QID Monthly Potato Price Inquiry

	Project Code 195	OMB NO. 0535-0007: Approval expires 11/30/2012
	MONTHLY POTATO PRICE INQUIRY – Master Copy
	DRAFT			NATIONAL AGRICULTURAL STATISTICS SERVICE
			California Field Office P.O. Box 1258 Sacramento, CA 95812 1-800-851-1127 Fax: 1-888-478-5637 [email protected]
Please make corrections to name, address and Zip Code, if necessary. Information requested in this survey is used to prepare estimates of selected agricultural commodities. Under Title 7 of the U.S. Code and CIPSEA (Public Law 107-347), facts about your operation are kept confidential and used only for statistical purposes in combination with similar reports from other producers. Response is voluntary. 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 0535-0007. The time required to complete this information collection is estimated to average 15 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. Please complete this questionnaire within the next few days and return it to us in the enclosed envelope to insure correct and prompt delivery. No stamp is required. You may fax your completed report to 1-877-743-6181.

INSTRUCTIONS: Only report sales of potatoes purchased directly from growers. Purchases should be reported for the month potatoes are delivered and the State where the potatoes were grown. Exclude any potatoes purchased from other shippers or warehouses. If no potatoes were purchased potatoes last month, enter “none”.

1. Did this operation purchase any potatoes directly from growers in <HOME STATE> during <REFERENCE MONTH, YEAR> or

<REFERENCE MONTH + 1, YEAR>? YES – [Continue] NO - [Go to item 2]

POTATOES PURCHASED DIRECTLY FROM <HOME STATE> FARMERS (include contract and open market sales)	REFERENCE MONTH, YEAR		FIRST HALF OF REF MONTH + 1, YR
	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)
a. For table stock or fresh market		$ . __ __		$ . __ __
b. For chipping or processing		$ . __ __		$ . __ __

2. Did this operation purchase any potatoes directly from growers in States other than < HOME STATE> during <REFERENCE

MONTH, YEAR> or <REFERENCE MONTH + 1, YEAR>? YES – [Continue] NO - [Go to item Survey Results]

Please specify the State where the purchased potatoes were grown in the blank provided. Purchases in addition states

should be reported on the back of this form. Exclude potatoes grown outside the United States.

POTATO PURCHASES DIRECTLY FROM ___________________ FARMERS (include contract and open market sales)	REFERENCE MONTH, YEAR		FIRST HALF OF REF MONTH + 1, YR
	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)
a. For table stock or fresh market		$ . __ __		$ . __ __
b. For chipping or processing		$ . __ __		$ . __ __

– PLEASE CONTINUE ON REVERSE SIDE –

POTATO PURCHASES DIRECTLY FROM ___________________ FARMERS (include contract and open market sales)	REFERENCE MONTH, YEAR		FIRST HALF OF REF MONTH + 1, YR
	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)
a. For table stock or fresh market		$ . __ __		$ . __ __
b. For chipping or processing		$ . __ __		$ . __ __

POTATO PURCHASES DIRECTLY FROM ___________________ FARMERS (include contract and open market sales)	REFERENCE MONTH, YEAR		FIRST HALF OF REF MONTH + 1, YR
	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)
a. For table stock or fresh market		$ . __ __		$ . __ __
b. For chipping or processing		$ . __ __		$ . __ __

POTATO PURCHASES DIRECTLY FROM ___________________ FARMERS (include contract and open market sales)	REFERENCE MONTH, YEAR		FIRST HALF OF REF MONTH + 1, YR
	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)	Quantity Purchased (Cwt)	Average Price Paid (Dollars per Cwt)
a. For table stock or fresh market		$ . __ __		$ . __ __
b. For chipping or processing		$ . __ __		$ . __ __

COMMENTS:

SURVEY RESULTS: To receive the complete results of this survey on the release date, go to www.nass.usda.gov/results/. Would you rather have a brief summary mailed to you at a later date?

1 Yes 3No

099

Respondent Name: ____________

9911 Phone: (_____) _____

9910 MM DD YY Date: __ __ __ __ __ __

OFFICE USE ONLY

Response

Respondent

Mode

Enum.

Eval.

Change

Optional Use

1-Comp 2-R 3-Inac 4-Office Hold 5-R – Est 6-Inac – Est 7-Off Hold – Est 8-Known Zero

9901

1-Op/Mgr 2-Sp 3-Acct/Bkpr 4-Partner 9-Oth

9902

1-Mail 2-Tel 3-Face-to-Face 4-CATI 5-Web 6-e-mail 7-Fax 8-CAPI 19-Other

9903

098

100

785

921

407

408

9906

9916

S/E Name