17-A200x United States 2017 Census of Agriculture - Short Form Ph

DUE FEBRUARY 5, 2018

OMB No. 0535-0226: Approval Expires xx/xx/xxxx

UNITED STATES 2017 CENSUS OF AGRICULTURE
Form Number: 17-A200x

Short Form - Follow-up

National Agricultural
Statistics Service
Return your
completed report to:
Census of Agriculture
1201 East 10th Street
Jeffersonville, IN 47132
OFFICE USE ONLY
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Make corrections to name, address, and ZIP code if necessary.

Thank you for returning your Census of Agriculture form. You've
indicated the following commodities [

]. We would like to ask

some follow-up questions.
Print the information below for the person completing this form:
Name
1092

Area Code and Phone Number
1093

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Date Completed (MM-DD-YYYY)
1094

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E-mail
1095

THANK YOU FOR YOUR COOPERATION.
Questions? Call us toll free at 1-888-424-7828.
¿Preguntas? Llámenos libre de cargos al 1-888-424-7828.
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 to this survey is
required by law.
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 0535-0226. 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.