QID 2014 Integrated Screening Survey - HQ Master Copy

2014 INTEGRATED SCREENING SURVEY
OMB No. 0535-0218
Approval Expires: 10/31/2015
Project Code: 905 QID:######
SMetaKey: ####
Version 6
NATIONAL
AGRICULTURAL
STATISTICS
SERVICE

HQ MASTER COPY
National Agricultural Statistics Service
U.S Department of Agriculture
NOC Division
9700 Page Avenue, Suite 400
St. Louis, MO 63132-1547
Phone: 1-800-727-9540
Fax: 314-595-9990
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.
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
0535-0218. 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.

1. Please make any needed corrections to the name, including the correct operation name, and mailing address on the
label.
2. During 2014, will this operation (name on label):
grow any crops, including field crops, fruits, vegetables, nursery/greenhouse, or other specialty crops; or
cut any hay; or
have any livestock or poultry; or
sell any agricultural products; or
receive government payments (CRP, WRP, etc.); or
have more than 19 acres of idle cropland or more than 99 acres of pastureland?
YES – [Go to SECTION 1]
NO – [Complete Items a and b, then go to SECTION 6 on back page.]
a. Has the operation name on the label been sold, rented, or turned over to someone else?
Will the land be used for any agricultural purpose by you
YES
NO
(the individual listed on the label), or anyone else in the
next year?
b. What is the name and address of the new operator?

YES
NO
DON’T KNOW
Please explain then go to SECTION 6 on back page.

Operation Name:_________________________________________ _________________________________________________________
Operator Name: _________________________________________ _________________________________________________________
Address: ________________________________________________

_________________________________________________________

City: ____________________ State: ____________ Zip: _________ _________________________________________________________
Phone: (

) ______________________________

_________________________________________________________

-#-

SECTION 1 2014 TOTAL ACRES OPERATED
1. Including the farmstead, all cropland, woodland, pasture land, wasteland, and government
program land, how many total acres does this operation –

Acres
901

+
a. own? ................................................................................................................................................
902

b. rent or lease from others, including for cash, shares or rent free?

+
(Exclude land used on an animal unit month (AUM) or fee per head basis under a grazing permit.) ...........
905

c.

–
rent to others, including for cash, shares or rent free? ....................................................................
900

2. Total Acres Operated: [Items 1a + 1b - 1c] ..................................................................................... =
3. Of the total [Item 2] acres operated, how many are considered cropland?

802

(Include hay land, summer fallow, idle cropland, cropland used for pasture, & cropland in government
programs.)

4. Does this operation have a Pesticide Grower Permit number from the Arizona Department
of Agriculture Environmental Services Division?
YES – [Continue]

NO – [Go to SECTION 2 on next page]

5. What Pesticide Grower Permit number does this operation use for reporting
chemical applications on these [Item 2] acres to the Arizona Department of
810
Agriculture – Environmental Services Division?...........................................................................

PGP 10 NUMBER

6. Is this permit number used to report chemical applications for acres other than these [Item 2] acres?
YES – [Continue]

NO – [Go to Item 7]

OFFICE USE
012

a. What other operation(s) is this permit number used to report for?
Name __________________________________________________

Name __________________________________________________

Address ________________________________________________

Address ________________________________________________

Phone (

Phone (

) __________________________________________

) __________________________________________

7. Does this operation use any OTHER Pesticide Grower Permit number
to report chemical applications to ADA - ESD for these [item 2] acres?
YES – [Continue]

NO – [Go to SECTION 2 on next page]
PGP 10 NUMBER
811

a. What are these PGP numbers? .......................................................................................

812

b. Do you use any of these ID’s to report chemical applications for
any other operation(s)?
YES – [Continue]

NO – [Go to SECTION 2 on next page]

813
814
815

OFFICE USE

(1) What other operation(s) use this Pesticide Grower Permit for reporting?
[Identify operation and ID]

013

Name ___________________________________________________

Name __________________________________________________

Reporting ID ____________________________________________

Reporting ID ____________________________________________

Address ________________________________________________

Address ________________________________________________

-#-

Phone (

) __________________________________________

Phone (

) __________________________________________

SECTION 2 2014 CROPS
1. For the crop listed below, please report acres planted and to be planted for all purposes for the 2014 crop year.
(Include acres planted and to be planted, even if the crop will not be harvested (for instance, used for cover crop, plowed under or
abandoned). If specified, also report acres harvested and to be harvested for grain in the 2014 crop year. Exclude crops planted on
land rented/leased to others.)
Check
Here if
NONE

Acres Planted
and to be Planted
for All Purposes
530

Acres Harvested
and to be Harvested
for Grain
####

Corn ..............................................................................................................
2. For the crop listed below, please report acres planted and to be planted for harvest in 2014. Also, report the acres to be
harvested in 2014. (Include acres planted and to be planted, even if the crop will not be harvested (for instance, used
for cover crop, plowed under or abandoned). Exclude crops planted on land rented/leased to others.)
Check
Here if
NONE

Acres Planted
and to be Planted
884

Fall Potatoes (Usually harvested September through November.
Exclude sweet potatoes.) .............................................................................

Acres HErikarvested
and to be Harvested
####

-#-

SECTION 3 2014 VEGETABLE CROPS
ACRES
803
1. Of the total cropland acres reported, how many acres are or will be planted to vegetable crops?
(Include double or other multiple croppings.) .....................................................................................................

.___

2. For each vegetable crop named, please give the total acres planted or intended to plant
during the 2014 crop year. (Include any acres already planted and harvested in the 2014
crop year. For double or other multiple croppings, count each planting.)
None

ACRES
300

. ___

Asparagus (Include bearing and non-bearing acres) ......................................................................
315

. ___

Snap Beans intended for fresh market ...............................................................................................
318

. ___

Snap Beans intended for processing ..................................................................................................
339

. ___

Broccoli ....................................................................................................................................................
345

. ___

Cabbage intended for fresh market ....................................................................................................
354

. ___

Cantaloupes ...............................................................................................................................
357

. ___

Carrots intended for fresh market ..............................................................................................
360

. ___

Carrots intended for processing .................................................................................................
366

. ___

Cauliflower ..................................................................................................................................
369

. ___

Celery .........................................................................................................................................
375

. ___

Sweet Corn intended for fresh market ................................................................................................
378

. ___

Sweet Corn intended for processing ...................................................................................................
384

. ___

Cucumbers intended for fresh market ........................................................................................
387

. ___

Cucumbers intended for processing ..........................................................................................
393

. ___

Eggplant .....................................................................................................................................
396

. ___

Garlic ..........................................................................................................................................
414

. ___

Honeydew Melons ......................................................................................................................
420

. ___

Head Lettuce ..............................................................................................................................
423

Other Lettuce..............................................................................................................................

. ___

-#-

SECTION 3 2014 VEGETABLE CROPS (Continued)
None

ACRES
432

. ___

Dry Onions .................................................................................................................................
447

. ___

Green Peas intended for processing..........................................................................................
453

. ___

Bell Peppers ...............................................................................................................................
456

. ___

Pumpkins ....................................................................................................................................
465

. ___

Spinach intended for fresh market .............................................................................................
475

. ___

Summer Squash.........................................................................................................................
476

. ___

Winter Squash ............................................................................................................................
474

. ___

All Squash ..................................................................................................................................
477

. ___

Strawberries (Include bearing acres only) ................................................................................
480

. ___

Tomatoes intended for fresh market ..........................................................................................
483

. ___

Tomatoes intended for processing .............................................................................................
489

. ___

Watermelons ..............................................................................................................................

3. Do you have a contract with a vegetable processor for any of these vegetable crops?

CODE

015
YES – [Enter code 1 and continue.]
NO – [Enter code 3, then go to SECTION 4 on next page.] ..................................................................

OFFICE USE
830

831

a. Which processor(s) do you have contracts with?
PROCESSOR 1

PROCESSOR 2

Name _________________________________________________

Name _________________________________________________

Address _______________________________________________

Address _______________________________________________

City _____________________

City _____________________ State _____

State _____

Zip ___________

Phone Number (_____) ________________________________

Zip ___________

Phone Number (_____) ________________________________

-#-

SECTION 4 2013 VALUE OF SALES
1. Considering:
sales of all crops, livestock, poultry, and livestock products (milk, eggs, etc.) sold in 2013;
the value of product removed for all crops, livestock, and poultry produced under contract in 2013;
sales of all miscellaneous agricultural products in 2013;
all government agricultural payments received in 2013; and
landlord’s share of government payments and crops sold in 2013,
a. What code represents the total Gross Value of Sales (GVS), including government agricultural payments?
Total Value

$
$
$
$
$
$
$
$
$
$
$
$

GVS Code

‘None’ during 2013 .............................. 99
1 –
$
999 .......... 1
1,000 –
$
2,499 .......... 2
2,500 –
$
4,999 .......... 3
5,000 –
$
9,999 .......... 4
10,000 –
$
24,999 .......... 5
25,000 –
$
49,999 .......... 6
50,000 –
$
99,999 .......... 7
100,000 –
$ 249,999 .......... 8
250,000 –
$ 499,999 .......... 9
500,000 –
$ 999,999 .......... 10
1,000,000 –
$ 2,499,999 .......... 11
2,500,000 –
$ 4,999,999 .......... 12

$ 5,000,000 and over ............................. 13
b. Is the GVS Code in box 860 equal to ‘1’ or ‘99’?
YES – [Go to Item c, next page.]
NO – [Go to Item 2, next page.]

GVS Code
860

-#-

SECTION 4 2013 VALUE OF SALES (Continued)
c.

Record all 2013 crops, land uses, and livestock or poultry now on the total acres operated.
Land Use

ACRES

Field Crops Intended
For Harvest

ACRES

ACRES

Other Crops

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

________________ ........

Cut Christmas Trees .......

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

________________ ........

Nursery & Greenhouse ....

Summer Fallow ................

________________ ........

________________ .........

________________ ........

________________ .........

_________________ ........
Government Payments

WHOLE
DOLLARS

Fruits/Nuts

ACRES

NUMBER

Livestock

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

________________ ........

Cattle – Dairy..................

Other Gov’t Payments .......

________________ ........

Cattle – Other .................

________________ ........

Chickens ........................

________________ ........

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

________________ ........

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

Pasture/Rangeland

ACRES

Cropland Used Only
For Pasture ..................

Mules/Burros ..................
ACRES

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

Vegetables/Melons

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

________________ ........

________________ ........

________________ ........

________________ ........

Aquaculture

NUMBER

Sheep & Goats ...............

________________ ........
OFFICE USE

Acres of Ponds in Use .......
Foodsize/Stockers ............

Berries

Fingerlings/Broodfish ........

________________ ........

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

________________ ........

Other Aquaculture .............

________________ ........

ACRES

Total Points
861

Pasture Points
869

2. Which of these categories represents the largest portion of the gross income
from the operation in 2013?
Farm Type 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
8 Other Crops and Hay, CRP and Pasture ...................................................................... 8
(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...........................................................................................13
(burros and donkeys)

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.)

Farm Type Code
862

-#-

SECTION 5 OPERATION TYPE
1. Are the day-to-day decisions for this operation made by one individual,
a hired manager, or partners? [Check one]
One individual – [Go to SECTION 6, below.]
A hired manager – [Go to SECTION 6, below.]
Partners – [Complete items a and b, then go to SECTION 6, below.]

Number

a. How many individuals, including the operator, are involved in the day-to-day
decisions for this operation? .................................................................................................................
b. Please record partners’ names and addresses then go to SECTION 6, below.
(Enter names and addresses of partners, including partners who jointly operate land and share in decision making.
Exclude landlords and tenants as partners.)
PARTNER 1

PARTNER 2

Partner name: ______________________________________________

Partner name: ______________________________________________

Address: ___________________________________________________

Address: ___________________________________________________

City: _____________________

State: ____________ Zip: __________ City: ____________________

State: ____________ Zip: __________

Phone: (______) __________________________

Phone: (______) __________________________

PARTNER 3

PARTNER 4

Partner name: ______________________________________________

Partner name: ______________________________________________

Address: ___________________________________________________

Address: ___________________________________________________

City: _____________________

City: ____________________

State: __________ Zip: ___________

Phone: (______) __________________________

SECTION 6

State: __________ Zip: ___________

Phone: (______) __________________________

CONCLUSION

1. Do you (the operator named on the label) make any day-to-day decisions for another farm or ranch?
YES – Please list the other operation(s):__________________________________________________________________________
NO – [Continue]

This completes the survey. Thank you for your help.

9911

Reported by: ___________________________________________________________

Telephone: ___________________________________

OFFICE USE
R. Unit
921

Response
9901

Ptr 1 Str
925

Respondent
9902

Ptr 2 Str
926

Mode
9903

Ptr 3 Str

Ptr 4 Str

927

Enum.
0098

928

Eval.
0100

OPS

SSO 1

923

407

Change
785

ADJ
922

Date

Optional Use
9906

9916

POID

9910

789

____ ____ ____ ____
M

M

D

D

14 ___ ___ ___ ___ ___ ___ ___ ___ ___