Form FSA-441 B FSA-441 B Custom Digitial Print Form

United States Department of Agriculture
This form is available electronically.

Form Approved - OMB No. 0560-0176

FSA-441B

Farm Service Agency
Aerial Photography Field Office

(07-16-15)

REQUEST FOR CUSTOM AERIAL PRINT
See Page 2 for Privacy Act and Paperwork Reduction Act Statements
1. NAME

INSTRUCTIONS
2. ADDRESS (STREET ADDRESS)

ORDERING - Products are made to order.
Don't know what to order? See Page 2 for additional information. Faxing
your order? Include your Credit Card number. Confirmation copies are not
necessary, but if you do - mark it ''CONFIRMATION ONLY.'' Otherwise we'll
handle it as a new order.

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

PAYMENT- Prepayment is required.
We accept Credit Cards. Make your check or money order payable to
USDA FSA. Purchase orders are accepted from tax-supported agencies.
Please do not send cash or blank checks.

5. CONTACT NAME
6. TELEPHONE NUMBER

7. FAX NUMBER

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

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

B. AGENCY CODE

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

FUNDS CHARGEABLE

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

10. CREDIT CARD NUMBER

11. EXP. DATE (MM/YY)

SIGNATURE
12. TOTAL REPRODUCTIONS

13. AMOUNT REMITTED / PO AMOUNT
TITLE
DATE
$
IMAGERY DATA SECTION (See Page 2 for Ordering Information)
14. Description of your Area of Interest (AOI): Include state, county, and year(s) desired. Provide quarter quad (QQ) name(s), shapefiles in NAD83 projection, latitude and longitude
coordinates, township/range/section(s), or a detailed map outlining your AOI boundaries.

15. What type of layer(s) would you like on your image?
Topography

Hydrography

Transportation

Public Land Survey

None

Other (specify):

16. Select your desired paper size.
20"x20" Metallic Photo Paper ($50.00)

24"x24" Metallic Photo Paper ($60.00)

30"x30" Metallic Photo Paper ($70.00)

20"x20" *Semi-Matte Photo Paper ($36.00)

24"x24" *Semi-Matte Photo Paper ($44.00)

30"x30" *Semi-Matte Photo Paper (57.00)

*Semi-matte photo paper requires additional labor charge typically between $6.25 and $15.00 depending on custom work involved.
17. Do you want the APFO template on your image?

YES, Enter border & text box color option number in A & B below.
Standard color options indicated above each template sample.

Standard Black & White Image Border Color No. 4 – Text Box Color No. 3

NO

Standard Natural Color Image Border Color No. 7 – Text Box Color No. 1

Standard Color Infrared Image Border Color No. 9 – Text Box Color No. 2
A. Border Color Option No.
B. Text Box Color Option No.

Note: Visit our website at http://www.apfo.usda.gov for Custom Aerial Print
and Template Color samples.
18. Would you like a white border around your template?

Address Order for
Product or Request
for Information to:

YES

NO

CUSTOMER SERVICE SECTION
USDA FSA AERIAL PHOTOGRAPHY FIELD OFFICE
2222 WEST 2300 SOUTH
SALT LAKE CITY UT 84119-2020

TELEPHONE:
FAX:
E-MAIL:
WEBSITE:

801-844-2922
855-415-2014
mailto:[email protected]
http://www.apfo.usda.gov

ORDERING INFORMATION
FSA-441B (Page 2) (07-16-15)

A

Your customer information - please include your street address (Item 2) and
telephone number (Item 6). If you are a tax-supported organization and
want to be billed, place your purchase order number here (Item 9C).

B

Total reproductions (Item 12) - in this area indicate the total number of
reproductions by product (i.e. 1-24x24)
Amount remitted/PO amount (Item 13) - by check, money order or Credit
Card (Item 10).

C

Area of Interest or AOI (item 14) – provide state, county, year(s), and
description of your area or location here.
Layer(s) available on your image (Item 15) – select option(s) listed or
specify other if you want to provide your own.
Paper Size and Type (Item 16) – select your desired paper size and type.
APFO Template (Item 17) – indicate if you would like a template around
your image. If YES, select available color options for border and text box in
A and B. You may visit our website at http://www.apfo.usda.gov to view
Custom Aerial Prints and use our interactive Template Color sampler.
Template Border (Item 18) – Indicate if you would like a white border.

D

Instructions - these are brief instructions related to your order. See ''HOW
TO ORDER CUSTOM AERIAL PRINTS” below.

E

U.S. Government Agency Use Only - this may substitute for your purchase
order. For FSA orders, your signature is required.

F

Available color options for template border and text box areas.

* HOW TO ORDER CUSTOM AERIAL PRINTS
Fill out items 14 through 18 on the FSA-441B, Request for Custom Aerial Print form. Furnish one or more of the following forms of information and we
will make a print selection for you:
•
•
•
•

Latitude and Longitude coordinates (point and radius or four corner points.)
Legal description of your area of interest in township, range, and section number.
A topographic, county, or city map outlining your area of interest as accurately as possible.
Electronic shapefiles in NAD83 projection.

Products are made after an order and payment is received. You may order over the telephone using a major credit card if you have a
complete description of your area of interest using any form of information listed above. We may require you to send us a written request.

* APFO CUSTOM AERIAL PRODUCTS AND SERVICES
Depending on the original film scale or digital resolution, custom print scales will vary depending on coverage area, paper size, and printer limitations.
Custom aerial prints are defined as a single image requiring geospatial layer(s) or a mosaic of multiple images that may or may not require geospatial
layer(s). Digital film scans are available in TIF format and may require geospatial services to provide a custom aerial print of historical imagery. APFO
utilizes Quarter Quad (QQ) and Compressed County Mosaic (CCM) products from the National Agriculture Imagery Program (NAIP). For special needs not
covered elsewhere on this form, contact us directly. Additional fees may apply.

* OTHER IMAGERY
Imagery secured for the Forest Service (FS) and National Resource Conservation Service (NRCS) can be purchased from us by the same procedures
outlined for FSA photography. The negative scales vary from 1:6,000 to 1:80,000, depending on the project area. Most FS photography has been flown in
natural color, some in black and white and color infrared. Most NRCS photography has been flown in black and white, some in natural color and color
infrared.
NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information identified on this form is the Agricultural
Adjustment Act of 1938 (7 U.S.C. 1387). The information will be used to process an order for aerial photography. The information collected on this form may be disclosed to other Federal, State, Local
government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses
identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated). Providing the requested information is voluntary. However, failure to furnish the requested information will
result in an inability on the part of the Aerial Photography Field Office to process the order for aerial photography.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0560-0176. The time required to complete this information collection is estimated to average 30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE USDA FSA AERIAL
PHOTOGRAPHY FIELD OFFICE AT THE ADDRESS LISTED ON PAGE 1.
The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity,
religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or
protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) Persons with
disabilities, who wish to file a program complaint, write to the address below or if you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact
USDA’s TARGET Center at (202) 720-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO or program complaint, please contact USDA
through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any
USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter by mail to U.S. Department
of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected]. USDA is an equal opportunity
provider and employer.