QID 044001 2013 Cost and Returns Report

Agricultural Resource Management, Chemical Use, and Post-harvest Chemical Use Surveys

0218 - ARMS III - Costs and Returns Report - 2013

Agricultural Resource Management, Chemical Use, and Contractor Expense Surveys

OMB: 0535-0218

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Project 904 – ARMS Phase III CRR - Version 1 – QID 044001

OMB No. 0535-0218 Approval Expires 12/31/2014

AGRICULTURAL RESOURCE MANAGEMENT SURVEY

NATIONAL

AGRICULTURAL

STATISTICS

SERVICE

COSTS AND RETURNS REPORT


DRAFT - 2013

U.S. Department of Agriculture,
Rm 5030, South Building
1400 Independence Ave., S.W.
Washington, DC 20250-2000

Phone: 1-800-727-9540

Fax: 202-690-2090

Email: [email protected]


CONTACT RECORD

DATE

TIME

NOTES















MILITARY TIME

INTRODUCTION:

[Introduce yourself, and ask for the operator. Rephrase in your own words.]


We are collecting information on costs and returns and need your help to make the information as accurate as possible.

Authority for collection of information on the Costs and Returns Report is Title 7, Section 2204 of the U.S. Code. 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.

Response is voluntary. You may skip any question(s) you prefer not to answer.


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 100 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.

We encourage you to refer to your farm records during the interview.


BEGINNING TIME [MILITARY]

0004

__ __ __ __


SCREENING BOX


0006


[ENUMERATOR NOTE: If screening box is code 1,

complete the screening supplement. If screening

box is blank, begin with Section A.]

[Name, address and partners verified and updated if necessary]

POID __ __ __ __ __ __ __ __ __

POID __ __ __ __ __ __ __ __ __

PARTNER NAME

PARTNER NAME

ADDRESS

ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

CITY

STATE

ZIP

PHONE NUMBER

POID __ __ __ __ __ __ __ __ __

POID __ __ __ __ __ __ __ __ __

PARTNER NAME

PARTNER NAME

ADDRESS

ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

CITY

STATE

ZIP

PHONE NUMBER



TOTAL POINTS

R. UNIT









OFFICE

USE

0929

0921

PARTNER

STRATUM

0925

0926

0927

0928


0009

0002



SECTION A

LAND IN FARM / RANCH

For 2013, please report farm/ranch land owned, rented, or used by you, your spouse, or by the partnership, corporation or

organization for which you are reporting. (Include all cropland, idle land, CRP, pastureland, woodland, wasteland, farmstead, acres used for

crop/livestock production facilities, and all other building sites associated with this operation, etc.)



ACRES OPERATED


ACRES

1. How many acres of farm/ranch land were owned? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

+

0020

2. How many acres of farm/ranch land were rented or leased from others---

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


ACRES

a. for a fixed or flexible cash rent payment?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

+

0021

b. for a share of the crop or livestock production? (Include hybrid rental arrangement

where rent paid is based on a fixed cash payment plus some shared production.). . . . . . . . . . . . . . . . . . . . . . . .

+

0023

c. for free?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

+

0024

3. How many acres of farm/ranch land were rented or leased to others?

(Include land rented for cash, for a share of crop or livestock production, or rent free.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

–

0025


TOTAL ACRES

4. Then the TOTAL ACRES in this operation in 2013 were: (total items 1 + 2a + 2b + 2c – 3). . . . . . . .

=

0026




5. Of the total acres in this operation (item 4), how many were---

ACRES

a. considered cropland? (Include land in government programs, fruit/nut/berry/nursery acres,

and land planted to hay, including wild hay. Exclude CRP acres planted to trees.). . . . . . . . . . . . . . . . . . . . . . . . . .

0030


b. covered under a Federal crop insurance policy?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0039


c. enrolled in the Conservation Reserve Program (CRP), Conservation Reserve Enhancement Program (CREP), and/or Wetlands Reserve Program (WRP)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .



0028


d. used to harvest certified organic crops? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0041



DOLLARS


6. In 2013, what was the total dollar amount received from CRP, CREP, and/or WRP payments?

(Verify that CRP, CREP, and/or WRP acres are reported in item 5c.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0477


7. In the 2013 crop year, did this operation use any land for annual crops (row crops, small grains, vegetables, etc. other than hay) that was used in 2012 for hay, grazing/pasture, CRP/CREP/WRP

or any other non-crop uses? (Include land that was in this operation in 2013 but not in 2012. Exclude land that was

in this farm in 2012 but not in 2013.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 8] . . . . . . . . .

CODE

0496

How many acres of each of these 2012 land uses were used for annual crops in the 2013 crop year?

ACRES

a. CRP/CREP/WRP land in 2012 that was used for annual crops in 2013. . . . . . . . . . . . . . . . . . . . . .

0497

b. Hay, grazing, or other non-crop, non-CRP/CREP/WRP land

in 2012 that was used for annual crops in 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0498

SECTION A continues on next page.




8. In the 2013 crop year, did this operation use any land for hay, grazing/pasture, CRP/CREP/WRP

or any other non-crop uses that was used in 2012 for annual crops (row crops, small grains,

vegetables, etc. other than hay)? (Include land that was in this operation in 2013 but not in 2012. Exclude land

that was in this farm in 2012 but not in 2013.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 9] . . . . . . . . .

CODE

0596

How many acres of land used for annual crops in the 2012 crop year were

in each of these uses in the 2013 crop year?

ACRES

a. CRP/CREP/WRP land in 2013 that was used for annual crops in 2012. . . . . . . . . . . . . . . . . . . . . .

0597

b. Hay, grazing, or other non-crop, non-CRP/CREP/WRP land in 2013

that was used for annual crops in 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0598

9. At any time during 2013 did you have a current Environmental Quality Incentives Program (EQIP), Conservation Security Program (CSP), and/or Conservation Stewardship Program (CStP) contract?

(Check yes if you had a current contract, regardless of whether you received a payment during 2013.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 10]. . . . . . . . . . . .

CODE

0526

a. What was the total acreage of fields subject to conservation treatments under---

(Include acreage of the fields where practices are applied (e.g., reduced tillage, terraces, and grassed waterways)

and acreage of fields/tracts that are adjacent to field-edge practice such as filter strips, riparian buffers, or fences.)

ACRES

(i) EQIP?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0071

(ii) CSP or CStP?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0072

b. What was the total dollar amount received under---

DOLLARS

(i) EQIP? (Verify that acreage is reported in item 9a(i).). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0540

(ii) CSP or CStP? (Verify that acreage is reported in item 9a(ii).). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0566

RENT PAID


10. Including rent for land and/or buildings, what was the total CASH RENT PAID in 2013 by

this operation? (Include rent paid in 2013 for previous years and rent paid in advance. Exclude storage bins,

to be reported in SECTION F, item 20. Exclude grazing of livestock, to be reported in item 11 below.). . . . . . . . . . . . . . . .

DOLLARS

0044

11. Did this operation use land (on a per head or AUM basis) that is administered either by:

  • public or private agencies,

  • industrial corporations,

  • grazing associations, or

  • rent from individuals on a short term grazing arrangement?

YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 12] . . . . . . . . . . . .

CODE

0049

a. In 2013, what were the total fees this operation paid for the use of publicly owned

land on an AUM basis? (Include fees paid for privately owned land administered by a public agency

through exchange-of-use.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOLLARS

0045

b. In 2013, how much did this operation spend on pasturing or grazing of livestock

on privately owned land (railroads, another farm/ranch, etc.) used on a fee per

head (AUM) or gain basis?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0046

RENT RECEIVED


12. Including rent for land and/or buildings, what was the total CASH RENT RECEIVED in 2013 for

acres rented TO others by this operation? (Include rent received in 2013 for previous years, rent received in advance, and government payments received from those acres. Exclude grazing of livestock, to be reported in SECTION E.). .

DOLLARS

0042

13. For acres share-rented to others, what was the total value of crop or livestock shares received in

2013 by this operation? (Include rent received in 2013 for previous years and government payments received from those acres.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0043



SECTION B

ACREAGE and PRODUCTION

1. For 2013, please report the acreage and quantity harvested, and amount used on this operation, on the total acres in this operation (Section A, item 4). (Include crops grown on a contract or custom basis. Exclude crops grown on land rented to others and cover crops if not harvested.)


[If share rented

from others, ask--]

1

2

3

4

5

CROP

How many acres

were HARVESTED?





ACRES

What was the

total production?

(Include landlord share

and amount used on operation.)


TOTAL AMOUNT

How much of

this operation’s share

of the total production

was (will be) used

on this operation?


TOTAL AMOUNT

How much of the production was the landlord’s share

of the crop?



TOTAL AMOUNT

FIELD CROPS





Corn for grain. . . . . . . . . . . . . . .

0105

0106

Bu.

0107

Bu.

0108

Bu.

Corn for silage or greenchop. . . . . .

0109

0110

Tons

0111

Tons

0112

Tons

Cotton, all types. . . . . . . . . . . . .

0113

0114

Lbs.


0116

Lbs.

Peanuts. . . . . . . . . . . . . . . . . . .

0117

0118

Lbs.

0119

Lbs.

0120

Lbs.

Potatoes (report sweet potatoes

in all other crops). . . . . . . . . . . .

0121

.____

0122

Cwt.

0123

Cwt.

0124

Cwt.

Rice. . . . . . . . . . . . . . . . . . . . .

0125

0126

Cwt.

0127

Cwt.

0128

Cwt.

Sorghum for grain. . . . . . . . . . . .

0129

0130

Bu.

0131

Bu.

0132

Bu.

Sorghum for silage. . . . . . . . . . . .

0133

0134

Tons

0135

Tons

0136

Tons

Soybeans. . . . . . . . . . . . . . . . .

0137

0138

Bu.

0139

Bu.

0140

Bu.

Tobacco, all types. . . . . . . . . . . .

0141

.____

0142

Lbs.


0144

Lbs.

SMALL GRAINS





Barley for grain. . . . . . . . . . . . . .

0145

0146

Bu.

0147

Bu.

0148

Bu.

Oats for grain. . . . . . . . . . . . . . .

0149

0150

Bu.

0151

Bu.

0152

Bu.

Wheat, all types, for grain. . . . . . .

0153

0154

Bu.

0155

Bu.

0156

Bu.

DRY HAY CROPS






Hay, dry, alfalfa and alfalfa mixtures.

0157

0158

Tons

0159

Tons

0160

Tons

Hay, dry, all others. . . . . . . . . . . .

0161

0162

Tons

0163

Tons

0164

Tons

OTHER CROPS






Canola. . . . . . . . . . . . . . . . . . .

0165

0166

Lbs.

0167

Lbs.

0168

Lbs.

Other oilseeds. . . . . . . . . . . . . . .

0169

0170

Lbs.

0171

Lbs.

0172

Lbs.

Sugarcane or sugarbeets. . . . . . . .

0173

0174

Tons

0175

Tons

0176

Tons

*Dry edible beans/peas/lentils. . . . .

0177




*Vegetables for processing. . . . . .

0178




*All other vegetables and melons

(Exclude vegetables grown under glass or other protection.). . . . . . .

0179




*Fruits, nuts, and berries. . . . . . . .

0180




*Nursery and greenhouse crops

(Include Christmas trees.). . . . . . .

0181

.____




*All other crops not listed above

(Include sweet potatoes.). . . . . . .

0182




Starred (*) crops are addressed in item 3.

SECTION B continues on next page.


2. What was the area grown for sale of nursery, floriculture, or greenhouse

crops, including Christmas trees, ornamental plants, flowers, mushrooms,

aquatic plants, sod, food crops under protection, vegetable seeds, flower seeds, or other propagative materials?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SQUARE FEET UNDER glass or other protection


ACRES in

the OPEN

0191


0192




. ___

3. [Ask only if starred (*) crops in item 1 were share rented from others.]

For acres rented to this operation on a share basis in 2013, what was

the estimated market value of your landlord’s share of the dry beans,

vegetables, fruits, nuts, nursery, greenhouse and all other crops?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .


DOLLARS

0183

4. Did this operation plant any corn, soybeans, wheat, or cotton intended for harvest in 2013,

or hay intended for livestock feed in 2013?


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 5] . . . . . . . . .

CODE

0238


a. How many acres planted or grown on this

operation were intended for harvest

in 2013? (For winter wheat, report acreage

planted in fall 2012. For double cropped acres,

include the acreage of both crops. Verify that

planted acreage is equal to or greater than

harvested acreage reported in Section B, item 1.). . .

Corn

Soybeans

Wheat

Cotton

Hay

0224

0230

0232

0239

0216

b. How many of these acres were planted

with no-till or strip-till?. . . . . . . . . . . . . . . . .

0225

0231

0233

0240


c. How many of these acres received

nitrogen fertilizer? (Exclude manure.). . .

0226


0234

0241

0217

For acres that received nitrogen fertilizer---





(i) what was the average total

application rate (lbs per acre)?. . . . . .

0227

lbs/

acre


0235

lbs/

acre

0242

lbs/

acre

0218

lbs/

acre

(ii) what percentage of nitrogen fertilizer was applied in the fall?. . . . . . . . . . . .

0228

%


0236

%

0243

%



(iii) what percentage of nitrogen fertilizer was applied after planting?. . . . . . . . .

0229

%


0237

%

0244

%



d. How many acres planted or grown on this operation were irrigated in 2013?. . . . . . . .

0219


0220

0221


0222


0223


5. How many acres of cropland were

(1) planted to a cover crop after the 2012 crop was harvested and

(2) subsequently planted to an annual crop (e.g., corn, wheat) for 2013?. . . . . . . . . . . . . . . . . . . . .

ACRES

0245



6. How many acres of cropland were left fallow during 2013?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0246

a. How many of these fallow acres were part of an on-going crop rotation that includes

fallow for moisture conservation or other purposes?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0247



SECTION C

LIVESTOCK

Please report the total numbers, including landlord’s share, of livestock, poultry, and/or livestock products sold and/or removed from this operation during 2013 and the total inventory on December 31, 2013, regardless of ownership. (Include landlord’s share, any sold on the open market (non-contract), and any removed from this operation under a production or marketing contract in 2013.)


1

2

3

4

1. Did this operation have on hand or produce
any [item] during 2013?

What was the

total number [column 1] sold or removed

in 2013?

On Dec. 31, 2013,

how many [column 1 regardless of ownership]

were on hand?

On Dec. 31, 2013,

how many [column 3]

were owned by

this operation?

a. Beef cows (Include beef heifers that have calved. Exclude heifers that have not calved, steers, calves,

and bulls.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0254

0255

0256

b. Milk cows, including any dry cows
(Exclude any heifers not yet freshened.). . . . . . . . . . . .

0257

0258

0259

(i) Milk produced in 2013 (report in cwt.). . . . . . .

0270



c. Other cattle and calves (Include heifers

that have not calved, steers, calves, and bulls.). . . . . . . .

0251

0252

0253

d. Total cattle and calves (total items a + b + c). . . . .

0260

0261

0295

e. All hogs and pigs. . . . . . . . . . . . . . . . . . . . . . . .

0262

0263

0296

f. Egg layers. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0248

0249

0250

(i) Chicken eggs (report in dozens). . . . . . . . . . . .

0266



g. Turkeys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0268

0269

0298

h. Broilers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0264

0265

0297

i. All other livestock and poultry


(Specify type(s): ______________________ ) . . . .

0272

0273

0299

2. [If SHARE RENTS from others and has livestock, ask---]


What was the estimated total market value of your landlord’s share of livestock production

sold or removed from this operation in 2013? (Exclude shared livestock production not part of a land

rental arrangement.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOLLARS

0276

OTHER OPERATIONS GROWING, FEEDING, OR RAISING LIVESTOCK FOR THIS OPERATION


3. Did any OTHER operation(s) grow, feed, or raise livestock or poultry owned by this operation
under a contract arrangement in 2013 (you are the contractor)?


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to SECTION D] . . . . . . . .

CODE

0271





















1

2

3

4

5

6

7

What livestock

or poultry

were being

raised or fed

for you?



[List type below.]

See

livestock

codes in

respondent

booklet



CODE

What was the

market value

of [type] on hand

on contractee

operations on

Jan.1, 2013?


DOLLARS

What was the estimated market

value (at placement)

of [type] placed

under contract

DURING 2013?


DOLLARS

How much was paid to contractees for labor, management, and reimbursement for expenses?



DOLLARS

How much were

your GROSS receipts from [type] sold or

removed under

this contract?



DOLLARS

On Dec. 31, 2013

what was the market value of unsold [type] remaining under

contract?



DOLLARS


0277

0278

0279

0280

0281

0282


0283

0284

0285

0286

0287

0288


0289

0290

0291

0292

0293

0294



SECTION D

COMMODITY MARKETING and INCOME

MARKETING CONTRACTS


1. Did this operation have marketing contracts for any commodities delivered1/ in 2013?

(A marketing contract is a verbal or written agreement reached before harvest of a crop or before completion

of a livestock production stage, setting a price or pricing formula and market for the commodity.)

YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 3] . . . . . . . . . . . . .

CODE

0300



UNIT CODES for ITEM 2, COLUMN 4



1 POUND

5 BIN

9 DOZEN

20 BARREL



2 CWT

6 BOX

10 FLAT

22 ACRE



3 TON

7 BALE

11 HEAD/BIRD

39 ANIMAL SPACE



4 BUSHELS

8 CARTON

13 PLANT/POT

40 KILOGRAM









2. (If Yes) Report the commodities delivered in 2013 through marketing contract(s). List the quantities marketed

and the final price received. (Include only the quantity owned by the operation. Exclude money received from contractors as

reimbursement for expenses (report this in SECTION F). Exclude landlord shares (report in SECTION B, items 1 & 3, and SECTION C, item 2).

Also exclude marketing charges (report in item 7) and money received for any reimbursements for expenses (report in SECTION F).)


1

2

3

4

5

6

What commodities did this operation have

MARKETING contracts for in 2013?

See

commodity

codes in

respondent

booklet

What quantity of this

commodity was delivered through this contract?

(Exclude landlord’s share.)

Unit Code


(from list

above)

What was (will be) the

FINAL PRICE RECEIVED

per [column 4] unit by this operation for this commodity

marketed under this contract?

(Exclude marketing charges.

Exclude money received as reimbursement for production expenses. Record this in SECTION F.)

What was the total dollar amount received in 2013

from this contract?

(Exclude marketing charges. Exclude money received as reimbursement for production expenses.

Record this in SECTION F.)

[Write in commodities]

CODE

QUANTITY

CODE

DOLLARS & CENTS

TOTAL DOLLARS


0301

0304

0305

0306

.___ ___ ___

0307


0316

0319

0320

0321

.___ ___ ___

0322


0331

0334

0335

0336

.___ ___ ___

0337


0346

0349

0350

0351

.___ ___ ___

0352


0361

0364

0365

0366

.___ ___ ___

0367


0376

0379

0380

0381

.___ ___ ___

0382


1351

1354

1355

1356

.___ ___ ___

1357


1366

1369

1370

1371

.___ ___ ___

1372


1381

1384

1385

1386

.___ ___ ___

1387


1396

1399

1400

1401

.___ ___ ___

1402


1411

1414

1415

1416

.___ ___ ___

1417


1426

1429

1430

1431

.___ ___ ___

1432

1/ “Delivered” includes commodities for which partial payment was made even if not physically delivered by December 31, 2013.

SECTION D continues on next page.


PRODUCTION CONTRACTS AND CUSTOM FED LIVESTOCK

3. Did this operation have production contracts for any commodities it produced in 2013?

(A production contract is a verbal or written agreement setting terms, conditions, and fees to be paid by the

contractor to the operation for the production of crops, livestock, or poultry. The contractor usually owns the

commodity and often provides inputs.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 5] . . . . . . . . . . . . .

CODE

0400



UNIT CODES for ITEM 4, COLUMN 4



1 POUND

5 BIN

9 DOZEN

20 BARREL



2 CWT

6 BOX

10 FLAT

22 ACRE



3 TON

7 BALE

11 HEAD/BIRD

39 ANIMAL SPACE



4 BUSHELS

8 CARTON

13 PLANT/POT

40 KILOGRAM









4. (If Yes) Report in the table below the commodities with production contracts in 2013. Also list the quantities
removed under these contracts and the final fee received. (Exclude money received to pay for production

expenses. Expense reimbursements should be reported in SECTION F.)


1

2

3

4

5

6

What commodities did this operation have

PRODUCTION

contracts for in 2013?

See

commodity

codes in

respondent

booklet

What quantity of this commodity was removed

from the operation under

this contract?

(Exclude landlord's share.)

Unit Code


(from list

above)

What was (will be) the

FINAL FEE RECEIVED

per [column 4] unit by this operation for producing

this commodity under

this contract?

(Exclude money received

as reimbursement for production expenses.

Record this in SECTION F.)

What were the

TOTAL FEES

RECEIVED in 2013

under this contract? 1/

(Exclude money received

as reimbursement for production expenses.

Record this in SECTION F.)

[Write in commodities]

CODE

QUANTITY

CODE

DOLLARS & CENTS

TOTAL DOLLARS


0401

0404

0405

0406

.___ ___ ___

0407


0416

0419

0420

0421

.___ ___ ___

0422


0431

0434

0435

0436

.___ ___ ___

0437


0446

0449

0450

0451

.___ ___ ___

0452


1441

1444

1445

1446

.___ ___ ___

1447


1456

1459

1460

1461

.___ ___ ___

1462


1471

1474

1475

1476

.___ ___ ___

1477


1486

1489

1490

1491

.___ ___ ___

1492

1/ Income received for commodities produced under contract in previous years should be recorded in item 8a(i) on page 10.

SECTION D continues on next page.



CASH or OPEN MARKET SALES


Exclude from item 5---

  • Marketing Contract sales (report in item 2)

  • Production Contract removals (report in item 4)

  • Landlord shares (report in Section B, items 1 & 3 and Section C, item 2)



5. After subtracting marketing expenses, what was the total dollar amount received in 2013

for cash or open market sales of each of the following crop and/or livestock commodities

produced in 2013 and earlier years? (Exclude marketing contract sales, production contract removals,

landlord’s share of market value.)

DOLLARS

a. Corn, rice, sorghum, soybeans, barley, oats, wheat (Include silage. Exclude sweet corn.) . . . . . . . . .

0501

b. Other grains and oilseeds, dry beans, and dry peas (flaxseed, other grain silage and forage,

other grains and oilseeds, popcorn, sunflowers, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0502

c. Tobacco, cotton, and cottonseed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0503

d. Vegetables, melons, potatoes and sweet potatoes (cabbage, cantaloupes, pumpkins,
red beets, sweet corn, tomatoes, watermelons, vegetable seeds, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0504

e. Fruit, tree nuts and berries (almonds, apples, blueberries, cherries, grapes, hazelnuts, kiwifruit,

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

0505

f. Nursery, greenhouse, cut Christmas trees, floriculture and sod (bedding plants, bulbs,
cut flowers, flower seeds, foliage plants, mushrooms, nursery potted plants, shrubbery, etc.) . . . . . . . . . . . . . . . . .

0506

g. Other crops, hay, and short rotation woody crops (grass seed, hay and grass silage, hops,

maple syrup, mint, peanuts, sugarcane, sugarbeets, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0507

h. Hogs and pigs (Exclude breeding stock.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0508

i. Hog breeding stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0509

(i) Recognized gain/loss on sales of breeding hogs reported in item 5i above
(can be negative (-) if losses were incurred) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0533

j. Milk from cows (before deduction of any hauling fees) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0510

k. Cattle and calves (fed cattle, beef and dairy cull animals, stockers and feeders, veal calves, etc.)
Exclude breeding stock.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0511

l. Cattle breeding stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0512

(i) Recognized gain/loss on sales of breeding cattle reported in 5l above
(can be negative (-) if losses were incurred) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0535

m. Broilers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0513

n. Eggs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0514

o. Turkeys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0515

p. Other poultry (other chickens, ducks, emus, geese, hatchlings, ostriches, pigeons, pheasants,

quail, poultry products, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0516

q. Other animals and other animal products (sheep, goats, and their products

(wool, mohair, and goat milk); horses, ponies, mules, burros, and donkeys; aquaculture;

bees and honey; semen and embryo sales) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0517

6. What was the total amount received from straw and other crop residue sales?

(Exclude hay sales.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOLLARS

0527

SECTION D continues on next page.




MARKETING CHARGES

7. In 2013, how much was spent by this operation

(operators, partners, landlords, and contractors)

for marketing and storage expenses incurred by

this operation? (Include check-off, commissions, storage,

inspection, ginning, etc. Include marketing expenses for contract sales.). . . . . . . . .




OPERATOR(S) and PARTNER(S)

LANDLORD(S)

CONTRACTOR(S)

DOLLARS

DOLLARS

DOLLARS

0868

0869

0870

ACCOUNTS RECEIVABLE / DEFERRED PAYMENTS


8. For each item below, report income received or the amount owed to the operation on the dates specified. Do not include crops in storage and not yet sold. (Include cash sales, marketing contract

sales, and production contract removals.)




[ENUMERATOR NOTE: Crops in storage and not sold as of the reference date should be reported in Section G, item 4a.]

a. On January 1, 2013, what was the total dollar amount owed to this operation for all

commodities produced and sold (cash or contract) before January 1, 2013?. . . . . . . . . . . . . . . . . .

DOLLARS

0885

(i) How much did this operation receive from item 8a during 2013?. . . . . . . . . . . . . . . . . . . . . . . .

0875

b. What was the total dollar amount owed to this operation on December 31, 2013, for all

commodities produced, sold (cash or contract), delivered, or removed under contract

in 2013 and earlier years?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOLLARS

0886
































































MARKETING EXPENSE WORKSHEET

COMMODITY

EXPENSE NAME

FEE PER UNIT

UNIT

NUMBER OF UNITS

TOTAL MARKETING EXPENSE



___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___






___ ___.___ ___ ___




TOTAL MARKETING CHARGES (EXPENSES)



OFFICE USE WORKSHEET


0946



SECTION E

OTHER FARM RELATED INCOME

1. In 2013, did this operation receive or repay any Commodity Credit Corporation (CCC) loans?


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 2] . . . . . . . . . . . . .

CODE

0560

a. In 2013, how much was received for all commodities placed under CCC loans? (Include Austrian winter peas, barley, canola, rapeseed, corn, cotton, crambe, dry edible peas, flaxseed, honey, lentils, mohair, mustard seed, oats, peanuts, rice, safflower, sesame seed, small chickpeas, sorghum, soybeans, sunflower seed, and wheat.). . .

DOLLARS

0518

b. In 2013, what was the amount spent to repay all CCC loans? (Exclude storage and service fees.). . . . . .

0519


[ENUMERATOR NOTE: If any of the crops redeemed from the CCC were sold in 2013, verify that these sales are

recorded in Marketing Contracts (SECTION D, item 2) or Cash Sales (SECTION D, item 5). If the redeemed crops were

NOT sold in 2013, their value should be reported in SECTION G, item 4a.]



2. In 2013, did this operation receive Federal, State or local farm program payments?
(Include government payments received through a cooperative. Exclude conservation-related payments

recorded in SECTION A and CCC loan payments.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 4] . . . . . . . . . . . .

CODE

0563

3. What was the total dollar amount this operation received in 2013 for---


a. payments from the Direct Counter-cyclical Payment (DCP)

and Average Crop Revenue Election (ACRE) programs?

(Include government payments received through a cooperative.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOLLARS

0525

(i) Of the total in item 3a, what percent was for DCP

direct payments?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +

PERCENT of 3a


0520


(ii) Of the total in item 3a, what percent was for DCP

counter-cyclical payments?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +



0522


(iii) Of the total in item 3a, what percent was for ACRE

direct payments?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +



0521





(iv) Of the total in item 3a, what percent was for ACRE

revenue payments?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +

0523


=

100%



DOLLARS

b. Loan Deficiency Payments (LDPs)? (Include government payments received through a cooperative.) . . . . . . . .

0528

c. Marketing Loan Gains (MLGs)? (Include government payments received through a cooperative.) . . . . . . . . . . .

0531

d. Milk Income Loss Contract (MILC) payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0536

e. net value of commodity certificates? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0565

f. Agriculture Disaster payments? (Include all disaster assistance and market loss payments.

Exclude milk income loss contract payments reported above and Federal crop insurance and

other indemnity payments, to be reported on the next page.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0537

g. any other Federal agricultural program payments? (Exclude CRP, CREP, WRP, EQIP,

CSP, and CStP payments reported in SECTION A.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0541

h. tobacco buyout payments including lump sum payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0476

i. any other local or State program payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0542

SECTION E continues on next page.



4. What is your estimate of the total dollar amount your landlord(s) received in government

payments for the acres you rented from them?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOLLARS

0543

.

5. In 2013, what was the total income received by you (the operator) and all partners for---

DOLLARS

a. custom work, machine hire, and other agricultural services provided by this operation

for farmers and others? (Exclude if this is a separate business.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0546

b. grazing of livestock? (Exclude contract arrangements previously reported.) . . . . . . . . . . . . . . . . . . . . . . . . . . .

0547

c. recreational and agri-tourism activities such as hunting, fishing, farm tours,

hospitality services, petting zoos, etc.?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0548

d. sales of all forest products? (Include firewood, timber, etc. Exclude maple syrup and Christmas trees.). . . . . . . .

0549

e. sales of farm machinery and vehicles? (farm share only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0550

f. proceeds from sales of farmland and other farm real estate owned by this operation only? . . . . . .

0558

(i) recognized gain/loss on sales of farmland and other farm real estate reported
above (item 5f)? (can be negative (-) if a loss was incurred). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0559


(ii) Were the sales of any farmland

or other farm real estate made to---

1 a non-relative

2 a relative

3 both non-relatives and relatives

. . . . . . . . . . . . . . .

CODE

0470


DOLLARS

g. Federal crop and livestock insurance payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0552

h. other crop and livestock insurance indemnity payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0551

i. cooperative patronage dividends and refunds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0554

j. sales of value-added goods produced (e.g. cheese, cider, jams, jellies, wines, and

other prepared items) from your farm commodities? (Exclude if this is a separate business.) . . . . . . . . . . .


0530



k. income from royalties or leases associated with energy production (e.g. natural gas,

oil, and wind turbines)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0555

l. all other farm related sources of income? [This may be a negative (-) number for hedging losses.]

(Show OTHER FARM INCOME in Respondent Booklet.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0556

List each income item and amount separately, below.

SECTION E continues on next page.



CODE

6. Which code from the list below represents the largest portion of this operation’s

2013 total gross value of sales, including Government agriculture payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0047


Include:

  • Sales of all crops, livestock, poultry and livestock products sold in 2013.

  • The VALUE OF PRODUCTS REMOVED for all crops, livestock,

and poultry produced under contract in 2013.

  • Sales of miscellaneous agricultural products in 2013.

  • All Government agricultural payments received in 2013.

  • Landlord’s share of Government payments.




Farm Type

Code

Farm Type

Code

Grains, oilseeds, dry beans, and dry peas (corn, flaxseed, grain,

silage and forage, grains and oilseeds for seeds, popcorn, rice,
small grains, sorghum, soybeans, sunflowers, etc.) . . . . . . . . . . . . .

01

Hogs and pigs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Milk and other dairy products from cows . . . . . . . . . . . . . . . . . .

09


10

Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Cotton and cottonseed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

02


03

Cattle and calves (beef and dairy cattle for breeding
stock, fed cattle, beef and dairy cull animals, stockers
and feeders, veal calves, etc.) . . . . . . . . . . . . . . . . . . . . . . . .

11

Vegetables, melons, potatoes and sweet potatoes (cabbage,

cantaloupes, pumpkins, red beets, sweet corn, tomatoes,
watermelons, vegetable seeds, etc.) . . . . . . . . . . . . . . . . . . . . . . .



04

Sheep, goats, and their products (wool, mohair, milk and cheese) .


Equine (horses, ponies, mules, burros and donkeys) . . . . . . . . . .

12


13

Fruit, tree nuts and berries (almonds, blueberries, cherries,
cranberries, grapes, apples, hazelnuts, kiwifruit, oranges,
pears, pecans, strawberries, walnuts, etc.) . . . . . . . . . . . . . . . . . . .



05

Poultry and eggs (broilers, chickens, turkeys, ducks, eggs,
emus, geese, hatchlings, ostriches, pigeons, pheasants,
quail, poultry products, etc.) . . . . . . . . . . . . . . . . . . . . . . . . .



14

Nursery, greenhouse, and floriculture (bedding plants, bulbs,
cut flowers, flower seeds, foliage plants, mushrooms,

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



06

Aquaculture (catfish, trout, other finfish, shellfish, etc.) . . . . . . . . .

15

Cut Christmas trees and short rotation woody crops . . . . . . . . . . . . .


07

Other animals and other animal products (bees, honey,

rabbits, other fur-bearing animals, semen, manure, other

animal specialties, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16

Other crops and hay (grass seed, hay and grass silage
straw, hops, maple syrup, mint, peanuts, sugarcane, sugarbeets,
CRP, pasture, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



08




NOTES AND CALCULATIONS



SECTION F

OPERATING and CAPITAL EXPENDITURES


OPERATING EXPENSES

Include only expenses related to this operation.

Exclude expenses NOT related to this farm/ranch; expenses of

performing custom work FOR others, if this is a separate

business; and expenses on land rented to others.



In 2013, how much was spent for (item) by [column]---

1

OPERATOR(S) &

PARTNER(S)


DOLLARS

2

LANDLORD(S)



DOLLARS

3

CONTRACTOR(S)



DOLLARS

1. seeds, sets, plants, seed cleaning and treatments, transplants,

trees and nursery stock? (Include technology or other fees, seed treatments, and seed cleaning cost. Exclude items purchased for resale

without additional growth.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




0600

0601

0602

2. nutrients, fertilizer, lime and soil conditioners?

(Include cost of custom application and organic materials.

Exclude potting mixes, vermiculite, and sterilized soil.) . . . . . . . . . . . . . . . . .




0606

0607

0608

3. biocontrols and agricultural chemicals for crops, livestock,

poultry, and general farm use? (Include biological pest controls

and custom application costs.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




0612

0613

0614

a. How much of this (item 3) was for custom

application only? (Include cost of chemicals.) . . . . . . . . . . . . . . . . .

0618

0619

0620

4. livestock purchases of---




a. breeding stock for beef cattle, dairy cattle,

hogs and sheep? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0621

0622

0623

b. other cattle, calves, hogs and pigs?

[Report other sheep in item 4d.] . . . . . . . . . . . . . . . . . . . . . . . . . .

0624

0625

0626

c. chickens and turkeys?

[Report ducks and game birds in item 4d.] . . . . . . . . . . . . . . . . . . .

0627

0628

0629

d. other livestock and poultry, including other sheep,

lambs, bees, brooder fish, fingerlings, goats, etc.? . . . . . . . . .

0630

0631

0632

5. leasing of livestock? (Include leasing of bees for pollination.) . . . . . . . . . .

0633

0634

0635

6. purchased feed for livestock and poultry?

(Include grain, hay, silage, mixed feeds, concentrates, etc.) . . . . . . . . . . . . . .

0636

0637

0638

7. bedding and litter for livestock? . . . . . . . . . . . . . . . . . . . . . . . . . . .

0639

0640

0641

8. medical supplies, veterinary and custom services

for livestock? (Exclude manure disposal. Include artificial

insemination (AI), branding, breeding fees, caponizing, castrating,

custom feed processing, hormone injections, performance testing,

pregnancy testing, seining, sheep shearing, etc.) . . . . . . . . . . . . . . . . . . . . .




0642

0643

0644

9. purchases for the farm business of---

  1. all fuels, oils and lubricants?

(total 9a(i) + 9a(ii) + 9a(iii) + 9a(iv) + 9a(v) + 9a(vi) must equal item 9a). . . . .




0663

0664

0665

(i) diesel fuel? (Include biodiesel.) . . . . . . . . . . . . . . . . . . . . . . .

0645

0646

0647

(ii) gasoline and gasohol? (Include ethanol blends.) . . . . . . . . . . .

0648

0649

0650

(iii) natural gas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0651

0652

0653

(iv) LP gas (propane, butane)? . . . . . . . . . . . . . . . . . . . . . . . .

0654

0655

0656

(v) oils and lubricants? (Include grease, hydraulic

fluids, motor oils, transmission fluids, etc.) . . . . . . . . . . . . . . . . . . .

0657

0658

0659

(vi) all other fuel? (Include coal, fuel oil, kerosene, wood, etc.) . . . . . .

0660

0661

0662


In 2013, how much was spent for (item) by [column]---

1

OPERATOR(S) &

PARTNER(S)


DOLLARS

2

LANDLORD(S)



DOLLARS

3

CONTRACTOR(S)



DOLLARS

10. electricity for the farm business? . . . . . . . . . . . . . . . . . . . . . . . . . .

0675

0676

0677





11. purchased water for irrigation from off-farm

suppliers? (Include irrigation assessments and fees.) . . . . . . . . . . . . . . . . .

0696

0697

0698

12. all other utilities, such as the farm share of telephone service,

water purchased other than for irrigation, and Internet access?. . .




0872

0873

0874

13. farm supplies, marketing containers, hand tools and farm shop power equipment? (Include expenses for temporary fencing. Exclude expenses for bedding/litter and permanent fencing.). . . . . . . . . . . . . . . . . . . .




0702

0703

0704

14. repairs, parts and accessories for motor vehicles, machinery

and farm equipment? (Include repairs to drying equipment, tune-ups, overhauls, repairs to livestock equipment, replacement parts for machinery,

tubes, tires, and accessories such as air conditioners, CB’s, radios and

hydraulic cylinders. Exclude irrigation equipment and pump repairs.). . . . . . . . . . .




0708

0709

0710

15. maintenance and repair for the upkeep of all farm buildings,
houses other than the operator’s, land improvements, and

all other farm/ranch improvements? (Include conservation improvements, corrals, feeding floors, feedlots, gravel, land drainage

structures, tiling, trench, silos, wells, irrigation equipment and pump

repairs and facilities. Exclude any new construction or remodeling.) . . . . . . . . . . .







0714

0715

0716

16. maintenance and repair of the operator’s house if it was

owned by the operation? (“Owned by the operation” means

the house is--
 recorded as an asset in farm record books, or
 deeded as part of the farm.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .







0726



17. insurance for the farm business? (Include all casualty insurance,

hail insurance, and any other crop or livestock insurance; motor vehicle

liability and blanket insurance policies. Include insurance on operator’s

dwelling, if owned by the operation. Exclude health insurance (reported

in SECTION F, item 26 or SECTION J, item 11) and other payroll insurance

items.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




0729

0730

0731

a. How much of this (item 17) was for Federal

crop insurance?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0732

0733

0734

18. interest and fees paid on debts---




a. secured by real estate? (Include interest paid

on the operator’s dwelling, if owned by the operation.) . . . . . . . . . . . . . . .

0738

0739


b. not secured by real estate? (Include service

fees on CCC loan redemptions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0741

0742


19. property taxes paid on---




a. real estate (land and buildings)? (Include real estate taxes

on the operator’s dwelling, if owned by the operation.) . . . . . . . . . . . . . . .

0744

0745

0746

b. livestock, machinery, and other farm production items? . . . . .

0747

0748

0749

SECTION F continues on next page.



In 2013, how much was spent for (item) by [column]---

1

OPERATOR(S) &

PARTNER(S)


DOLLARS

2

LANDLORD(S)



DOLLARS

3

CONTRACTOR(S)



DOLLARS

20. renting or leasing of tractors, vehicles, equipment
or storage structures? (Include farm machinery, cars, trucks,
irrigation equipment and other equipment. Exclude custom hire.) . . . . . . . . . . .




0750

0751


21. vehicle registration and licensing fees? . . . . . . . . . . . . . . . . . . . . .

0753

0754


22. depreciation expense claimed by this operation in 2013 for all

capital assets? (If partnership, include amounts claimed by all partners

in this operation. Estimate from 2012 if necessary.). . . . . . . . . . . . . . . . . . .




0756



a. How much of this depreciation expense (item 22)
was claimed for breeding livestock? . . . . . . . . . . . . . . . . . . . . .

0757



23. CASH WAGES paid to hired farm and ranch labor?

(Include cash wages, incentives and bonuses, payments to corporate

officers and paid family members, including yourself and other operators

if they received a wage. Exclude wages paid for custom and contract

work, wages paid for housework, Social Security on the owner-operator,

withdrawals for living expenses, employer’s share of Social Security and

unemployment taxes, health and life insurance, pensions or retirement

plans, and worker’s compensation.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




0758

0759

0760

24. Of item 23, how much salary or wage was paid to---
(total 24a + 24b + 24c + 24d + 24e must equal item 23)




a. you (the principal operator)? . . . . . . . . . . . . . . . . . . . . . . . . . .

0764

0765

0766

b. your (the principal operator’s) spouse? (Even if

your spouse is an operator, include his/her wages here.) . . . . . . . . . . . . .

0767

0768

0769

c. other members of your (the operator’s) household? (Even if your other household members are operators, include their wages here.) . . .

0574

0575

0576

d. other operators (outside the operator’s household)? (Those persons responsible for the day-to-day management decisions for this operation.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




0770

0771

0772

e. all other paid farm and ranch labor? . . . . . . . . . . . . . . . . . . . . .

0773

0774

0775

25. payroll taxes for hired labor? (Include employer’s share of Social

Security and unemployment taxes. Include any amounts the farm paid

for farm workers that are part of your (the operator’s) household.). . . . . . . . . . . . . .




0705

0706

0707

26. benefits for hired labor? (Include employer’s share of health insurance,

pension or retirement plans, Workers’ Compensation, etc. Include any amounts the farm paid for farm workers that are part of your (the operator’s) household.). . .




0915

0916

0917

27. contract labor? (Include expenses for labor, such as harvesting of fruit, vegetables, berries, etc. performed on a contract basis by a contractor, crew leader, cooperative, etc. Exclude contract work for building construction,

repairs, or farm improvements, and payments to other operations that

fed/raised livestock under contract FOR this operation.) . . . . . . . . . . . . . . . . . . . . .




0782

0783

0784

28. custom work such as---

(Custom work is work performed by machines and labor hired as a unit.)




a. hauling? Include all custom grain, livestock, milk,

manure, and other custom hauling. . . . . . . . . . . . . . . . . . . . . .

0788

0789

0790

b. all other custom work done on this operation, including machine hire and rental of machinery and equipment?
(Report custom livestock services in item 8.) . . . . . . . . . . . . . . . . . . . . .




0791

0792

0793

SECTION F continues on next page.



In 2013, how much was spent for (item) by [column]---

1

OPERATOR(S) &

PARTNER(S)


DOLLARS

2

LANDLORD(S)



DOLLARS

3

CONTRACTOR(S)



DOLLARS

29. workers who were members of your (the operator’s) household---


what was the cash value of any commodities provided

to them as PAYMENT for farm work? [Example: value of a

percentage of crops, calves, etc. Exclude operator payments or draws.]. . . . . . .




0797

30. workers who were NOT household members---


what was the cash value of all commodities, feed,

fuel, housing, meals, other food, utilities, vehicles

for personal use, and any other non-cash PAYMENT

for farm work? (Include meat, poultry, other livestock and

livestock products, berries, firewood, fruits, vegetables, etc.

Exclude home gardens, unless expenses were recorded previously.

Also exclude partner payments or draws.) . . . . . . . . . . . . . . . . . . . . . . . . .




0798



31. What was the market value of commodities produced

and used on this operation for home consumption?

(Exclude any commodities provided as payment to household

members for farm work reported in item 29.) . . . . . . . . . . . . . . . . . . . . . . . .




0799




PERCENT



a. What percent of this (item 31) was for livestock

and livestock products? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0800




32. professional or farm management services such as

record keeping, accounting, tax and business planning,

farm product advice, conservation practices, etc.?. . . . . . . . . . . . .

DOLLARS



0801




PERCENT



a. What percent of this (item 32) was for farm management

or planning? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0858




b. What percent of this (item 32) was for conservation

practices? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0814










Show the respondent the list of General Business Expenses

in the Respondent Booklet.


DOLLARS

DOLLARS

DOLLARS

33. general business expenses? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0804

0805

0806

List general business expense items and amounts below.






CAPITAL EXPENSES

34. improvements on land such as land preparation, irrigation improvements, well drilling, ponds, feedlots, trench silos,

lagoons, new fences, etc.? (Exclude moveable equipment.) . . . . . . . . .

DOLLARS

DOLLARS

DOLLARS

0807

0808

0809

35. new construction and remodeling of dwellings (excluding

the operator’s dwelling), barns, buildings, hog houses, poultry

houses, milk barns, storage facilities, sheds, silos, etc.?

(Exclude repairs and maintenance.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




0810

0811

0812





36. new construction or remodeling of the operator’s dwelling,

if owned by the operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0813



SECTION F continues on next page.



Report the TOTAL NET COST (after deducting the value of trade-ins, rebates

and discounts) of the following items purchased for the farm/ranch in 2013.



DOLLARS


37. Cars – Include new and used. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0816




PERCENT


a. What percent of this (item 37) was the farm’s share? . . . . . . . . . . . . . . . . . . . . . .

0817




DOLLARS


38. Trucks – Include new and used trucks, pickups,
sport utility vehicles, vans, campers and buses . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0818






PERCENT


a. What percent of this (item 38) was the farm’s share? . . . . . . . . . . . . . . . . . . . . .

0819






DOLLARS


39. Tractors – Include new and used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0820


40. Self-propelled equipment – Include implements and self-propelled

equipment for livestock, dairy, or poultry production (Exclude tractors.). . . . . . . . . . . . . .



0821


41. Other farm machinery, non-self-propelled farm equipment,

pumps, and capital equipment for crop or livestock production

(Include farm share only.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



0822


42. Office equipment, furniture, and computers that were placed
on a depreciation schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0823


43. Farmland and other farm real estate for expanding
this operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0803


a. Of the total amount spent on acres purchased in 2013

(item 43), what amount was---

DOLLARS


(i) paid for by cash?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0971


(ii) debt financed?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0972


(iii) paid for in some other way?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0973





44. All other capital expenditures (Include all other capital expenditures

that were placed on a depreciation schedule.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0824


[List all other capital expenditure items and amounts below.]




___________________________________________________________




___________________________________________________________




___________________________________________________________




45. What other expenses did this operation

have in 2013 that I have not recorded? . . . . . . . . . . . . . . . . . . . . .

OPERATOR(S) & PARTNER(S)


DOLLARS

LANDLORD(S)



DOLLARS

CONTRACTOR(S)



DOLLARS

0825

0826

0827

[List each expense item and amount below.]




_______________________________________________________________




_______________________________________________________________




_______________________________________________________________






SECTION G

FARM ASSETS

1. In order to estimate the financial position of farms correctly, we need to obtain the
MARKET VALUE of the following assets OWNED by this operation on December 31, 2013:

(Include owned assets on rented land.)


a. farm operator’s dwelling, if owned by the operation (Owned by the operation

means the house is recorded as an asset in farm record books or deeded as part of the farm.) . . . . . . . . . . . . . . . . . .

DOLLARS

0850

b. all other dwellings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0851

c. all other farm buildings and structures (Include barns, cribs, grain bins, greenhouses,

silos, storage sheds, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0852

d. orchard trees and vines, nursery trees, and trees grown for woody crops. . . . . . . . . . . . . . . . . . . .

0853

e. land (Include land rented to others. Exclude houses, buildings, orchard trees and vines,

and trees grown for woody crops.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0854

2. What is the estimated market value of the land and buildings on the acres rented

or leased FROM OTHERS on December 31, 2013? (Reported in SECTION A, items 2a, 2b, and 2c.). . . . . . . .


0855



3. What is the estimated market value of the land and buildings on the acres rented

or leased TO OTHERS on December 31, 2013? (Reported in SECTION A, item 3.). . . . . . . . . . . . . . . . . . . .

0857

For each item below, report the market value(s) of the assets owned by

the operation on the dates specified.



Beginning of Year

End of Year

4. What was the ESTIMATED MARKET VALUE for the farm share of [item] on---

JAN. 1, 2013?

DEC. 31, 2013?

DOLLARS

DOLLARS

a. crops owned and stored on or off this operation

(Include crops stored at co-op or gin warehouse, specialty crops, fruit storage, hay, silage,

and nursery and greenhouse products not in the ground. Exclude crops under CCC loans.). . . . .

0888

0889

b. breeding livestock owned by and located on or off this operation

(Include aquaculture, bees, cattle, equine, hogs, mink, poultry, sheep, etc., kept for

breeding purposes. Exclude livestock being produced under contract on another operation

(reported in Section C, item 3).). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



0863

0864

c. non-breeding livestock owned by and located on or off this operation

(Include aquaculture, bees, cattle, equine, hogs, mink, poultry, sheep, etc., kept for non-

breeding purposes. Exclude livestock being produced under contract on another operation

(reported in Section C, item 3).). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



0876

0877

d. production inputs owned by this operation, such as processed feed,

fertilizer, chemicals, fuels, parts, purchased seed and other supplies. . . . . . . . . .

0878

0879

e. production inputs already used by this operation for cover crops or crops

planted but not yet mature for harvest (also known as sunk costs), or the value

of inputs used for production contracts that have yet to be delivered. . . . . . . . . .



0880

0881

f. trucks and cars owned by the operation (farm share only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0882

g. tractors, machinery, tools, equipment and implements owned by the operation . . . . . . . . . . . . . . .

0883

h. stock in farm cooperatives and the Farm Credit System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0884

LIQUID ASSETS - [Show OTHER FARM ASSETS & VALUE CODES in Respondent Booklet.]

5. Which value code represents the value of all other farm assets not previously listed

on December 31, 2013? (Include money owed to this operation (except money owed from

commodity sales), cash certificates of deposit, savings and checking accounts, hedging account

balances, government payments due, balance of land contract sales, and any other farm assets

not reported earlier. Exclude any personal debt owed to the operator(s).). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

END OF YEAR

VALUE CODE

0887



SECTION H

FARM DEBT

1. Was debt used in funding the operation of this farm/ranch in 2013, including any loans
obtained in earlier years? (Include seasonal production and other loans taken and repaid during 2013.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to SECTION I] . . . . . . . . .

CODE

1080

2. Did you have an established line of farm credit with a lender during 2013?


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 4] . . . . . . . . . . . . .


1081



3. In 2013, how much did you borrow
against the established line of credit? . . . . . . . . .

1 - Borrowed full amount

2 - Borrowed MORE by extending previous limit

3 - Borrowed LESS than full amount available

4 - Did not borrow against line of credit in 2013

. . . . . . . . .


1082


DOLLARS

4. What was the total amount of all farm business loans taken out and repaid in 2013?

(Include seasonal production and other loans.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0890

5. Did this operation owe money to any banks, co-ops, individuals, merchants or Federal

agencies on December 31, 2013? (Include money owed against your line of credit and multi-purpose

loans used for both farm and non-farm purposes. Exclude CCC commodity loans and any loans used exclusively

for non-farm purposes.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to SECTION I] . . . . . . . . .

CODE

1058

6. To estimate the financial position of farms correctly and their ability to service debt and to categorize

debt by types, we need to list loans this operation had on December 31, 2013, including any line of

credit. (Include farm/ranch loans, debt on the operator’s house if owned by the operation, and multi-purpose loans used for

both farm and non-farm purposes. Exclude CCC commodity loans and any loans used exclusively for non-farm purposes.)

1

2

3

4

5

6

7

8

9

Who is

the lender?





[Show lender

codes

in the

Respondent

Booklet.]

What was the

balance owed

on Dec. 31, 2013

including outstanding principal plus

unpaid interest?

What was the

interest rate

on 12/31/2013?




[Report in hundredths

of a percent.

Example:

9% = 09.00]

What is

the type

of loan?




[See the

Respondent

Booklet.]

What

year

was it

obtained?

What is

the original term of

the loan?





















NUMBER

of YEARS

What

percent

is for

operating

expenses,

capital

expenditures,

or other

expenses

of the farm

operation?

What is

the primary farm purpose

of this loan?



[Show codes

in the

Respondent Booklet.]

Is this a---

1 fixed rate loan?

If this is a variable

or adjustable rate loan, how often

is it repriced?

2 monthly

3 quarterly

4 annually

5 more than annually

CODE

DOLLARS

PERCENT

CODE

YEAR

PERCENT

CODE

CODE

1001

1002

1003

. __ __

1004

1005


__ __ __ __

1008

1006

1007

1009

1010

1011

1012

.__ __

1013

1014


__ __ __ __

1017

1015

1016

1018

1019

1020

1021

.__ __

1022

1023


__ __ __ __

1026

1024

1025

1027

1028

1029

1030

.__ __

1031

1032


__ __ __ __

1035

1033

1034

1036

1037

1038

1039

.__ __

1040

1041


__ __ __ __

1044

1042

1043

1045

7. If you had farm loans in addition to the five that I’ve just recorded, what is the total amount of debt from these loans owed on December 31, 2013? (Include farm/ranch loans and debt on the operator’s house if it is owned by the operation. Exclude any loans for non-farm purposes that are secured by assets of the farm/ranch.). . . . . . . . .

DOLLARS

1047

8. How much of the total debt owed on December 31, 2013 (reported in items 6 and 7 above),

was for the operator’s dwelling? (If the operator’s dwelling is owned by the operation, debt should be included

here and above. Exclude operator’s dwelling if not owned by the operation.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1057





OFFICE USE

ONLY

0999



SECTION I

FARM MANAGEMENT and USE OF TIME

1. In 2013, was more than 50% of the ownership interest in this operation held by you (the principal operator) and/or persons related to you by blood, marriage, or adoption, including relatives not residing in your household? (Ownership interest is defined as having ownership of at least some of the farm business assets. Potential owners include individuals, partners, corporate shareholders, and members of a Limited Liability Company. Potential owners DO NOT INCLUDE landlords, contractors, and lenders.)


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CODE

1249



NUMBER

2. In 2013, how many owners of this operation were there? (Exclude landlords, contractors,

and lending institutions holding farm debt. Include yourself if you have an ownership interest.). . . . . . . . . . . . . . . . . . . . .

1246


PERCENT

a. What percent of the ownership interest did you (the operator) and your

household hold? (Exclude relatives not living in your household.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1248



3. In 2013, what was this
operation’s legal status
for tax purposes? . . . . . . . . .

1 Family or Individual operation? (Exclude partnerships and corporations.)

2 A legal partnership operation? (Include family partnerships.)

3 C - Corporation?

4 S - Corporation?

5 Other? (Include estates, trusts, cooperatives, grazing associations, etc.)


CODE

. . . . . . .

1240



4. Was this operation organized as a Limited Liability Company (LLC) under State law?


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1202


[ENUMERATOR NOTE: If item 3 = code 2 (operation is a partnership), continue; else go to item 7.]

PARTNERSHIP QUESTIONS


5. Is this partnership registered under State law?


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CODE

1204


NUMBER

6. How many partners are there in this operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1232

SHARE OF NET FARM INCOME


7. In 2013, did any households, other than your (the principal operator’s) household,

share in the net farm income of this business? (Sharing can occur by receiving a share of

profits/losses or, if incorporated, receiving corporate dividends.)


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 8] . . . . . . . . . . . . .

CODE

1225

a. How many other households shared in the net income of the farm business?. . . . . . . . . . . . . . . . .

NUMBER

0976

8. Is this operation a C-Corporation or an LLC that chose to file as a C-Corporation?


YES - [Enter code 1, then go to item 8a] NO - [Enter code 3, then go to item 8b] . . . . . . . .

CODE

1226

a. What value code represents the corporate dividends that you (the operator) and

your household received from this farming operation? (If your operation is an LLC that

elected to file for tax purposes as a C-Corporation, consider this as income here.) [See Value Code

list in Respondent Booklet. Skip 8b and proceed to item 9.]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VALUE CODE

0975

  1. What percent of net income (whether profit or loss) were you (the operator) and

your household entitled to receive from this farming operation? (If your operation is

an LLC that elected to report income for tax purposes as a pass-through, consider this as income here.). . . . . . . . . . . . . . .

PERCENT

0974

SECTION I continues on next page.

[ENUMERATOR NOTE: If the operation is NOT a family or individual operation, continue; else go to item 10.]


ACRES

9. If the operation rented or leased land from others (reported in Section A, items 2a, 2b,

and 2c), how many of those rented acres are owned by your household?. . . . . . . . . . . . . . . . . . . . . . .

0977

FARM OPERATORS


10. In 2013, how many operators (individuals) were involved in the day-to-day decisions for this

operation? (Enter the number of operators, including the operator named on the front of this form, and family

members if they are also operators. Exclude family members unless they make day-to-day decisions for the

operation. Exclude hired workers unless they are a hired manager.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NUMBER

1200

11. Did you (the principal operator) have a spouse for at least part of 2013?


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 13] . . . . . . . . . . .

CODE

1205


12. Did the principal operator’s spouse make day-to-day decisions for this farm/ranch at any point

during 2013? [If yes, the principal operator’s spouse should be included in item 10 above.]


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . . . . . .

CODE

1209

For items 13-16, please answer the following questions for up to three primary operators of this operation as of December 31, 2013.

If one of the operators is the principal operator’s spouse, record his/her information in operator 2.

PRINCIPAL

OPERATOR


OPERATOR 2


OPERATOR 3

NAME


NAME


NAME

13. What was the full name of the operator(s)? . . . . . . . . . . . . . . . . .







AGE


AGE


AGE

14. What was the age of the operator(s) on December 31, 2013?. . .

1242


1262


1282



YEAR


YEAR


YEAR

15. In what year did the operator(s) begin

to operate any farm operation?. . . . . . . . . . . . . . . . . . . . . . . . . . .

1241


___ ___ ___ ___


1261


___ ___ ___ ___


1281


___ ___ ___ ___




CODE


CODE


CODE

16. What was the gender of the operator(s)? . . . . . .

1 Male

2 Female

. . .

1243


1263


1283

17. Is the principal operator’s spouse listed as OPERATOR 2 in item 13?


YES - [Enter code 1, then go to item 18] NO - [Enter code 3, then continue with item a] . . .

CODE

1203


AGE

a. If NO, and the principal operator had a spouse at any point during 2013,

what was the age of the principal operator’s spouse on December 31, 2013?. . . . . . . . . . . . . . . . . .

1206

18. Were you a hired manager for this operation (meaning you received a wage, salary,
or in-kind payment for making day-to-day management decisions for this operation)?


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . . .

CODE

0995

SECTION I continues on next page.

INTERNET USE


19. Do you use the Internet in the farm business?

YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 19e]. . . . . . . . . . .

CODE

1201

a. Do you have high-speed access to the Internet?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

1210

b. Has the Internet become more useful as a farm business tool (over the last two years)?. .

YES = 1

1211

c. Do you buy (farm goods or services) or sell (farm commodities, products,

or services) on-line?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

1212

d. Exclusive of buying or selling goods and services on-line (item 17c), do you

communicate with farm business associates (farm owners, farm managers,

business partners, cooperative associations, other farmers, bankers, brokers,

etc.) through the Internet?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

1233


[ENUMERATOR NOTE: If item 19 = code 3 (Internet not used in farm business), continue; else go to item 20.]



CODE

e. What is your primary reason

for NOT using the Internet in

the farm business?. . . . . . . . . .


1 Not useful

2 Too expensive

3 High-speed access not available

4 Internet security concerns

5 Other reasons

. . . . . . . . . . . . . . . . . . . . . . . . . . .

1234


20. Do you use a smart phone (Blackberry, iPhone, etc.) in your business?

YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . . .


1235




DISTANCE

MILES

21. About how many miles was it from your home to the nearest town or city with a

population of 10,000 or more?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1277


22. Where did you buy the majority of the following input items used by

this operation and the principal operator’s household in 2013?

Input Item

What is the distance

from your farm to

where you purchased

the input item?


MILES

Did you purchase

the input item in

the nearest town

or city of any size?


1 Yes

3 No

If NO, ask---

What is the

main reason?

1 Price of the input

2 Not available

3 Other

a. Fuel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1278

1236

1293

b. Fertilizer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1279

1237

1294

c. Chemicals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1280

1238

1295

d. Machinery and Implements (Include supplies and repairs.). . . . . .

1250

1239

1296

SECTION I continues on next page.

DIRECT SALES

23. During 2013 did you produce, raise, or grow any commodities that this operation sold or provided directly to individual consumers for human consumption, directly to retail outlets, directly to regional distributors (including food hubs, CSAs, and other local foods aggregators), or directly to institutions (such as schools and hospitals) that provide dining services to consumers? (Include commodities reported in Section D if sold to any of the above channels. Exclude non-edible products such as Christmas trees and flowers, craft items, and processed products such as jellies, sausages, and hams.)

CODE

YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 28]. . . . . . . . . . . .

1244

24. Were any of these products delivered under a production contract to a local retail outlet

(e.g., restaurant, grocery store) and reported in Section D, items 3-4?


YES - [Enter code 1, then continue] NO - [Enter code 3, then continue]. . . . . . . . . . . . . . . .

1245

25. Were any of these products delivered under a production contract to a local institution

(e.g., school or hospital) and reported in Section D, items 3-4?


YES - [Enter code 1, then continue] NO - [Enter code 3, then continue]. . . . . . . . . . . . . . . .

1247

26. Were any of these commodities reported as a marketing contract in Section D, items 1-2,

or cash or open market sales in Section D, item 5?


YES - [Enter code 1, then continue] NO - [Enter code 3, then go to item 28]. . . . . . . . . . . .

1276



27. What were the cash market, open market or marketing contract sales sold directly

to these consumers or outlets? (Exclude commodities produced under production contracts.)

Crop

Commodities



DOLLARS

Livestock Products and Livestock Commodities


DOLLARS

a. Sales directly to consumers at farmers markets?. . . . . . . . . . . . . . . . . . . . . . . . .

1284

1285

b. Sales directly to consumers from on-farm stores, u-pick,

road-side stands, or CSAs?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1286

1287

c. Sales to a local retail outlet, e.g., restaurant, grocery stores?. . . . . . . . . . . . . . . .

1288

1289

d. Sales to a regional distributor, e.g., food hubs, CSAs? . . . . . . . . . . . . . . . . . . . . .

1290

1291

e. Sales to a local institutional outlet, e.g., schools, hospitals?. . . . . . . . . . . . . . . . .

1292

1297

ENERGY GENERATION

28. At any time during 2013 did this operation generate energy or electricity on the farm using wind

or solar technology, methane digester, etc.?

YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . .

CODE

1298

29. Did you lease land to others who installed windmills or solar arrays?

YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . . . . . . . . . . . . . .


1299

SECTION I continues on next page.

USE OF TIME

30. In order to estimate the returns farm households receive for their labor correctly, we need to obtain time allocations.

We know there are 168 total hours in a week (7 days with 24 hours in a day) that you allocate to various activities.


On average, for each of the three month periods

DURING 2013, about how many hours per week did---

1

Jan-Mar

2

April-June

3

July-Sept

4

Oct-Dec

HOURS/WEEK

HOURS/WEEK

HOURS/WEEK

HOURS/WEEK

a. you (the principal operator) --





(i) work for this farm/ranch without paying yourself
a wage or salary? . . . . . . . . . . . . . . . . . . . . . . . . . . .

0480

0481

0482

0483

(ii) work for this farm/ranch for a wage or salary? . . . . . .

0484

0485

0486

0487

(iii) operate another business other than this

farm/ranch? (Include operating another farm/ranch.

Exclude commuting time.). . . . . . . . . . . . . . . . . . . . . . . . .

1091

1092

1093

1094

(iv) work at other employment off this farm/ranch?

(Exclude commuting time.). . . . . . . . . . . . . . . . . . . . . . . . .

0488

0489

0490

0491

(v) spend otherwise? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0492

0493

0494

0495

TOTAL

168

168

168

168


b. your spouse (the principal operator’s) --





(i) work for this farm/ranch, without being paid

a wage or salary? . . . . . . . . . . . . . . . . . . . . . . . . . . .

0580

0581

0582

0583

(ii) work for this farm/ranch for a wage or salary?. . . . . .

0584

0585

0586

0587

(iii) operate another business other than this

farm/ranch? (Include operating another farm/ranch.

Exclude commuting time.). . . . . . . . . . . . . . . . . . . . . . . . .

1095

1096

1097

1098

(iv) work at other employment off this farm/ranch?

(Exclude commuting time.). . . . . . . . . . . . . . . . . . . . . . . . .

0588

0589

0590

0591

(v) spend otherwise? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0592

0593

0594

0595

TOTAL

168

168

168

168


31. On average, for each of the three-month periods

during 2013, about how many hours per week

(work and management time) did ---

1

Jan-Mar

2

April-June

3

July-Sept

4

Oct-Dec

HOURS/WEEK

HOURS/WEEK

HOURS/WEEK

HOURS/WEEK

a. other operators (excluding the principal operator and

principal operator’s spouse) work for this farm/ranch

without receiving a wage or salary? . . . . . . . . . . . . . . . . .

1061

1062

1063

1064

b. other operators (excluding the principal operator and

principal operator’s spouse) work for this farm/ranch

for a wage or salary? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1065

1066

1067

1068

(Example: If the operation had 4 other salaried operators who averaged 40 paid hours per week during Jan-Mar, report 160 for column 1 of 31b.)


32. For the other workers on this operation (excluding the principal operator, the principle operator’s spouse, other operators, custom hire, and contract labor), on average, for each of the three-month periods during 2013, about how many hours per week (work and management time) did ---

1

Jan-Mar

2

April-June

3

July-Sept

4

Oct-Dec

HOURS/WEEK

HOURS/WEEK

HOURS/WEEK

HOURS/WEEK

a. unpaid workers (such as non-operator partners,
family members, etc.) work for this farm/ranch? . . . . . . . . .

0840

0841

0842

0843

b. paid workers work for this farm/ranch?
(Exclude custom hire and contract labor.) . . . . . . . . . . . . . . . . . .

0859

0860

0861

0862

(Example: If the operation had 4 paid workers who averaged 40 hours per week during Jan-Mar, report 160 for column 1 of question 32b.)



OFFICE USE

ONLY

2001



SECTION J

FARM HOUSEHOLD


[ENUMERATOR NOTE: If the principal operator has a spouse (SECTION I, item 11), please answer for both the principal operator and his/her spouse.]

1. Are the principal operator and/or principal operator’s spouse of Spanish,

Hispanic, or Latino origin or background, such as Mexican, Cuban, or

Puerto Rican, regardless of race?


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . .




OPERATOR


SPOUSE

1219


1220






ENTER CODE 1 FOR ALL THAT APPLY






OPERATOR


SPOUSE


American Indian or
Alaska Native? (Specify tribe_________)

. . .

1213


1214

2. Which of these do you and/or your spouse (the principal operator and/or

principal operator’s spouse) consider yourself? Are you--- . . . . . . . . . . . . . . .

Asian?

. . .

1215


1216

Black or African American?

. . .

1217

1218


Native Hawaiian or Other Pacific Islander?

. . .

1221


1222


White?

. . .

1223


1224


3. What is the highest level of

formal education achieved by

the principal operator and the
principal operator’s spouse?. . . . . .

  1. Less than high school diploma

  2. High school

  3. Some college (Include associates degree)

4 4-year college graduate and beyond


OPERATOR


SPOUSE

. . .

1257


1260


4. In 2013, what was the primary

occupation of the principal operator

and the principal operator’s spouse? . . .

  1. Farm or ranch work

  2. Work other than farming or ranching

  3. Currently not in the paid workforce


OPERATOR


SPOUSE

. . .

1207


1208

5. Do you (the principal operator) now consider yourself

to be retired from farming/ranching?


YES - [Enter code 1] NO - [Enter code 3] . . . . . . . . . . .

CODE


1259


SECTION J continues on next page.


6. How many persons lived in the principal operator’s household on December 31, 2013?

(Include operator, spouse, children, and others living in the operator’s household.). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NUMBER

1227



7. Of the people who lived in your (the principal operator’s) household on December 31, 2013,

how many were---



In each age category?

Were covered by any health insurance for any part of year?

NUMBER

NUMBER

a. younger than 6 years old?. . . . . . . . . . . . . . . .

+

1228

1126

b. from 6 through 17 years old?. . . . . . . . . . . . . .

+

1229

1127

c. from 18 through 64 years old?. . . . . . . . . . . . .

+

1230

1128

d. 65 years or older?. . . . . . . . . . . . . . . . . . . . . .

+

1231

1129

e. Total persons in household

(should equal number reported in item 6). . . .

=




8. In 2013, how many of these persons had health insurance that was

provided through---

Household Members

Under 65

Years of Age


Household Members 65 Years and Over

a. an employer (or former employer) from the operator’s off-farm work? . . . . . . . . . . .

1264



1271

b. an employer (or former employer) from the spouse’s off-farm work? . . . . . . . . . . . .

1265



1272

c. other employer or group sponsored policies (e.g., purchased through

a cooperative, union, or farm organization)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1266



1273

d. this farming operation?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1269



1270

e. direct purchase private policy (fully purchased by or for the household)? . . . . . . . .

1267



1274

f. Medicare, Medicaid, or other public insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1268



1275


























[ENUMERATOR NOTE: If SECTION I, item 1 = 3 (50% or less interest held by operator and relatives), go to CONCLUSION; else continue.]


[ENUMERATOR NOTE: If the principal operator and/or the principal operator’s spouse worked off the farm and reported hours of non-farm work in Section I, items 30a(iii), 30a(iv), 30b(iii), or 30b(iv), ask; otherwise go to item 10.]


OPERATOR


SPOUSE

9. How many miles is it one way from your home to your and/or your

spouse’s off-farm job? (Enter zero for home based jobs such as truck driver,

salesperson, enumerator, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MILES


MILES

0941


0942

SECTION J continues on next page.



10. Which value code from the list below represents the total income the household, the principal operator, and spouse received in 2013 from--- (Exclude farm income reported earlier.)


SOURCE

TOTAL HOUSEHOLD

INCOME


VALUE CODE

OPERATOR

INCOME


VALUE CODE

SPOUSE

INCOME


VALUE CODE


a. all off-farm wages, salaries, and tips before taxes and withholdings?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0952

0950

0951


(i) Which business code (from list in respondent booklet) represents the type of off-farm business you and/or your spouse worked at?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1070

1071


(ii) Which occupational code (from list in respondent booklet) represents the type of job you and/or your spouse had at this off-farm business?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1059

1060


b. net cash income from operating another farm or ranch (net of depreciation)? (can be negative (-) if a loss was incurred). . . . .

0957

0955

0956


c. net cash income from renting farmland to others, excluding

land rented to others from this operation? (can be negative

(-) if a loss was incurred) (Include rental of farmland that is not part

of this operation, which may include whole farms or ranches owned by household members as well as smaller parcels of land. Include cash

or share-rental income.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0963



d. net cash income from operating any other business (net of depreciation)? (can be negative (-) if a loss was incurred). . . . .

0960

0958

0959


(i) Which business code (from list in respondent booklet) represents the type of off-farm business you and/or your spouse operated?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1072

1073


(ii) What was the total number of employees who worked at this business? (Include the operator and spouse.). . . . . . . . . . . . .


1074

1075


e. interest income?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0969



f. dividend income?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0966



g. total proceeds from the sale of farm and non-farm capital assets? (Include operator household’s share only.). . . . . . . . . . . . . . . .

0978



(i) recognized gain/loss on the sale of capital assets

reported above? (item 10g) (can be negative (-) if

capital losses were incurred). . . . . . . . . . . . . . . . . . . . . . . . .

0981



h. income from private pensions and private disability payments?.

0939



i. income from public sources? (Include Social Security, military and other public retirement, veteran’s benefits, public disability, unemployment,

or other public assistance.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0998



j. other off-farm sources of income?. . . . . . . . . . . . . . . . . . . . . . . .

0993
















Dollar Range

Value

Code


Dollar Range

Value

Code


Dollar Range

Value

Code


Dollar Range

Value

Code


None. . . . . . . . . . . . . . . . . . . . 01


$10,000 – 14,999. . . . . . . . . . 10


$80,000 – 99,999. . . . . . . . . . . 19


$1,000,000 – 1,499,999. . . . . . 28



$1 - 499. . . . . . . . . . . . . . . . . .02


$15,000 – 19,999. . . . . . . . . . 11


$100,000 – 124,999. . . . . . . . . 20


$1,500,000 – 1,999,999. . . . . . 29



$500 – 999. . . . . . . . . . . . . . . 03


$20,000 – 24,999. . . . . . . . . . 12


$125,000 – 149,999. . . . . . . . . 21


$2,000,000 – 2,999,999. . . . . . 30



$1,000 – 1,999. . . . . . . . . . . . 04


$25,000 – 29,999. . . . . . . . . . 13


$150,000 – 199,999. . . . . . . . . 22


$3,000,000 – 4,999,999. . . . . . 31



$2,000 – 2,999. . . . . . . . . . . . 05


$30,000 – 34,999. . . . . . . . . . 14


$200,000 – 274,999. . . . . . . . . 23


$5,000,000 – 7,499,999. . . . . . 32



$3,000 – 3,999. . . . . . . . . . . . 06


$35,000 – 39,999. . . . . . . . . . 15


$275,000 – 349,999. . . . . . . . . 24


$7,500,000 – 9,999,999. . . . . . 33



$4,000 – 4,999. . . . . . . . . . . . 07


$40,000 – 49,999. . . . . . . . . . 16


$350,000 – 499,999. . . . . . . . . 25


$10,000,000 and over. . . . . . .. 34



$5,000 – 7,499. . . . . . . . . . . . 08


$50,000 – 59,999. . . . . . . . . . 17


$500,000 – 749,999. . . . . . . . . 26





$7,500 – 9,999. . . . . . . . . . . . 09


$60,000 – 79,999. . . . . . . . . . 18


$750,000 – 999,999. . . . . . . . . 27














SECTION J continues on next page.




[Show VALUE CODES in Respondent Booklet.]

11. Which value code represents how much this household spent in 2013 on---

VALUE CODE

a. food, including food away from home? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1105

b. rent payments for principal operator’s dwelling, if not owned by the household (item 12c, below)

or farm business (SECTION G, item 1a has a zero value)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1104

c. utilities and household supplies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1106

d. non-farm transportation:


(i) renting or leasing of vehicles for household use, public transportation expenses, etc.?. . . . . . .

1107

(ii) fuel, maintenance and repairs, vehicle insurance, parking and license fees for
non-farm share of vehicles? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1119

e. health and medical expenses:


(i) health and/or dental insurance costs? (costs not covered by the farm operation or an
off-farm employer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1108

(ii) out of pocket expenses for health and medical needs? (Include co-payments,

co-insurance, deductibles, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1112

f. contributions to personal insurance (including life, disability, and liability insurance but not including
health, homeowner or vehicle insurance) and retirement plans including pensions and Social Security?. . .

1109

g. contributions to individuals outside of the household, including alimony, child support,
gifts (not including bequests) and charitable contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1110

h. mortgage interest for operators who live in a dwelling owned by the household and not the operation? (Exclude any parts of mortgage principal.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1120

i. property taxes for operators who live in a dwelling owned by the household and not the operation? (Exclude any parts of mortgage principal.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1121

j. all other family living expenses, such as non-farm household insurance payments,

clothing and personal care products and services; house furnishings and equipment,

education and child (or adult) care, entertainment (hobbies, recreation, and vacations)? . . . . . . . .


1118


[Show VALUE CODES in Respondent Booklet.]


12. Which value code represents the total value of each of the following categories of off-farm assets

owned by the operator and members of the operator’s household on December 31, 2013, for---
(Exclude assets of this operation, reported in SECTION G.)


a. financial assets held in non-retirement accounts? (Include cash, checking, savings, money market
accounts, certificates of deposit, savings bonds, government securities, outstanding personal loans due to the
operator or household, corporate stock, mutual funds, cash surrender value of life insurance, other financial assets. Exclude all farm business-related assets.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VALUE CODE

0953

b. retirement accounts? (401k, 403b, IRA, Keogh, other retirement accounts) . . . . . . . . . . . . . . . . . . . . . . .

0954

c. operator’s dwelling, if not owned by the operation? (not reported in Section G, item 1a) . . . . . . . . . . . . . .

0984

d. real estate and other personal (second) homes? (other farms, residential rental, commercial,
and other real estate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0985

e. business not part of this farm? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0986

f. all household vehicles? (including household share of vehicles partly owned by the operation) . . . . . . . . . . . . . .

0982

g. other assets not reported elsewhere? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0987

SECTION J continues on next page.



[Show VALUE CODES in Respondent Booklet.]

13. Which value code represents the total value of each of the following categories of

off-farm debt (debt not associated with this operation) owed by the operator and

members of the operator’s household on December 31, 2013, for---

(Include off-farm debt secured with farm assets. Exclude any debt – household debt, credit cards,

etc. – reported in SECTION H, Farm Debt.)




[ENUMERATOR NOTE: If mortgage debt on the operator dwelling was reported earlier in SECTION H,

item 8, then skip item 13a and continue with 13b. If mortgage debt on the operator dwelling was NOT reported in SECTION H, item 8, then continue with item 13a.]



VALUE CODE

a. mortgages on operator’s dwelling, if not owned by the operation? (Include home mortgages,
home equity loans, and lines of credit secured by the operator’s dwelling.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0988

b. mortgages on other real estate and other personal (second) homes? (Include mortgages,
equity loans, and lines of credit secured by other real estate, including other farms, residential rental,

commercial, and other real estate.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


0989

c. loans on businesses that are not a part of this farm operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1101

d. personal loans? (Include credit cards, auto loans, unpaid taxes, medical bills, any other debts/liabilities
not reported elsewhere.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1102

e. all other off-farm debt owed by the operator or household? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0983



14. Which value code represents the amount of off-farm debt owed by the operator or household members that was secured by farm assets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1117



[ENUMERATOR NOTE: Items 15 - 17 refer to Income and Expense items for 2012.]


15. Which value code represents the total farm sales in the previous year (2012)?

(Total farm sales includes livestock and crop income from cash and marketing contract sales, fees received

from livestock and crop production contracts, the net change in CCC loans, and government payments.) . . . . . . . . . . . . . . . . . .

VALUE CODE

1113

16. Which value code represents the net operating income for this operation in the previous

year (2012)? (cash income from all farm sources minus production costs and depreciation; if negative net

operating income, indicate a minus sign before the value code) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1114

17. Which value code represents the total off-farm income in the previous year (2012)?

(wages, salaries, tips, interest, dividends, other public sources, etc. before taxes, income from operating

another farm, income from operating any other business; if negative off-farm income, indicate a minus sign

before the value code) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1115



OFFICE USE

ONLY

2002



CONCLUSION

1. To receive the complete results of this survey on the release date, go to www.usda.gov/results/.

Would you rather have a brief summary mailed to you at a later date?

YES - [Enter code 1] NO - [Enter code 3]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CODE

0099



MILITARY TIME

2. ENDING TIME [MILITARY]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0005


__ __ __ __


OFFICE USE

TIME IN HOURS


0008


.__



Reported by:_______________________________________________

Telephone (_____)_________________________________________



OFFICE USE



0093



OFFICE USE



0092


Response

Respondent

Mode

Enum

Eval

Duplication

Adjustor

Date

MM DD YY

Optional

1-Comp

2-R

3-Inac

9901

1-Op/Mgr

2-Sp

3-Acct/Bkpr

4-Partner

9-Other

9902

2-Tel

3-Face-to -Face

9903

0098

0100

0922

9910


__ __ __ __ 12

0003

Office Use for POID

0919


__ __ __ - __ __ __ - __ __ __

S/E Name







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