Form 9476 TVA Form 9476

Land Use Survey Questionnaire Vicinity of ______________________ Nuclear Power Plant Tennessee Valley Authority

OMB No. 3316-0016 Exp. Date: MM/DD/YY

Sector      

Distance      

Check: NR NG G MC

New Location? Yes No

Interviewer      

Date      

Name (optional)      

Telephone Number (optional)      

Address

     

Section I - Nearest Residence and Garden Location

1. What is your present source of drinking water?

Stream Well Farm pond Public water system

Other (specify)

     

2. a. Do you have a home garden? Yes No

b. If yes, do you produce green leafy vegetables such as collards, turnip greens, cabbage, and lettuce for home consumption? Yes No

c. How many months of the year do you harvest these crops? ___________

3. a. Do you use irrigation? Yes No

b. If yes, what is your present source of irrigation? __________________________________________________

Section II - Milk Location

4. a. Is cows’ milk produced for human consumption on this farm? Yes No

b. If yes, number of cows producing milk: ___________

c. If cows’ milk is consumed unprocessed, complete the following table:

List the number of consumers of unprocessed milk in each age group.
Infant (0 - <1 year)	Child (1 - <11 years)	Teen (11 - <17 years)	Adult (>17 years)
     	     	     	     

5. a. Is goats’ milk produced for human consumption on this farm? Yes No

b. If yes, number of goats producing milk: ___________

c. If goats’ milk is consumed unprocessed, complete the following table:

List the number of consumers of unprocessed milk in each age group.
Infant (0 - <1 year)	Child (1 - <11 years)	Teen (11 - <17 years)	Adult (>17 years)
     	     	     	     

6. If milk is produced for human consumption, complete the following table:

Percent Substitutional (Non-Pasture) Feeding for Dairy and Goat Herds
Month	Dairy Herds	Goat Herds		Month	Dairy Herds	Goat Herds		Month	Dairy Herds	Goat Herds
January	      %	      %		May	      %	      %		September	      %	      %
February	      %	      %		June	      %	      %		October	      %	      %
March	      %	      %		July	      %	      %		November	      %	      %
April	      %	      %		August	      %	      %		December	      %	      %

Paperwork Reduction Act Statement

Required Burden Estimate Statement

Public reporting burden for this collection of information 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden, to Agency Clearance Officer, Tennessee Valley Authority, 1101 Paperwork Reduction Project (3316-0016), Washington, DC 20503.

Privacy Act of 1974

The Tennessee Valley Authority is conducting this survey under the authority of the Tennessee Valley Authority Act of 1933 and the national Environmental Policy Act to collect information concerning farming operations in the areas surrounding proposed and operating nuclear-fueled generating plants.

Your cooperation in this program will be of great benefit since the requested information will enable TVA to assess the possible effects that such a plant might have on the production of crops and livestock in this area. However, your cooperation with this program is voluntary and you may decline to participate in the survey without affecting your relationship with TVA. The information you provide will not be used in making any decisions about you individually. Information you provide may be used in and verified through a computer match.

Information which you furnish and which is personally identifiable to you will be considered confidential and will not be disclosed unless TVA is required to do so by law. Otherwise, information furnished by you will be used to prepare environmental statements and evaluations and may be disclosed during licensing procedures concerning a proposed plant, in litigation, or to other Federal agencies with authority to review TVA’s activities. Your cooperation is appreciated and if there are any questions concerning this survey, please feel free to contact Manager of Western Area Radiological Laboratory, Tennessee Valley Authority, WAR 1A, P.O. Box 1010, Muscle Shoals, Alabama 35662-1010.

This statement is provided to you in accordance with section 3(e)(3) of Privacy Act of 1974 (Pub. L. 93-579).

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