Form FSA 441 FSA 441 Request for Aerial Photography

This form is available electronically.

FSA-441
(09-05-12)

Form Approved - OMB No. 0560-0176

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

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

INSTRUCTIONS
2. ADDRESS (STREET ADDRESS)

ORDERING - Products are made to order.
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.

3. ADDRESS (PO BOX)
4. CITY, STATE, ZIP+4

PAYMENT- Prepayment is required.
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.

5. CONTACT NAME
6. TELEPHONE NUMBER

7. FAX NUMBER

SHIPMENT- We ship the most economical method.
No COD's, shipping costs are included in the price of the product.

8. E-MAIL ADDRESS
A. CUSTOMER CODE
9. IF
KNOWN:

B. AGENCY CODE

FOR U.S. GOVERNMENT AGENCY USE ONLY
ORDERING UNIT CODE

FUNDS CHARGEABLE

C. PURCHASE ORDER (PO) NUMBER
I CERTIFY THAT THESE ITEMS ARE NECESSARY FOR USE IN THE PUBLIC SERVICE

10. CREDIT CARD NUMBER

11. EXP. DATE (MM/YY)

SIGNATURE
12. TOTAL REPRODUCTIONS

14. STATE OR REGION

13. AMOUNT REMITTED / PO AMOUNT
TITLE
$
IMAGERY DATA SECTION (See Page 2 for Ordering Information)
15. SPECIAL INSTRUCTIONS

DATE

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 NAMES/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

TELEPHONE:
FAX:
E-MAIL:
WEBSITE:

801-844-2922
801-956-3653
[email protected]
http://www.apfo.usda.gov

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of 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, political beliefs, genetic information, 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, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue,
S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay).
USDA is an equal opportunity provider and employer.

ORDERING INFORMATION
FSA-441 (Page 2) (09-05-12)

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 - as amended). The authority for requesting the information identified on this form is the Agricultural
Adjustment Act of 1938 (7 U.S.C. 1387). The information will be used to process an order for aerial photography. The information collected on this form may be disclosed to other Federal, State, Local
government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses
identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated). Providing the requested information is voluntary. However, failure to furnish the requested information will
result in an inability on the part of the Aerial Photography Field Office to process the order for aerial photography.
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.