retail sales

Wholesale sales

Quantity grown

and sold

Total value of

retail sales (Dollars)

Quantity grown

and sold

Total value of

wholesale sales (Dollars)

Carnation (Heads)

360

1

2

$

3

4

$

Dendrobium Orchids (Heads)

370

1

2

$

3

4

$

Vandaceous (Heads)

380

1

2

$

3

4

$

Pikake (Strands)

390

1

2

$

3

4

$

Plumeria (Blossoms)

400

1

2

$

3

4

$

Protea (Blossoms)

410

1

2

$

3

4

$

Tuberose (Blossoms)

420

1

2

$

3

4

$

Other Lei Flowers Not

Reported Above

(Report quantity of “other lei

flowers” as percent of total

quantity sold, cells 1+3=100%)

430

1





%

2





$

3





%

4





$



Section 4. Did this operation produce and sell any POTTED FLOWERING PLANTS or

POTTED FLOWERING BULBS (for indoor or patio use) during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Exclude:

  • Plants intended for landscape use.

  • Finished plants purchased from others and resold.

  • Bedding plants, geraniums, potted blooming annuals, or flowering hanging baskets (these should be

reported in Section 5).

  • Hardy/garden mums (these should be reported in Section 5).

  • Sales of bulbs (these should be reported in Section 9).

Potted Flowering Plants

Code

Type of container

Retail sales in 2008

Wholesale sales in 2008

Quantity

grown

and sold

Total value of

retail sales (Dollars)

Quantity grown

and sold

Total value of

wholesale sales (Dollars)

African Violet

(Saintpaulia)

500

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Anthurium

510

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Azalea, Finished

Florist

(Showing color)

520

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Bromeliad

530

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Chrysanthemum,

Florist

(Exclude hardy/garden mums)

540

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Lily, Easter

570

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Poinsettia

600

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Roses, Florist (Potted)

610

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Spring Flowering Bulbs

(Plants grown from bulbs,

including Tulips, Hyacinths,

Daffodils/Narcissus, other

lilies, etc.)

620

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Other Potted

Flowering Plants

(Exclude potted blooming

annuals)

630

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$


A partial list of Other Potted Flowering Plants include:

Begonia Christmas pepper Gardenia Hibiscus (potted) Primula

Carnation (potted) Cyclamen Gerbera Daisy Hydrangea Regal pelargonium

Christmas cherry Exacum Gloxinia Kalanchoe Zygocactus


Section 5. Did this operation produce and sell any BEDDING/GARDEN PLANTS or

HERBACEOUS PERENNIALS during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Include:

  • Annual bedding/garden plants finished and sold by this operation and not used in commercial vegetable production.


Exclude:

  • Finished bedding/garden plants purchased from others and resold.

  • Prefinished plants sold to others for finishing (these should be reported in Section 8).

  • Transplants used in commercial vegetable production.

  • Foliage plants (these should be reported in Section 6).

  • Plugs and propagative materials (these should be reported in Section 8).


When reporting flats, please specify size if not 11”X 22” 993 __ __.__ __ inches X 994__ __.__ __ inches

- Report as FLATS, when using a common insert (for example: 606, 1206, 1801, 1803, etc.)

- Report as POTS, if produced as separate units, including pots produced in shuttle trays, carrier flats, or flats of individual pots.

- Report as POTS, if containers of annuals and mixed annuals such as color bowls, strawberry jars, or combination planters.


Annual Bedding/Garden

Plants

Code

Type of container

Retail sales in 2008

Wholesale sales in 2008

Quantity grown and sold

Total value of retail sales (Dollars)

Quantity grown and sold

Total value of wholesale sales (Dollars)

Begonia

650

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

Geranium

(from vegetative

cuttings)

670

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

Geranium

(from seed and

plug seedlings)

690

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

New Guinea

Impatien

710

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

Impatiens, Other

(I. Wallerana)

730

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$


Section 5. (continued)

Annual Bedding/Garden

Plants

Code

Type of container

Retail sales in 2008

Wholesale sales in 2008

Quantity grown and sold

Total value of retail sales (Dollars)

Quantity grown and sold

Total value of wholesale sales (Dollars)

Marigold

750

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

Pansy/Viola

770

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

Petunia

790

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

All Other Flowering

and Foliar

Bedding Plants

810

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$

Vegetable Type

Bedding Plants

for Home Use

830

Flats

1

2

$

3

4

$

Pots less than 5”

5

6

$

7

8

$

Pots 5” or more

9

10

$

11

12

$

Hanging baskets

13

14

$

15

16

$



Herbaceous

Perennials

Code

Type of container

Retail sales in 2008

Wholesale sales in 2008

Quantity grown and sold

Total value of retail sales (Dollars)

Quantity grown and sold

Total value of wholesale sales (Dollars)

Chrysanthemums

(Hardy/garden mums)

850

Pots less than 5”

1

2

$

3

4

$

Pots 5” or more

5

6

$

7

8

$

Hosta

860

Less than 1 gallon

1

2

$

3

4

$

1 gal. up to 2 gal.

5

6

$

7

8

$

2 gal. or larger

9

10

$

11

12

$

Other Herbaceous

Perennials

880

Less than 1 gallon

1

2

$

3

4

$

1 gal. up to 2 gal.

5

6

$

7

8

$

2 gal. or larger

9

10

$

11

12

$


Section 6. Did this operation produce and sell any POTTED FOLIAGE (FOR INDOOR USE) during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Include:

  • Only those plants FINISHED for indoor or patio use and not intended for landscape use.

  • Plants may have flowers which are secondary compared with foliage features.

  • Ivy, cacti, ferns, palms, and succulents, etc. as well as indoor/patio shrubs, trees and vines FINISHED by you.


Exclude:

  • Foliage plants purchased from others, but grown by you for less than 4 weeks before resale.

  • UNFINISHED plants sold to others for further “growing on” (these should be reported in Section 8).



Potted Foliage

Code

Potted foliage sales in 2008

Retail sales

Wholesale sales

Quantity grown and sold

Total value of retail sales (Dollars)

Quantity grown and sold

Total value of wholesale sales (Dollars)

Dracaena

930


2

$


4

$

Palms

940


2

$


4

$

All Other Potted Foliage

for Indoor or Patio Use

950


2

$


4

$

Total

(Report quantity of “total

potted foliage” as percent of

the total quantity sold, cell

1+3=100%)

960

1





%

2





$

3





%

4





$


Baskets

Code

Foliage basket sales in 2008

Retail sales

Wholesale sales

Quantity grown and sold

Total value of retail sales (Dollars)

Quantity grown and sold

Total value of wholesale sales (Dollars)

Foliage Hanging Baskets

970

1

2


$

3

4


$



Section 7. Did this operation produce and sell any CUT CULTIVATED GREENS during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Cut Cultivated Greens

Code

Cut cultivated green sales in 2008

Retail sales

Wholesale sales

Quantity grown and sold

Total value of retail sales (Dollars)

Quantity grown and sold

Total value of wholesale sales (Dollars)

Leatherleaf Ferns *

440

1

2

$

3

4

$

Ti Leaves *:

Floral use

450

1

2

$

3

4

$

Other uses

460

1

2

$

3

4

$

All Other Cut Cultivated

Greens including plant

cuttings for floral use

(Report quantity of “other

cut cultivated greens” as

percent of the total quantity

sold, cells 1+3=100%)

470

1








%

2








$

3








%

4








$

* If reporting for leatherleaf ferns or ti leaves, please indicate whether quantity grown is in bunches or dozens.



If reporting for leatherleaf ferns or ti leaves, how many pieces make up a bunch?


Cut Cultivated Greens

Pieces per bunch

Leatherleaf Ferns


Ti Leaves



Section 8. Did this operation produce and sell any PROPAGATIVE FLORICULTURE MATERIAL

during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Include:

  • Cuttings, liners, plug seedlings, prefinished plants, or tissue cultured plantlets.

  • Plants sold to other growers for further growing on.


Exclude:

  • Finished plants sold to others.

  • Nursery or landscape type plant propagative material (these should be reported in Section 9 as Landscape Plant Material).

  • Seeds, bulbs, tubers, rhizomes, or corms (these should be reported in Section 9 as All Other Nursery Products).


What were the total sales of PROPAGATIVE (unfinished) materials by category?


Propagative Material (Unfinished)

Total value of sales

(Dollars)


Cut Flowers

981


$


Potted Flowering Plants (for indoor use)

982


$


Annual Bedding/Garden Plants

983


$


Herbaceous Perennials

984


$


Foliage (for indoor use)

985


$


Cut Cultivated Greens

986


$




Section 9. Did this operation produce and sell any LANDSCAPE PLANT MATERIAL, SOD, or OTHER

FLORICULTURE or NURSERY MATERIAL not reported in the previous sections during 2008?


Yes- Please report for your operation below. No- Go to the next section.



  1. 990

    $

    What was the total value of retail and wholesale sales of LANDSCAPE PLANT

MATERIAL in 2008? (Exclude sod, report it in Section 9, question 2).


Include:

  • Broadleaf and coniferous evergreens, deciduous shade and flowering trees, palms, citrus, fruit and tree nuts, etc.


Exclude:

  • Sod (it should be reported in Section 9, question 2).

  • Bedding and garden plants (these should be reported in Section 5).

  • Palms for indoor or patio use (these should be reported in Section 6).

  • Potted foliage for indoor or patio use (these should be reported in Section 6).

  • Propagative floriculture material (these should be reported in Section 8).

  • Any value reported in previous sections.


992

$



2. What was the total value of retail and wholesale sales of SOD in 2008?




991

$


3. What was the total value of retail and wholesale sales of ALL OTHER NURSERY

PRODUCTS in 2008?


Include:

  • Christmas trees, bonsai plants, seeds, bulbs, hapu`u logs, and products not included in previous sections.


Exclude:

  • Any value reported in previous sections.




Section 10. Did this operation have PLANT RENTAL services during 2008?


Yes- Please report for your operation below. No- Go to the next section.


90

$


1. What were your gross receipts for PLANT RENTAL services in 2008?


Section 11. Area Used for Production



In 2008, how much greenhouse, other covered space, and outdoor land area was used for the production of floriculture and nursery products grown by you?


  • Include aisles, walkways, etc.

  • 1 acre = 43,560 square feet.


Note: The roof covering (glazing) determines the type of greenhouse covering classification. For example, a greenhouse with a glass roof having film polyethylene insulation and fiberglass sides would be considered a glass greenhouse.


Total area = ________________________Square feet or ________________________Acres


A. Type of Area


Glass greenhouses


(Sq. feet)


Fiberglass, rigid plastic, etc., greenhouses

(Sq. feet)


Saran, slat, shade houses and other covers

(Sq. feet)

Film plastic greenhouses: single or double cover

(Sq. feet)


Open ground and natural shade


(Acres)

Floriculture Crops 1

11

12

13

14

15 Nearest 10th



._____

Nursery and Other

Plants 2

21

22

23

24

25 Nearest 10th



._____

1 Floriculture crops include cut and lei flowers, orchids, flowering and foliage plants (indoor use), annual bedding/

garden plants, cut cultivated greens, herbaceous perennials, and floriculture propagative material.


2 Nursery and other plants include potted foliage (outdoor landscaping use), trees, Christmas trees, sod, plant rentals, vegetable and flower seeds, aquatic plants, dried bulbs, corms, rhizomes, tubers, etc.




B. Type of Flower

or Nursery Product



Glass greenhouses or glass substitute


(Sq. feet)


Artificial shade, saran, lath, frames, cloths, etc.


(Sq. feet)



Natural shade, e.g., hapu`u, citrus, etc.


(Acres)

Open field used for production excluding land covered by structures

(Acres)

Anthurium

31

32

33 Nearest 10th


._____

34 Nearest 10th



._____


Dendrobium Orchids

(Cut or lei flowers)

41

42

43 Nearest 10th


._____

44 Nearest 10th



._____


Dendrobium Orchids

(Potted plants)

51

52

54 Nearest 10th



_____

54 Nearest 10th



._____



Section 12. Gross Value of Sales and Number of Hired Workers



91

$

1. What was the total gross value of sales for the reported floriculture & nursery

crops in 2008?


(Circle sales group)

99


0 to 999 dollars

6

50,000 to 99,999 dollars

1


1,000 to 9,999 dollars

7

100,000 to 249,999 dollars

2


10,000 to 19,999 dollars

8

250,000 to 499,999 dollars

3


20,000 to 24,999 dollars

9

500,000 to 999,999 dollars

4


25,000 to 39,999 dollars

10

1,000,000 dollars or more

5


40,000 to 49,999 dollars







2. What was the largest number of floriculture and nursery workers on the payroll on any one day in 2008?


92



Include: None Workers

  • Full time, part time workers, hired managers, and PAID family members.


Exclude:

  • Workers employed only for the retail operation, those working as landscapers, and unpaid family members.








Section 13. Did this operation ship any floriculture and nursery products OUT-OF-STATE during 2008?


Yes- Please report for your operation below. No- Go to the next section.


Include:

  • Both from your own production and those purchased from other growers.


Exclude:

  • Mailing or shipping cost.


Crop

Total value of

sales in 2008

(Dollars)

Crop

Total value of

sales in 2008

(Dollars)

CUT FLOWERS

Anthuriums

60


$


Phalaenopsis, potted

70


$


Bird of Paradise

61


$

Other potted orchids

71


$


Ginger, Red

62


$

Vandaceous, cut flower

and potted

72


$


Gingers, Other

63


$

FOLIAGE

Potted foliage plants

76


$


Heliconias

64


$


Ti leaves, cut

74


$


Proteas

73


$


Other cut greens

75


$

ORCHIDS

Cattleya, each

65


$


Unfinished foliage plants

77


$

Cymbidiums, cut

66


$

POTTED FLOWERING PLANTS

78


$

Dendrobiums, cut

67


$

OTHER NURSERY PRODUCTS

NOT SPECIFIED ELSEWHERE

(seeds, leis, blossoms, propagated

material, etc.)

79





$

Oncidiinae, cut

68


$

Dendrobiums, potted

69


$

MIXED ASSORTMENT OF CUT

FLOWERS (Include bouquets and

other mixed flower assortments which

cannot be individually separated.)

89





$

Oncidiinae, potted

94


$



Section 14. Conclusion


  1. Are you involved in any additional floriculture farms or greenhouses in this State?


Yes - Please list name and address of operation(s) in the State of Hawaii:


___________________________________________________________________________________


1a. Did you include the production from the additional operations(s) in this report? Yes No


No – Continue.


  1. Does this operation operate any floriculture farms or greenhouses in any other State(s)?


Yes - Please list name and address of operation(s) in other State(s)?


___________________________________________________________________________________


2a. Did you include the production from the additional operations(s) in this report? Yes No


No – Continue.


  1. The national Floriculture Crops 2008 Summary will be released at 3:00 p.m. on April 23, 2009. It will be available on the internet at http://www.nass.usda.gov/. To receive an e-mail delivery of the national Floriculture Crops 2008 Summary, subscribe (free) to the same website above. The Hawaii Flowers & Nursery Products Annual Summary will be available on the internet at http://www.nass.usda.gov/hi/flower/flower.pdf


  1. Would you like to receive a paper copy of the Hawaii Flowers & Nursery Products Annual Summary?

001



Yes No


83

5. Please write-in the island and farm location of your floriculture and nursery operation.


Island: __________________ Location: _________________________________


Reported by:___________________________________________Date:____________________________


Telephone Number:(______)______________________________


Comments: ____________________________________________________________________________


______________________________________________________________________________________


______________________________________________________________________________________

OFFICE USE

Edited 995 (mm/dd/yy)

Respondent

Mode

Response

Enum.

Eval

1-OP/Mgr 4-Partner

2-Sp 9-Other

3-Acct/Bkpr

85

1-Mail 7 Fax

2-Tel 19 Other

3-Face-to-Face

86

1-Comp

5-R - Est

6-Inac - Est

7-Off Hold - Est

95

87

88

Punched

Verified

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB number is 0535-0093. The time required to complete this information collection is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Thank you for your cooperation!

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