Form FSA 441 FSA 441 Request for Aerial Photography

Form Approved - OMB No. 0560-0176

This form is available electronically.

FSA-441

U.S. DEPARTMENT OF AGRICULTURE

(10-30-07)

FARM SERVICE AGENCY

REQUEST FOR AERIAL PHOTOGRAPHY
See Page 2 for Privacy Act and Public Burden Statements

1. NAME

2. ADDRESS (STREET ADDRESS)

INSTRUCTIONS
ORDERING - Products are made to order.

3. ADDRESS (PO BOX)

Don't know what to order? See Page 2 for additional information. Faxing
your order? Include your Credit Card number. Confirmation copies are not
necessary, but if you do - mark it ''CONFIRMATION ONLY.'' Otherwise
we'll handle it as a new order.

4. CITY, STATE, ZIP+4

5. CONTACT NAME

PAYMENT- Prepayment is required.

6. TELEPHONE NUMBER

(

We accept Credit Cards. Make your check or money order payable to
USDA FSA. Purchase orders are accepted from tax-supported agencies.
Please do not send cash or blank checks.

7. FAX NUMBER

)

(

)

8. E-MAIL ADDRESS

SHIPMENT- We ship the most economical method.

No COD's, shipping costs are included in the price of the product.
A. CUSTOMER CODE
9. IF
KNOWN:

B. AGENCY CODE

FOR U.S. GOVERNMENT AGENCY USE ONLY
C. PURCHASE ORDER (PO) NUMBER

ORDERING UNIT CODE
11. EXP. DATE (MM/YY)

10. CREDIT CARD NUMBER

FUNDS CHARGEABLE

I CERTIFY THAT THESE ITEMS ARE NECESSARY FOR USE IN THE PUBLIC SERVICE
SIGNATURE

12. TOTAL REPRODUCTIONS

13. AMOUNT REMITTED / PO AMOUNT

TITLE

DATE

$
IMAGERY DATA SECTION (See Page 2 for Ordering Information)
15. SPECIAL INSTRUCTIONS

14. STATE OR REGION

16. COUNTY (OR FOREST AREA)

17. IMAGERY IDENTIFICATION
DIGITAL REPRODUCTIONS
FILM SIZE AND TYPE REPRODUCTIONS
A

QUAN.
EACH
B

YEAR
C

PROGRAM
SYMBOL
D

RES.
ROLL NO.
E

QUARTER QUAD NAME/NO.
EXPOSURE(S) (RANGE(S))
F

18. AREA OR LOCATION
DESCRIPTIONS
Include information in boxes below
or Item 15 above.

•

Latitude / Longitude - point and
radius or four corner points

•

Legal Description - Township,
Range, Section(s)

•

Map - Detailed topographic,
county, or city map outlining
your area of interest as
accurately as possible.

- attach to form or email to
address below.

•

Electronic shapefiles with
projection.

- attach to email address
below.

Address Order for
Photography or
Information:

CUSTOMER SERVICE SECTION
USDA FSA AERIAL PHOTOGRAPHY FIELD OFFICE
2222 WEST 2300 SOUTH
SALT LAKE CITY UT 84119-2020

801-844-2922
TELEPHONE:
801-956-3653
FAX:
[email protected]
E-MAIL:
WEBSITE: http://www.apfo.usda.gov

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual
orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative
means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400
Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

ORDERING INFORMATION
FSA-441 (Page 2) (10-30-07)

A

Your customer information - please include your street address (Item 2) and
telephone number (Item 6). If you are a tax-supported organization and want to
be billed, place your purchase order number here (Item 9C).

B

Total reproductions (Item 12) - in this area indicate the total number of
reproductions by product (i.e. 1-24x24, 2-38x38).
Amount remitted/PO amount (Item 13) - by check, money order or Credit Card
(Item 10).

C

Special instructions (Item 15) - provide any special instructions you require of
us to process your order. Include area or location description here.
Digital reproductions, film size and type reproductions (Item 17A) refer to Prices for Aerial Photographic Reproductions (FSA-441A).
Program or symbol (Item 17D)- you may know it as project code (ID), FIPS
codes, etc.
Resolution (Res.) or film roll number (Item 17E) - resolution of digital imagery
or a unique number related to a specific project.
Quarter Quad Name / No. or Exposure(s) (range(s)) (Item 17F) - indicate
quarter quad name or number or the film exposure number or range of
exposures here. Refer to FSA-441A (Page 2).

D

Instructions - these are brief instructions related to your order. See ''HOW
TO ORDER AERIAL PHOTOGRAPHY'' below. Also, see FSA-441A .

E

U.S. Government Agency Use Only - this may substitute for your purchase
order. For FSA orders, your signature is required.

F

Preferred types of area or location descriptions (Item 18).

* HOW TO ORDER AERIAL PHOTOGRAPHY
Fill out items 14 through 18 on the FSA-441, Request for Aerial Photography form. If you do not have the aerial photo identification
numbers, furnish one or more of the following forms of information and we will make print selections for you:
Latitude and Longitude coordinates (point and radius or four corner points.)
Legal description of your area of interest in township, range, and section number.
A topographic, county, or city map outlining your area of interest as accurately as possible.
Electronic shapefiles with projection.
Products are made after an order and payment is received. You may order over the telephone using a major credit card if you have
complete aerial photo (symbol, roll, exposure) or quarter quad identification.

* APFO PRODUCTS AND SERVICES
Depending on the original film scale or digital resolution, photographs are available in selected scales ranging from 1 inch = 5,000 feet to
1 inch = 200 feet. Paper sizes: 10"x10" contact prints, 12"x12" to 38"x38" enlargements. Digital scans from film (10"x10") are available
in TIF format. Digital Compressed County Mosaics (CCM) and Quarter Quads (QQ). See FSA-441A (Prices for Aerial Photographic
Reproductions) for specific size and scale availability. For special needs not covered elsewhere on this form, contact us directly.
Additional fees may apply.

* OTHER PHOTOGRAPHY
Photography secured for the Forest Service (FS) and National Resource Conservation Service (NRCS) can be purchased from us by the
same procedures outlined for FSA photography. The negative scales vary from 1:6,000 to 1:80,000, depending on the project area. Most
FS photography has been flown in natural color, some in black and white and color infrared. Most NRCS photography has been flown in
black and white, some in natural color and color infrared.
NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The Farm Service Agency, Aerial Photography Field
Office is an Agency of the Department of Agriculture and is authorized to coordinate aerial photography programs and operations under Section 387 of the Agricultural Adjustment Act of 1938 (7 USC
1387). The requested information on this form will be used to process aerial photography orders as specified. Furnishing the requested information is strictly voluntary, however, orders may not be
processed if information is incomplete. This information may be provided: 1) to the appropriate agency, whether Federal, State, local, or foreign, charged with the responsibility of investigating or
prosecuting a violation of law, or of enforcing or implementing a statute, rule, regulation or order issued pursuant thereto, of any records within this system when information available indicates a violation
or potential violation of law, whether civil, criminal or regulatory in nature and whether arising by general statute or particular program statute, or by rule, regulation or order issued pursuant thereto; 2) to
a court, magistrate, or administrative tribunal, or to opposing counsel in a proceeding before any of the above, of any record within the system which constitutes evidence in that proceeding, or which is
sought in the course of discovery to the extent that records sought are relevant to the subject of the proceeding.
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 control number for this information collection is 0560-0176. The time required to complete this information collection is estimated to average 40 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. RETURN THIS COMPLETED
FORM TO THE USDA FSA AERIAL PHOTOGRAPHY FIELD OFFICE AT THE ADDRESS LISTED ON PAGE 1.