QID 2016 Integrated Screening Survey - Revised

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2016 INTEGRATED SCREENING SURVEY
OMB No. 0535-0218
Approval Expires: ##/XX/XXXX
Project Code: 905 QID: ######
SMetaKey: 1222
Version X
NATIONAL
AGRICULTURAL
STATISTICS
SERVICE

HQ MASTER VERSION
U.S Department of Agriculture
National Operations Division
9700 Page Avenue, Suite 400
St. Louis, MO 63132-1547
Phone: 1-888-424-7828
Fax: 314-595-9990
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. Please return your report in the enclosed postage paid envelope. Thank you for your help.
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 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.
1.

Please make any needed corrections to the name, including the correct operation name, and mailing address on the label.

2.

During 2016, will this operation (name on label):

grow any crops, including field crops, fruits, vegetables, nursery/greenhouse, or other specialty crops; or

cut any hay; or

have any livestock or poultry or bees; or

sell any agricultural products; or

receive government payments (CRP, WRP, etc.); or

have more than 19 acres of idle cropland or more than 99 acres of pastureland?
Exclude crops planted on land rented\leased to others.
YES – [Go to SECTION 1.]
NO – [Complete items a and b, then go to SECTION 5 on back page.]
a.

Has the operation name on the label been sold, rented, or turned over to someone else?
YES

NO

Will the land be used for any agricultural purpose by you (the
individual listed on the label), or anyone else in the next year?
YES

b. What is the name and address of the new operator?

NO

DON’T KNOW

Please explain, then go to SECTION 5 on back page.

Operation Name: __________________________________________ _________________________________________________________
Operator Name: __________________________________________

_________________________________________________________

Address: _________________________________________________

_________________________________________________________

City: ____________________ State: ____________ Zip: _________

_________________________________________________________

Phone: (

_________________________________________________________

) ______________________________

-2-

SECTION 1 – 2016 TOTAL ACRES OPERATED
1.

Including the farmstead, all cropland, woodland, pasture land, wasteland, and government
program land, how many total acres does this operation –
a.

own? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +

b.

rent or lease from others, including for cash, shares or rent free?

c.

901
902

(Exclude land used on an animal unit month (AUM) or fee per head basis under a grazing permit.)

2.

Acres

........ +
905

rent to others, including for cash, shares or rent free? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –

900

Total Acres Operated: [item 1a + 1b - 1c] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =

3. Of the total [item 2] acres operated, how many acres are considered cropland?
(Include hay land, summer fallow, idle cropland, cropland used for pasture, and cropland in government programs.)

....

802

4. Does this operation have a Pesticide Grower Permit number from the Arizona Department
of Agriculture Environmental Services Division?
YES – [Continue]

NO – [Go to SECTION 2 on next page]

5. What Pesticide Grower Permit number does this operation use for reporting
chemical applications on these [Item 2] acres to the Arizona Department of
810
Agriculture – Environmental Services Division?...........................................................................

PGP 10 NUMBER

6. Is this permit number used to report chemical applications for acres other than these [Item 2] acres?
YES – [Continue]

NO – [Go to Item 7]

OFFICE USE
012

a. What other operation(s) is this permit number used to report for?
Name __________________________________________________

Name __________________________________________________

Address ________________________________________________

Address ________________________________________________

Phone (

Phone (

) __________________________________________

) __________________________________________

7. Does this operation use any OTHER Pesticide Grower Permit number
to report chemical applications to ADA - ESD for these [item 2] acres?
YES – [Continue]

NO – [Go to SECTION 2 on next page]
PGP 10 NUMBER
811

a. What are these PGP numbers? .......................................................................................

812

b. Do you use any of these ID’s to report chemical applications for
any other operation(s)?
YES – [Continue]

NO – [Go to SECTION 2 on next page]

813
814
815

OFFICE USE

(1) What other operation(s) use this Pesticide Grower Permit for reporting?
[Identify operation and ID]

013

Name ___________________________________________________

Name __________________________________________________

Reporting ID ____________________________________________

Reporting ID ____________________________________________

Address ________________________________________________
Phone (
)
__________________________________________

Address ________________________________________________
Phone (
)
__________________________________________

-2-

SECTION 2 – 2016 CROPS
1. For the crop listed below, please report acres planted and to be planted for all purposes for the 2016 crop year.
(Include acres planted and to be planted, even if the crop will not be harvested (for instance, used for cover crop, plowed under or
abandoned). If specified, also report acres harvested and to be harvested for grain in the 2016 crop year. Exclude crops planted on
land rented/leased to others.)
Check
Here if
NONE

Acres Planted
Acres Harvested
and to be Planted and to be Harvested
for All Purposes
for Grain
####

####

Corn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. For the crop listed below, please report acres planted and to be planted for harvest in 2016. Also, report the acres to be
harvested in 2016. (Include acres planted and to be planted, even if the crop will not be harvested (for instance, used
for cover crop, plowed under or abandoned). Exclude crops planted on land rented/leased to others.)
Check
Here if
NONE

Acres Planted
and to be Planted
884

Acres HErikarvested
and to be Harvested
####

Fall Potatoes (Usually harvested September through November.
Exclude sweet potatoes.) .............................................................................

SECTION 3 – 2016 VEGETABLE CROPS
ACRES
803

1. Of the total cropland acres reported, how many acres are or will be planted to vegetable crops?
(Include double or other multiple croppings.) .....................................................................................................

.___

2. For each vegetable crop named, please give the total acres planted or intended to plant
during the 2016 crop year. (Include any acres already planted and harvested in the 2016
crop year. For double or other multiple croppings, count each planting.)
None

ACRES
300

. ___

Asparagus (Include bearing and non-bearing acres) ......................................................................
315

. ___

Snap Beans intended for fresh market ...............................................................................................
318

. ___

Snap Beans intended for processing ..................................................................................................
339

. ___

Broccoli ....................................................................................................................................................
345

. ___

Cabbage intended for fresh market ....................................................................................................
354

. ___

Cantaloupes ...............................................................................................................................
357

. ___

Carrots intended for fresh market ..............................................................................................
360

. ___

Carrots intended for processing .................................................................................................
366

. ___

Cauliflower ..................................................................................................................................
369

. ___

Celery .........................................................................................................................................
375

Sweet Corn intended for fresh market ................................................................................................

. ___

-2378

. ___

Sweet Corn intended for processing ...................................................................................................
384

. ___

Cucumbers intended for fresh market ........................................................................................
387

. ___

Cucumbers intended for processing ..........................................................................................
393

. ___

Eggplant .....................................................................................................................................
396

. ___

Garlic ..........................................................................................................................................
414

. ___

Honeydew Melons ......................................................................................................................
420

. ___

Head Lettuce ..............................................................................................................................
423

. ___

Other Lettuce..............................................................................................................................
432

. ___

Dry Onions .................................................................................................................................
447

. ___

Green Peas intended for processing..........................................................................................
453

. ___

Bell Peppers ...............................................................................................................................
456

Pumpkins ....................................................................................................................................

. ___

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SECTION 3 – 2016 VEGETABLE CROPS (Continued)
None

ACRES
465

. ___

Spinach intended for fresh market .............................................................................................
475

. ___

Summer Squash.........................................................................................................................
476

. ___

Winter Squash ............................................................................................................................
474

. ___

All Squash ..................................................................................................................................
477

. ___

Strawberries (Include bearing acres only) ................................................................................
480

. ___

Tomatoes intended for fresh market ..........................................................................................
483

. ___

Tomatoes intended for processing .............................................................................................
489

. ___

Watermelons ..............................................................................................................................

3. Do you have a contract with a vegetable processor for any of these vegetable crops?

CODE

YES – [Enter code 1 and continue.]
NO – [Enter code 3, then go to SECTION 4 on next page.] ..................................................................

015

OFFICE USE
830

831

a. Which processor(s) do you have contracts with?
PROCESSOR 1

PROCESSOR 2

Name _________________________________________________

Name _________________________________________________

Address _______________________________________________

Address _______________________________________________

City _____________________

City _____________________ State _____

State _____

Zip ___________

Phone Number (_____) ________________________________

Phone Number (_____) ________________________________

SECTION 4 – 2016 Dairy
Check
Here if
NONE

1. During 2016, what was or will be the peak number of dairy cows, both dry
and in milk, on this operation, including milk heifers that have calved?
Exclude replacement heifers, bulls, and calves. ...........................................

2

Will this operation produce certified organic milk during 2016?
YES – [Continue]

NO – [Continue]

Zip ___________

Number
XXXX

-2-

SECTION 5 – 2015 VALUE OF SALES
1. Considering:






sales of all crops, livestock, poultry, and livestock products (milk, eggs, etc.) sold in 2015;
the value of product removed for all crops, livestock, and poultry produced under contract in 2015;
sales of all miscellaneous agricultural products in 2015;
all government agricultural payments received in 2015; and
exclude dollars received on land rented to others.

a. What code represents the total gross value of sales, including government agricultural payments?
Total Value

GVS Code

‘None’ during 2015. . . . . . . . . . . . .
$
1 –
$
999 …..
$
1,000 –
$
2,499 …..
$
2,500 –
$
4,999 …..
$
5,000 –
$
9,999 …..
$
10,000 –
$
24,999 …..
$
25,000 –
$
49,999 …..
$
50,000 –
$
99,999 …..
$
100,000 –
$
249,999 …..
$
250,000 –
$
499,999 …..
$
500,000 –
$
999,999 …..
$ 1,000,000 –
$ 2,499,999 …..
$ 2,500,000 –
$ 4,999,999 …..

99
1
2
3
4
5
6
7
8
9
10
11
12

$ 5,000,000 and over. . . . . . . . . . . .

13

b. Is the GVS Code in box 860 equal to ‘1’ or ‘99’?
YES – [Go to item c, next page.]
NO – [Go to item 2, next page.]

GVS Code
860

-3-

SECTION 5 – 2015 VALUE OF SALES (Continued)
c.

Record all 2016 crops, land uses, and livestock or poultry now on the total acres operated.
Land Use

ACRES

Field Crops Intended For
Harvest

ACRES

ACRES

Other Crops

CRP/WRP. . . . . . . . . . . .

________________. . .

Cut Christmas Trees. . .

Idle Cropland. . . . . . . . . .

________________. . .

Nursery & Greenhouse.

Summer Fallow. . . . . . . . .

________________. . .

________________. . .

_________________. . . . .

________________. . .

________________. . .

Government Payments

WHOLE
DOLLARS

Fruits/Nuts

ACRES

NUMBER

Livestock

CRP/WRP Payments. . . . .

________________. . .

Cattle - Dairy. . . . . . . .

Other Gov’t Payments. . . .

________________. . .

Cattle - Other. . . . . . . .

________________. . .

Chickens. . . . . . . . . . .

________________. . .

Hogs. . . . . . . . . . . . . .

________________. . .

Horses. . . . . . . . . . . . .

Pasture/Rangeland

ACRES

Cropland Used Only
For Pasture. . . . . . . . . .

Mules/Burros. . . . . . . .
ACRES

Permanent Pasture. . . . . .

Vegetables/Melons

Woodland Pasture. . . . . . .

________________. . .

________________. . .

________________. . .

________________. . .

Aquaculture

NUMBER

Sheep & Goats. . . . . . .

________________. . .
OFFICE USE

Acres of Ponds in Use. . . .
Foodsize/Stockers. . . . . . .

Berries

Fingerlings/Broodfish. . . . .

________________. . .

Trout Eggs. . . . . . . . . . . .

________________. . .

Other Aquaculture. . . . . . .

________________. . .

ACRES

Total Points
861

Pasture Points
869

2. Which of these categories represents the largest portion of the gross income
from the operation in 2015?
Farm Type Code

1 Grains, Oilseeds, Dry Beans, and Dry Peas ……………….…………………..……..

1

(corn, flaxseed, grain silage and forage, grains and oilseeds, popcorn, rice,
small grains, sorghum, soybeans, sunflowers, straw, etc.)

2 Tobacco ………………………………………………………………….……………...…..
3 Cotton and Cottonseed ……………………………………………………….…...……..
4 Vegetables, Melons, Potatoes and Sweet Potatoes ………………………………...

2
3
4

(beets, cabbage, cantaloupes, pumpkins, sweet corn, tomatoes, watermelons, vegetable seeds, etc.)

5 Fruit, Tree Nuts and Berries ………………………………………………………...…..

5

(almonds, apples, blueberries, cherries, grapes, hazelnuts, kiwifruit,
oranges, pears, pecans, strawberries, walnuts, etc.)

6 Nursery, Greenhouse, Floriculture and Sod ………………………………...............

6

(bedding plants, bulbs, cut flowers, flower seeds, foliage plants,
mushrooms, nursery potted plants, shrubbery, sod, etc.)

7 Cut Christmas Trees and Short Rotation Woody Crops ……………………….…..
8 Other Crops and Hay, CRP and Pasture …………………………………..................

7
8

(grass seed, hay and grass silage, hops, maple syrup, mint, peanuts, sugarcane, sugarbeets, CRP, etc.)

9 Hogs and Pigs …………………………………………………………………….……….. 9
10 Milk and Other Dairy Products from Cows …………………………………………… 10
11 Cattle and Calves ………………………………………………………………................ 11
(beef and dairy cattle for breeding stock, fed cattle, beef and dairy cull animals,
stockers and feeders, veal calves, etc.)

12 Sheep, Goats, and their Products …………………………………………………..…. 12
(wool, mohair, milk and cheese)

13 Horses, Ponies, and Mules ………………………………………………………...……. 13
(burros and donkeys)

14 Poultry and Eggs ………………..……………………………………………...……….... 14
(broilers, chickens, turkeys, ducks, eggs, emus, geese, hatchlings,
ostriches, pigeons, pheasants, quail, poultry products, etc.)

15 Aquaculture ………………………..…………..………………………………………...... 15
(catfish, trout, ornamental and other fish, mollusks, crustaceans, etc.)

16 Other Animals and Other Animal Products ………………..………………............... 16
(bees, honey, rabbits, fur-bearing animals, semen, manure, other animal specialties, etc.)

Farm Type Code
862

-4-

SECTION 6 – OPERATION TYPE
1. Are the day-to-day decisions for this operation made by one individual,
a hired manager, or partners? [Check one]
One individual – [Go to SECTION 7, below.]
A hired manager – [Go to SECTION 7, below.]
Partners – [Complete items a and b, then go to SECTION 7, below.]

Number

a. How many individuals, including the operator, are involved in the day-to-day
decisions for this operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Please record partners’ names and addresses, then go to SECTION 5, below.
[Enter names and addresses of partners, including partners who jointly operate land and share in decision making.
Do not include landlords and tenants as partners.]

PARTNER 1

PARTNER 2

Partner name: ______________________________________________

Partner name: ______________________________________________

Address: ___________________________________________________

Address: ___________________________________________________

City: _____________________

City: ____________________

State: ____________ Zip: __________

State: ____________ Zip: __________

Phone: (______) __________________________

Phone: (______) __________________________

PARTNER 3

PARTNER 4

Partner name: ______________________________________________

Partner name: ______________________________________________

Address: ___________________________________________________

Address: ___________________________________________________

City: _____________________

City: ____________________

State: __________ Zip: ___________

Phone: (______) __________________________

State: __________ Zip: ___________

Phone: (______) __________________________

SECTION 7 – CONCLUSION
1. Do you (the operator named on the label) make any day-to-day decisions for another farm or ranch?
YES – Please list the other operation(s):__________________________________________________________________________
NO – [Continue.]

This completes the survey. Thank you for your help.

Reported by: __________________________________

9911

9910
____ ____ ____ ____
M

M

D

16

D

Telephone: ________________

OFFICE USE
R. Unit
9921

Ptr 1 Str
9922

Response
1-Comp
2-R
3-Inac
4-Office Hold
5-R – Est
6-Inac – Est
7-Off Hold – Est
8-Known Zero

Ptr 2 Str
9923

Ptr 3 Str
9927

Respondent
9901

1-Op/Mgr
2-Sp
3-Acct/Bkpr
4-Partner
9-Other

9902

Ptr 4 Str
9928

OPS
923

Mode
1-Mail
2-Tel
3-Face-to-Face
4-CATI
5-Web
6-E-mail
7-Fax
8-CAPI
19-Other

SSO 1
9907

ADJ
922

Enum.
9903

9998

Optional Use
9906

9916

POID
9989
___ ___ ___ ___ ___ ___ ___ ___ ___
Eval.
9900

Change
9985