This form is used to gather three years production history from applicants.
Submit the original of the completed form in hard copy or facsimile to the appropriate USDA office. Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA office, provided the customer submitting the form is the only person required to sign the transaction.
Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.
Applicants must complete all Items.
Fld Name /
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Instruction |
1 Name |
Enter the applicant’s name. |
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Enter the last two digits of the year for which information is provided at the beginning of each column. Complete the appropriate column for the year that information is being provided. |
A |
Dairy Production |
A1a Herd Number |
Enter the average number of milk cows for each of the three preceding years. |
A1b Lbs. of Milk Sold |
Enter the total pounds of milk sold for each of the three preceding years. |
A1c Average Production Per Cow |
Enter the average milk production per cow for each of the preceding three years. The number should be the Herd Number (A1a) divided by the pounds of milk sold (A1b). |
A1d Calves Sold |
Enter the number of calves sold each year for the preceding three years. |
A1e Calves Average Sale Weight |
Enter the average weight of calves at the time they were sold for each of the three preceding years.
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A1f Number of Cows Culled |
Enter the number of cows culled for each of the three preceding years. |
B |
Livestock and Poultry Production |
B1 Livestock (Type) |
Enter the type of livestock being raised (cattle, hogs, sheep, etc.). For clarification purposes break down the type of livestock further, such as “brood cows,” “market animals,” “calves,” etc., when applicable. Enter each different type of livestock as a separate set of information. |
B1a Units Raised |
Enter the number of livestock that were raised (for the type described only) on the farm for each of the three preceding years. |
B1b Units Purchased |
Enter the number of livestock (for the type described only) that were purchased for each of the three preceding years. |
B1c Total Units |
Enter the total number (the total of units raised and units purchased) of livestock of this type for each of the preceding three years.. |
B1d Units Sold |
Enter the total number of livestock of this type that were sold during each of the preceding three years. |
B1e Death Loss |
Enter the total number of loss due to death for the type of animal described in item B1 for each of the preceding three years. |
B1f Purchase Weight |
Enter the average weight per unit of livestock that was purchased for sale in each of the three preceding years. |
B1g Sales Weight |
Enter the average weight per unit of livestock that was sold in each of the three preceding years. |
B2 Livestock (Type) |
Enter the type of livestock being raised (cattle, hogs, sheep, etc.). For clarification purposes break down the type of livestock further, such as “brood cows,” “market animals,” “calves,” etc., when applicable. Enter each different type of livestock as a separate set of information. |
B2a Units Raised |
For the type described only, enter the number of livestock that were raised on the farm for each of the three preceding years. |
B2b Units Purchased |
For the type described only, enter the number of livestock that were purchased for each of the three preceding years. |
B2c Total Units |
Enter the total number of livestock (the total of units raised and units purchased) of this type for each of the preceding three years. |
B2d Units Sold |
Enter the total number of livestock of this type that were sold during each of the preceding three years |
B2e Death Loss |
Enter the total number of loss due to death for the type of animal described in item B1 for each of the preceding three years. |
B2f Purchase Weight |
Enter the average weight per unit of livestock that was purchased for sale in each of the three preceding years. |
B2g Sales Weight |
Enter the average weight per unit of livestock that was sold in each of the three preceding years. |
B3 Livestock (Type) |
Enter the type of livestock being raised (cattle, hogs, sheep, etc.). For clarification purposes break down the type of livestock further, such as “brood cows,” “market animals,” “calves,” etc., when applicable. Enter each different type of livestock as a separate set of information. |
B3a Units Raised |
For the type described only, enter the number of livestock that were raised on the farm for each of the three preceding years. |
B3b Units Purchased |
For the type described only, enter the number of livestock that were purchased for each of the three preceding years. |
B3c Total Units |
Enter the total number of livestock (the total of units raised and units purchased) of this type for each of the preceding three years. |
B3d Units Sold |
Enter the total number of livestock of this type that were sold during each of the preceding three years. |
B3e Death Loss |
Enter the total number of loss due to death for the type of animal described in item B1 for each of the preceding three years. |
B1f Purchase Weight |
Enter the average weight per unit of livestock that was purchased for sale in each of the three preceding years. |
B1g Sales Weight |
Enter the average weight per unit of livestock that was sold in each of the three preceding years. |
C |
Crop Production |
C1 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. Note: Complete a separate section for each type of crop raised, including crops that were only raised for a portion of the reporting period. |
C1a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C1b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C1c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C2 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C2a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C2b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C2c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C3 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C3a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C3b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C3c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C4 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C4a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C4b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C4c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C5 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C5a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C5b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C6 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C6a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C6b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C6c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C7 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C7a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C7b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C7c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C8 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C8a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C8c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
C9 Crop/Unit |
Enter a description for each type of crop and how that unit is marketed (bushels, pounds, etc.) for all crops raised in each of the three preceding years. |
C9a Total Yield |
Enter the total yield (bushels, pounds, etc.) for each crop described above, for each of the three preceding years. |
C9b Acres |
Enter the total number acres of the described crop raised in each of the three preceding years. |
C9c Average Yield |
Enter the average yield per acre of the described crop for each of the three preceding years. Average yield should be the total yield divided by the number of acres. |
D |
Signature |
D1 Signature |
Enter the applicant’s signature. If faxing or mailing the form, print the form and manually enter your signature. This form is approved for electronic transmission. If you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA office. Electronic submission may only be completed if you are the only person required to sign this form. |
D2 Date |
Enter the date the applicant signed the form. |
Page
File Type | application/msword |
File Title | Template Users: Select the text for each of the instruction components below and type over it without changing the font type, |
Author | Preferred Customer |
Last Modified By | Cathy.Quayle |
File Modified | 2007-05-02 |
File Created | 2007-05-02 |