Form QID 150028 QID 150028 Agricultural Labor Survey - October, 2015

Generic Clearance of Survey Improvement Projects

0109 - Agricultural Labor - Oct 2015

Generic Testing for Ag Labor

OMB: 0535-0248

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AGRICULTURAL LABOR SURVEY - October 2015


OMB No. 0535-0109

Approval Expires: 3/31/2018

Project Code: 956 QID: 150028

SMetaKey: 3275


United States

Department of

Agriculture




NATIONAL

AGRICULTURAL

STATISTICS

SERVICE







USDA/NASS

National Operations Division

9700 Page Avenue, Suite 400

St. Louis, MO 63132-1547

Phone: 1-888-424-7828

Fax: 1-855-415-3687

E-mail: [email protected]











The information you provide will be used for statistical purposes only. In accordance with the Confidential Information Protection provisions of
Title V, Subtitle A, Public Law 107–347 and other applicable Federal laws, your responses will be kept confidential and will not be disclosed in
identifiable form to anyone other than employees or agents. By law, every employee and agent has taken an oath and is subject to a jail term,
a fine, or both if he or she willfully discloses ANY identifiable information about you or your operation.  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 control number is 0535-0109. The time required to complete this
information collection is estimated to average 30 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.

























Attempted Contacts







Date

Time

Notes












State

POID

Tract

Subtr.







__ __

__ __ __ __ __ __ __ __ __

__ __

__ __






1. [Verify name and mailing address of this operation. Make any corrections necessary (including the correct operation name) on the label and continue.]

[Check if name label verified]

2. Since June 1, 2015, have you or will you (name on label)--

a. grow any crops or cut hay?

[Include grains, row crops, oilseeds, fruits, nuts, vegetables (including strawberries and melon crops), nursery and greenhouse, Christmas trees, and other specialty crops.]



1 Yes - [Go to item 3.] 3 No - [Continue.]

b. own or raise any livestock or poultry?

[Include livestock and poultry owned, and any being raised under contract for someone else.]



1 Yes - [Go to item 3.] 3 No - [Continue.]

c. sell any agricultural products?



1 Yes - [Go to item 3.] 3 No - [Continue.]

d. receive government agricultural payments?

[Exclude government payments received as a landlord.]



1 Yes - [Go to item 3.] 3 No - [Continue.]


e. have more than 19 acres of idle cropland or more than

99 acres of pastureland?



1 Yes - [Go to item 3.] 3 No - [Go to Section 5, page 11, item 1.]









OFFICE USE

3. Are the day-to-day decisions for this operation made by one individual,

a hired manager, or partners? [Check one]



R. UNIT



9921

1 One individual – [Go to Section 1, page 4, item 1.]

8 A hired manager – [Go to Section 1, page 4, item 1.]

2 Partners – How many partners make the day-to-day decisions?



SUB.



9941

Number


JUNE 1

[Enter number of partners, including operator, and then continue.]. . . . . .. . . . . . . . . .

     


9930

4. Please identify the other person(s) in this partnership, then go to Section 1, page 4.

(Verify partners’ names and make necessary corrections if names have already been entered.)

Name: __________________________________________


Name: __________________________________________

Address: ________________________________________


Address: ________________________________________

City: ____________________ State: ______ ZIP: _______


City: ____________________ State: ______ ZIP: _______

Phone: (______ ) - ______________________


Phone: (_______) - ____________________




Did this partner also operate land individually on June 1, 2015?


Did this partner also operate land individually on June 1, 2015?

Yes No


Yes No



Name: __________________________________________


Name: __________________________________________

Address: ________________________________________


Address: ________________________________________

City: ____________________ State: ______ ZIP: _______


City: ____________________ State: ______ ZIP: _______

Phone: (______) - _____________________


Phone: (_______) - ____________________




Did this partner also operate land individually on June 1, 2015?


Did this partner also operate land individually on June 1, 2015?

Yes No


Yes No




For Office Use Only


For Office Use Only


For Office Use Only


For Office Use Only

Stratum


Stratum


Stratum


Stratum

9922


9923


9927


9928

Ind. Op.


Ind. Op.


Ind. Op.


Ind. Op.

9924


9924


9924


9924




Skip to next page


Or


Space for Notes and Comments







October 2015



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Section 1 - PAID WORKERS for OCTOBER

1. Did this operation have anyone on the payroll to do agricultural work the week of October 12th through the 18th?

[Only report workers directly hired and paid by the farm operation. Include part-time workers, paid family members, and hired managers. Include all hired workers regardless of method of pay. Exclude contract and custom workers, retail workers and “value-added” workers (exclude retail sales workers, for example)].

CODE


599

10

1 Yes - [Enter 1 and continue.]

2 Don't Know - [Enter 2, then go to Section 2.]

3 No - [Enter 3 then go to Section 2.]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

600

2. For the paid workers, record the number of workers, hours worked, and the gross wages paid the week of October 12th through the 18th.
**Record each worker only once.
**Separate the workers by the main type of work they were hired to do based on the groups outlined on page 5:


Work Hired to Do

Worker

Code

(shown on page 5)

Number

of Paid

Workers

Total

Hours

Worked

Total Gross Wages That Week

(Dollars)


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


3. TOTAL PAID WORKERS

660


4. In 2015, how many of these TOTAL PAID WORKERS will be paid by this operation----

NUMBER OF WORKERS

a. for 150 days or more of work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

700

b. for 149 days or less of work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

701



Sum MUST equal TOTAL PAID WORKERS, item 3 above. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL

702





Office Use – Completion Code – Usability

1 – Incomplete, Has Labor

2 – Incomplete, Unknown

3 – No Labor

698




Worker codes for Sections 1 and 2

Code

Work Hired to Do



FIELD WORKERS


11

Agricultural Equipment Operators - Crop, Nursery and Greenhouse:

Drive and control farm equipment to till soil and to plant, cultivate, and harvest crops.

12

Farmworkers - Crop, Nursery and Greenhouse:

Manually plant, cultivate, and harvest vegetables, fruits, nuts, horticultural specialties, field crops, Christmas trees and short rotation woody crops. Use hand tools, such as shovels, trowels, hoes, tampers, pruning hooks, shears, and knives. Duties may include tilling soil and applying fertilizers; transplanting, weeding, thinning, or pruning crops; applying pesticides; or cleaning, grading, sorting, packing, and loading harvested products. May construct trellises, repair fences and farm buildings, or participate in irrigation activities.

13

Graders And Sorters - Crop, Nursery and Greenhouse Products:

Grade, sort, or classify agricultural crops by size, weight, color or condition.

14

Hand Packers And Packagers - Crop, Nursery and Greenhouse Products:

Pack or package by hand a wide variety of products and materials.

15

All Other Field Workers:

All agricultural workers working with crops, nursery or greenhouse products not included in codes 11-14.



LIVESTOCK WORKERS


21

Farmworkers - Farm, Ranch, and Aquacultural Animals:

Attend to live farm, ranch, or aquacultural animals that may include cattle, sheep, swine, goats, horses and other equines, poultry, finfish, shellfish, and bees. Attend to animals produced for animal products, such as meat, fur, skins, feathers, eggs, milk, and honey. Duties may include feeding, watering, herding, grazing, castrating, branding, de-beaking, weighing, catching, and loading animals. May maintain records on animals; examine animals to detect diseases and injuries; assist in birth deliveries; and administer medications, vaccinations, or insecticides as appropriate. May clean and maintain animal housing areas. Includes workers who drive and control equipment to accomplish the tasks described.

22

Graders And Sorters - Farm, Ranch, and Aquacultural Animal Products:

Grade, sort, or classify unprocessed food and other agricultural products by size, weight, color, or condition.

23

Hand Packers And Packagers - Farm, Ranch and Aquacultural Animal Products:

Pack or package by hand a wide variety of products and materials.

24

All Other Livestock Workers:

All agricultural workers working with farm, ranch and aquacultural animals or products not included in codes 21 – 23.



SUPERVISORS


31

Farmers, Ranchers and Other Agricultural Managers:

Plan, direct, or coordinate the management or operation of farms, ranches, greenhouses, aquacultural operations, nurseries, tree farms, or other agricultural establishments.

32

First-Line Supervisors of Farm Workers:

Directly supervise and coordinate the activities of agricultural, aquacultural, and related workers.



OTHER WORKERS


41

Agricultural Inspectors:

Inspect agricultural commodities, processing equipment and facilities, and aquacultural operations, to ensure compliance with regulations and laws governing health, quality, and safety.

42

Animal Breeders:

Select and breed animals according to their genealogy, characteristics, and offspring.

43

Pesticide Handlers and Sprayers:

Mix or apply pesticides, herbicides, fungicides, or insecticides through sprays, dusts, vapors, soil incorporation, or chemical application to all crops including nursery and greenhouse products and facilities, and livestock, and livestock facilities. Usually requires specific training and state or federal certification. Excludes pilots who dust or spray crops from aircraft.

44

Any Other Worker Not Listed Above:

Including, but not limited to, mechanics, shop workers, truck drivers, accountants, bookkeepers, office workers. Excluding contract & custom workers, retail workers, and “value-added” workers.





July 2015



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Section 2 - PAID WORKERS for JULY


1. Did this operation have anyone on the payroll to do agricultural work the week of July 6th through the 12th?

[Only report workers directly hired and paid by the farm operation. Include part-time workers, paid family members, and hired managers. Include all hired workers regardless of method of pay. Exclude contract and custom workers, retail workers and “value-added” workers (exclude retail sales workers, for example)].

CODE


599

7

1 Yes - [Enter code 1, and continue.]

2 Don't Know - [Enter code 2, then go to Section 3.]

3 No - [Enter code 3 then go to Section 3.]

600

2. For the paid workers, record the number of workers, hours worked, and the gross wages paid the week of July 6th through the 12th.
**Record each worker only once.
**Separate the workers by the main type of work they were hired to do based on the groups outlined on page 7:


Work Hired to Do

Worker

Code

(shown on page 7)

Number

of Paid

Workers

Total

Hours

Worked

Total Gross Wages That Week

(Dollars)


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


611

612

613

614


3. TOTAL PAID WORKERS

660


4. In 2015, how many of these TOTAL PAID WORKERS will be paid by this operation----

NUMBER OF WORKERS

a. for 150 days or more of work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

700

b. for 149 days or less of work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

701



Sum MUST equal TOTAL PAID WORKERS, item 3 above. . . . . . . . . . . . . . . . . . . . . .

TOTAL

702



Office Use – Completion Code – Usability

1 – Incomplete, Has Labor

2 – Incomplete, Unknown

3 – No Labor

698




Worker codes for Sections 1 and 2

Code

Work Hired to Do



FIELD WORKERS


11

Agricultural Equipment Operators - Crop, Nursery and Greenhouse:

Drive and control farm equipment to till soil and to plant, cultivate, and harvest crops.

12

Farmworkers - Crop, Nursery and Greenhouse:

Manually plant, cultivate, and harvest vegetables, fruits, nuts, horticultural specialties, field crops, Christmas trees and short rotation woody crops. Use hand tools, such as shovels, trowels, hoes, tampers, pruning hooks, shears, and knives. Duties may include tilling soil and applying fertilizers; transplanting, weeding, thinning, or pruning crops; applying pesticides; or cleaning, grading, sorting, packing, and loading harvested products. May construct trellises, repair fences and farm buildings, or participate in irrigation activities.

13

Graders And Sorters - Crop, Nursery and Greenhouse Products:

Grade, sort, or classify agricultural crops by size, weight, color or condition.

14

Hand Packers And Packagers - Crop, Nursery and Greenhouse Products:

Pack or package by hand a wide variety of products and materials.

15

All Other Field Workers:

All agricultural workers working with crops, nursery or greenhouse products not included in codes 11-14.



LIVESTOCK WORKERS


21

Farmworkers - Farm, Ranch, and Aquacultural Animals:

Attend to live farm, ranch, or aquacultural animals that may include cattle, sheep, swine, goats, horses and other equines, poultry, finfish, shellfish, and bees. Attend to animals produced for animal products, such as meat, fur, skins, feathers, eggs, milk, and honey. Duties may include feeding, watering, herding, grazing, castrating, branding, de-beaking, weighing, catching, and loading animals. May maintain records on animals; examine animals to detect diseases and injuries; assist in birth deliveries; and administer medications, vaccinations, or insecticides as appropriate. May clean and maintain animal housing areas. Includes workers who drive and control equipment to accomplish the tasks described.

22

Graders And Sorters - Farm, Ranch, and Aquacultural Animal Products:

Grade, sort, or classify unprocessed food and other agricultural products by size, weight, color, or condition.

23

Hand Packers And Packagers - Farm, Ranch and Aquacultural Animal Products:

Pack or package by hand a wide variety of products and materials.

24

All Other Livestock Workers:

All agricultural workers working with farm, ranch and aquacultural animals or products not included in codes 21 – 23.



SUPERVISORS


31

Farmers, Ranchers and Other Agricultural Managers:

Plan, direct, or coordinate the management or operation of farms, ranches, greenhouses, aquacultural operations, nurseries, tree farms, or other agricultural establishments.

32

First-Line Supervisors of Farm Workers:

Directly supervise and coordinate the activities of agricultural, aquacultural, and related workers.



OTHER WORKERS


41

Agricultural Inspectors:

Inspect agricultural commodities, processing equipment and facilities, and aquacultural operations, to ensure compliance with regulations and laws governing health, quality, and safety.

42

Animal Breeders:

Select and breed animals according to their genealogy, characteristics, and offspring.

43

Pesticide Handlers and Sprayers:

Mix or apply pesticides, herbicides, fungicides, or insecticides through sprays, dusts, vapors, soil incorporation, or chemical application to all crops including nursery and greenhouse products and facilities, and livestock, and livestock facilities. Usually requires specific training and state or federal certification. Excludes pilots who dust or spray crops from aircraft.

44

Any Other Worker Not Listed Above:

Including, but not limited to, mechanics, shop workers, truck drivers, accountants, bookkeepers, office workers. Excluding contract & custom workers, retail workers, and “value-added” workers.




Section 3 - VALUE of SALES

1. Please classify this operation in terms of total gross value of sales

[Be sure sales represent only 2014 and earlier years’ production.]




Considering:

  • Sales of all crops, livestock, poultry, and livestock products (milk, eggs, etc.) sold in 2014.

  • The value of product removed for all crops, livestock, and poultry produced under contract

in 2014.

  • Sales of all miscellaneous agricultural products in 2014.

  • All government agricultural payments received in 2014.

  • Landlord’s share of government payments and crops sold in 2014.


a. What code represents the total gross value of sales, including government agricultural payments?

Total Value

GVS Code


None’ during 2014. . . . . . . . . . . .

99









$

$

$

$

$

$

$

$

$

$

$

$

1 ---

1,000 ---

2,500 ---

5,000 ---

10,000 ---

25,000 ---

50,000 ---

100,000 ---

250,000 ---

500,000 ---

1,000,000 ---

2,500,000 ---

$

$

$

$

$

$

$

$

$

$

999

2,499

4,999

9,999

24,999

49,999

99,999

249,999

499,999

999,999

2,499,999

4,999,999

….

….

….

….

….

….

….

….

….

….

….

….

1

2

3

4

5

6

7

8

9 10

11

12

GVS Code

550


$


5,000,000 and over ………….

13







b. Does the GVS (gross value of sales) Code in Code Box 550 equal ‘1’ or ‘99’?

Yes - [Continue.] No - [Go to page 9, item 2.]

c. Record all 2015 crops, land uses, and livestock or poultry now on the total acres operated,

then go to page 9, item 2.


Land Use

ACRES

Field Crops Intended For Harvest

ACRES

Other Crops

ACRES

CRP/WRP . . . . . . . . . . . . . . . . . .

     

__________________

     

Cut Christmas Trees

     

Idle Cropland . . . . . . . . . . . . . . . .

     

__________________

     

__________________

     

Summer Fallow

     

__________________

     

__________________

     

____________________

     

__________________

     

__________________

     





Livestock

NUMBER

Government Payments

WHOLE

DOLLARS

Fruits/Nuts

ACRES

Cattle – Dairy . . . . . . .

     

CRP/WRP Payments . . . . . . . . .

     

__________________

     

Cattle – Other . . . . . . .

     

Other Gov’t Payments . . . . . . . . .

     

__________________

     

Chickens . . . . . . . . . .

     



__________________

     

Hogs . . . . . . . . . . . . . .

     

Pasture/Rangeland


Cropland Used Only For Pasture

ACRES

__________________

     

Horses . . . . . . . . . . . .

     

__________________

     

Mules/Burros . . . . . . .

     

     



__________________

     

Permanent Pasture . . . . . . . . . . .

     

Vegetables/Melons

ACRES

__________________

     

Woodland Pasture . . . . . . . . . . .

     

__________________

     

__________________

     



__________________

     

__________________

     

Aquaculture

NUMBER

__________________

     


Office Use

Acres of Ponds in Use . . . . . . . .

     




TOTAL POINTS

Foodsize/Stockers . . . . . . . . . . . .

     

Berries

ACRES


552

Fingerlings/Broodfish . . . . . . . . .

     

__________________

     


PASTURE POINTS

Trout Eggs . . . . . . . . . . . . . . . . . .

     

__________________

     


554




Section 3 - VALUE of SALES (continued)


2.

Of the farm or ranch income reported, which of these categories represents the largest

portion of the gross income from this operation?

Code







1 - Grains, Oilseeds, Dry Beans, and Dry Peas . . . . . . . . . . . . . . . . . . . . . . . .

1




(corn, flaxseed, grain silage and forage, grains and oilseeds, popcorn, rice,

small grains, sorghum, soybeans, sunflowers, straw, etc.)






2 - Tobacco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2




3 - Cotton and Cottonseed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3




4 - Vegetables, Melons, Potatoes and Sweet Potatoes. . . . . . . . . . . . . . . . . .

4




(beets, cabbage, cantaloupes, pumpkins, sweet corn,

tomatoes, watermelons, vegetable seeds, etc.)






5 - Fruit, Tree Nuts and Berries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5




(almonds, apples, blueberries, cherries, grapes, hazelnuts, kiwifruit,

oranges, pears, pecans, strawberries, walnuts, etc.)






6 - Nursery, Greenhouse, Floriculture and Sod. . . . . . . . . . . . . . . . . . . . . . . .

6




(bedding plants, bulbs, cut flowers, flower seeds, foliage plants,

mushrooms, nursery potted plants, shrubbery, sod, etc.)






7 - Cut Christmas Trees and Short Rotation Woody Crops. . . . . . . . . . . . . .

7


FARM TYPE CODE

8 - Other Crops and Hay, CRP and Pasture. . . . . . . . . . . . . . . . . . . . . . . . . . .

8

551

(grass seed, hay and grass silage, hops, maple syrup, mint,

peanuts, sugarcane, sugarbeets, CRP, etc.)



9 - Hogs and Pigs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9




10 - Milk and Other Dairy Products from Cows. . . . . . . . . . . . . . . . . . . . . . . . . .

10




11 - Cattle and Calves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11




(beef and dairy cattle for breeding stock, fed cattle, beef and dairy cull animals,

stockers and feeders, veal calves, etc.)






12 - Sheep, Goats, and their Products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12




(wool, mohair, milk and cheese)






13 - Horses, Ponies, and Mules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(burros and donkeys)

13




14 - Poultry and Eggs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14




(broilers, chickens, turkeys, ducks, eggs, emus, geese, hatchlings,

ostriches, pigeons, pheasants, quail, poultry products, etc.)






15 - Aquaculture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15




(catfish, trout, ornamental and other fish, mollusks, crustaceans, etc.)






16 - Other Animals and Other Animal Products . . . . . . . . . . . . . . . . . . . . . . . . .

16




(bees, honey, rabbits, fur-bearing animals, semen, manure,

other animal specialties, etc.)























Section 4 - OTHER AGRICULTURAL LABOR INFORMATION

NUMBER OF WORKERS

1. During 2015, what was or will be the largest number of hired workers, including paid family members, on the payroll on any one day?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

277


CODE

2 Don’t Know - [Enter code 2.]

3 None - [Enter code 3.]

278

2. During 2015, did or will this operation have any H-2A Temporary Agricultural Workers on the payroll?

CODE

1 Yes - [Enter code 1.]

2 Don't Know - [Enter code 2.]

3 No - [Enter code 3.]

279

[Skip page 11, go to back page, item 1, and continue.]





Section 5 - CHANGE IN OPERATOR


Complete this section only if you answered “NO” for all questions in item 2 on the face page.

1. Has the operation named on the label been sold, rented or turned over to someone else?


1 Yes - [Go to item 2] 3 No - [Continue ]

a.

Will the land be used for any agricultural purpose by you (the operator), or anyone else in the next year (including growing crops or raising livestock)?










1 Yes 2 Don’t Know 3 No







Regardless of answer to above, write a note to explain the situation, then go to back page, item 1.




























2.

Please provide the following information for the operation that has taken over the land:



Operation Name: _______________________________________________________________________________


Operator Name: ________________________________________________________________________________


Address: ________________________________________ Phone: (________) - _________________________


City: ______________________________________________________ State: __________ ZIP: _________




3. Was this new operation, reported in item 2, in business before June 1, 2015?


1 Yes - [Go to back page, item 1.]



3 No - [Continue.]





4.

Is this new operation managed?



1 Yes - [Go to back page, item 1.]



3 No - [Continue.]





5.

Were any individuals associated with the new operation, reported in item 2 above, operating land

individually before June 1, 2015?


1 Yes - [Go to back page, item 1.]


3 No - [Go to back page, item 1.]






Section 6 - CONCLUSION






















1. Do you (the operator named on the label) make any day - to - day decisions for ANOTHER farm or ranch?




a. 1Yes - What is the name of this other
operation? . . . . . . . . . . . . . . . . . . . .

Operation Name: ________________________________________

3No - [Go to item 2 below.]

Address: __________________________________________


City: ____________________

State:____

ZIP: ______


Phone: (______) ____________________




[ENUMERATOR NOTE: IF ADDITIONAL OPERATION IS INDIVIDUAL OR PARTNERSHIP, complete a separate questionnaire for the additional operation.]



b. Was this additional operation in business before June 1, 2015?



1 Yes – [Continue.] 3 No – [Continue.]



COMMENTS:


2. 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 3 No

9990




Respondent Name:

9911


Phone: (_____) _____-- __________

9910 MM DD YY

Date: __ __ __ __ __ __

This completes the survey. Thank you for your help.

Office Use Only

Response

Respondent

Mode

Enum.

Eval.

Change

Office Use for POID

1-Comp

2-R

3-Inac

4-Office Hold

5-R – Est

6-Inac – Est

7-Off Hold – Est

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

9998

9900

9985

9989 
__ __ __ - __ __ __ - __ __ __


Optional Use

9907

9908

9906

9916

S/E Name







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authornassuser
File Modified0000-00-00
File Created2021-01-29

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