Form QID Cost of Pollination Inquiry

cost of pollination inquiry – November 1, 2015
							OMB No. Approval Expires: Project Code: QID: SMetaKey:
								United States Department of Agriculture
								NATIONAL AGRICULTURAL STATISTICS SERVICE
							USDA/NASS National Operations Division 9700 Page Avenue, Suite 400 St. Louis, MO 63132-1547 Phone: 1-888-424-7828 Fax: 1-855-415-3687 Email: [email protected]
Please make corrections to name, address and ZIP Code, if necessary.
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 number is xxxx-xxxx. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

SECTION 1 – HONEY BEE POLLINATION
During 2015, did the operation listed on the label own or bring in honey bee colonies to pollinate crops?
xxx 1 Yes – Continue to Item 2
3 No – Go to Section 3
	Colonies
During 2015, how many total honey bee colonies did this operation use to pollinate crops? (Include all colonies owned or brought onto this operation.)
	Dollars
During 2015, what was the total amount this operation paid to beekeepers to pollinate all crops?	$

SECTION 2 – COST OF HONEY BEE POLLINATION

1	2	3	4	5	6
Please answer for all crops pollinated by honey bees in 2015 (whether the bees are owned by the operation or brought in). (Crop)	How many acres of the crop in column 1 did honey bees pollinate? (Acres)	How many colonies of honey bees did this operation own or bring in to pollinate the crop in column 1? (Colonies)	Did this operation pay for honey bees to pollinate acres of the crop in column 1?	For how many acres of the crop in column 1 did this operation pay for pollination? (Acres)	What was the total amount this operation paid for honey bees to pollinate the crop in column 1? (Dollars)

4. Please report for all NUT crops grown for any purpose on this operation:

(Crop)		(Acres)		(Colonies)			(Acres)	(Dollars)
	xxx ALMONDS		xxx . ____		xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
						3 No – Go to next crop
	xxx OTHER/ SPECIFY ___________		xxx . ____		xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
						3 No

5. Please report for all MELON crops grown for any purpose on this operation:

(Crop)	(Acres)	(Colonies)		(Acres)	(Dollars)
WATERMELON	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
CANTALOUPE	xxx . ____	xxx	xxx 1 Yes –Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No

6. Please report for all OIL/HAY/SEED crops grown for any purpose on this operation

(Crop)	(Acres)	(Colonies)		(Acres)	(Dollars)
CANOLA/ RAPESEED	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
SUNFLOWERS	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No

7. Please report for all VEGETABLE crops grown for any purpose on this operation:

1	2	3	4	5	6
Please answer for all vegetable crops pollinated by honey bees in 2015 (whether the bees are owned by the operation or brought in).	How many acres of the crop in column 1 did honey bees pollinate?	How many colonies of honey bees did this operation own or bring in to pollinate the crop in column 1?	Did this operation pay for honey bees to pollinate acres of the crop in column 1?	For how many acres of the crop in column 1 did this operation pay for pollination?	What was the total amount this operation paid for honey bees to pollinate the crop in column 1?
(Crop)	(Acres)	(Colonies)		(Acres)	(Dollars)
CUCUMBER	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
PUMPKIN	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
SQUASH	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No

8. Please report for all TREE FRUIT crops grown for any purpose on this operation:

1	2	3	4	5	6
Please answer for all tree fruit crops pollinated by honey bees in 2015 (whether the bees are owned by the operation or brought in).	How many acres of the crop in column 1 did honey bees pollinate?	How many colonies of honey bees did this operation own or bring in to pollinate the crop in column 1?	Did this operation pay for honey bees to pollinate acres of the crop in column 1?	For how many acres of the crop in column 1 did this operation pay for pollination?	What was the total amount this operation paid for honey bees to pollinate the crop in column 1?
(Crop)	(Acres)	(Colonies)		(Acres)	(Dollars)
APPLES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
CHERRIES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
ORANGES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
PEACHES/ NECTARINES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
PEARS	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No

9. Please report for all BERRY AND OTHER FRUIT crops grown for any purpose on this operation:

1	2	3	4	5	6
Please answer for all berry and other fruit crops pollinated by honey bees in 2015 (whether the bees are owned by the operation or brought in).	How many acres of the crop in column 1 did honey bees pollinate?	How many colonies of honey bees did this operation own or bring in to pollinate the crop in column 1?	Did this operation pay for honey bees to pollinate acres of the crop in column 1?	For how many acres of the crop in column 1 did this operation pay for pollination?	What was the total amount this operation paid for honey bees to pollinate the crop in column 1?
(Crop)	(Acres)	(Colonies)		(Acres)	(Dollars)
BLUEBERRIES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
CRANBERRIES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
GRAPES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
RASPBERRIES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
STRAWBERRIES	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No

10. Please report for ALL OTHER crops grown for any purpose on this operation:

1	2	3	4	5	6
Please answer for all other crops pollinated by honey bees in 2015 (whether the bees are owned by the operation or brought in).	How many acres of the crop in column 1 did honey bees pollinate?	How many colonies of honey bees did this operation own or bring in to pollinate the crop in column 1?	Did this operation pay for honey bees to pollinate acres of the crop in column 1?	For how many acres of the crop in column 1 did this operation pay for pollination?	What was the total amount this operation paid for honey bees to pollinate the crop in column 1?
(Crop)	(Acres)	(Colonies)		(Acres)	(Dollars)
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No – Go to next crop
xxx OTHER/ SPECIFY ___________	xxx . ____	xxx	xxx 1 Yes – Continue	xxx . ____	xxx $
			3 No

SECTION 3 – OTHER POLLINATION COSTS

During 2015, did this operation pay for products or services to increase pollination that did not involve honey bees? (Exclude any fees, maintenance expenses, and transportation costs related to honey bees.)
xxx 1 Yes – Continue to Item 11.a
3 No – Go to Section 4
	None		Dollars
How much did this operation pay in 2015 for pollination using other (that is, non-apis) bees? (Bumble, cutter, etc…)			$
How much did this operation pay in 2015 for artifical pollination?			$
How much did this operation pay in 2015 for all other forms of increasing pollination? (Include flower mixes, bee attractents, bat houses, etc…)			$

SECTION 4 – COMMENTS

SECTION 5 – CHANGE IN OPERATOR

1. Has this operation (name on label) been sold or turned over to someone else?

Yes – Identify the new operator(s) below No – Go to Section 6

Operation Name:
Operator Name:
Address:					Phone:	( )
City:	________________________________________________________			State:	_______		Zip:	______________

SECTION 6 – CONCLUSION

1. Survey Results: To receive the complete results of this survey on the release date, go to www.nass.usda.gov/results.
Would you like us to send you a brief summary at a later date?	1Yes 3 No	9990

THANK YOU FOR YOUR COOPERATION.

Office Use Only

	9911	9910	MM DD YY
Respondent Name:	Phone:	Date:

Response		Respondent		Mode		Enum.	Eval.	Change		Office Use for POID
1-Comp 2-R 3-Inac 4-Office Hold 5-R – Est 6-Inac – Est 7-Off Hold – Est	9901	1-Op/Mgr 2-Sp 3-Acct/Bkpr 4-Partner 9-Oth	9902	1-Mail 2-Tel 3-Face-to-Face 4-CATI 5-Web 6-E-mail 7-Fax 8-CAPI 19-Other	9903	9998	9900	9985		9989 __ __ __ - __ __ __ - __ __ __
							R. Unit			Optional Use
							9921			9907	9908	9906		9916
S/E Name