QID 113310 20XX Contractor Expense Survey - Broilers and Starter Pu

20XX CONTRACTOR EXPENSE SURVEY - BROILERS AND STARTER PULLETS
	OMB No. 0535-0218 Approval Expires: 10/31/2015 Project Code: 904 QID: 113310 SMetaKey: 3310
			NATIONAL AGRICULTURAL STATISTICS SERVICE

USDA/NASS - Iowa Upper Midwest Region 210 Walnut St., #833 Des Moines, IA 50309 Phone: 1-800-772-0825 Fax: 1-855-271-9802 E-mail: [email protected]

We are collecting information on costs and returns and need your help to make the information as accurate as possible. The information you provide will be used for statistical purposes only. In accordance with the Confidential Information Protection provisions of Title V, Subtitle A, Public Law 107-247, and other applicable Federal laws, your responses will be kept confidential and will not be disclosed in identifiable form to anyone other than employees or agents. By law, every employee and agent has taken an oath and is subject to a jail term, a fine, or both if he or she willfully discloses ANY identifiable information about you or your operation. Response is voluntary. 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 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

1. During 20XX, were you a production contractor where you paid a fee to someone else to raise broilers and starter pullets that you owned? 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.

Yes - Continue No - Record name and telephone number on back page

2. For 20XX, please report the average cost of inputs provided to contract growers per head.

Inputs	Pullets for Hatching Flock		Pullets for Table Egg Flock		Broilers
a. Total Head Under Contract. . . . . . . . . . . . . . .	hd		hd		hd
b. Total Number of Contractees. . . . . . . . . . . . .	#		#		#
c. Total Cost per Head. . . . . . . . . . . . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
Of the total cost per head, how much was for--
(i) fee paid to contractee?. . . . . . . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
(ii) marketing charges?. . . . . . . . . . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
(iii) disinfectants & insecticides?. . . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
(iv) chicks placed on the operation?. . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
(v) feed?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
(vi) litter?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __
(vii) medication, vaccination, debeaking, veterinary & custom services?. . . . . . . . . . .	$	. __ __	$	. __ __	$	. __ __

Please continue on back

Inputs		Pullets for Hatching Flock		Pullets for Table Egg Flock		Broilers
(viii) fuel?
(a) Diesel Fuel. . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __		$		. __ __
(b) Gasoline. . . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __		$		. __ __
(c) Natural Gas. . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __		$		. __ __
(d) LP Gas. . . . . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __		$		. __ __
(e) Other (Specify: ______________)	. . .	$	. __ __	$	. __ __		$		. __ __
(ix) utilities?
(a) Electricity. . . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __	$		. __ __
(b) Water / Other. . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __	$		. __ __
(x) supplies?. . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __	$		. __ __
(xi) taxes?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __	$		. __ __
(xii) hauling?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	. __ __	$	. __ __	$		. __ __
(xiii) other expenses? (Include admin. cost, depreciation, technical services & other) (Specify: ______________________)	. . .	$	. __ __	$	. __ __	$		. __ __

Reported by:_______________________________________________

9911 Telephone (_____)_________________________________________

Response

Respondent

Mode

Enum

Eval

Rep. Unit

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

1-Mail 2-Tel 3-Face-to-Face

9903

0098

0100

0921

0922

9910 __ __ __ __ 14

0003

Office Use for POID

0789 __ __ __ - __ __ __ - __ __ __

S/E Name