QID Montana Malting Barley Survey

	OMB No. 0535-0002 Approval Expires: 08/31/2015
	Montana Malting Barley Survey 20XX 20YY Crop		NATIONAL AGRICULTURAL STATISTICS SERVICE
	SPONSORED BY THE MONTANA WHEAT & BARLEY COMMITTEE	Montana Field Office 10 West 15th Street, Suite 3100 Helena, MT 59626 Phone 1-800-835-2612, Fax 1-800-915-6277 E-mail: [email protected]

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

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number is 0535-0002. The time required to complete this information collection is estimated to average 10 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.

Montana Produced Barley Purchased Between July 1, 20YY and June 30, 20XX for Malting and Brewing Purposes

VARIETY

ORIGINATING IN AGRICULTURAL STATISTICS DISTRICT

Northwest

North Central

Northeast

Central

Southwest

South Central

Southeast

Bushels

% Protein

% Plump

Bushels

% Protein

% Plump

Bushels

% Protein

% Plump

Bushels

% Protein

% Plump

Bushels

% Protein

% Plump

Bushels

% Protein

% Plump

Bushels

% Protein

% Plump

Please comment on the quality, protein content, or plumpness of this year’s malting barley purchase:

.REPORTED BY PHONE NUMBER NAME OF FIRM DATE

AGRICULTURAL STATISTICS DISTRICTS