QID Agricultural Activity Survey

AGRICULTURAL ACTIVITY SURVEY
OMB No. 0535-0140
Approval Expires: 01/31/2019
Project Code: 535
SMetaKey: 4040

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
E-mail: [email protected]
The information you provide will be used for statistical purposes only. Your responses will be kept confidential and any person who willfully discloses ANY
identifiable information about you or your operation is subject to a jail term, a fine, or both. This survey is conducted in accordance with the Confidential
Information Protection provisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal laws. For more information on how we protect your
information please visit: https://www.nass.usda.gov/confidentiality. 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 0535-0140. 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.

1. Complete this form even if you are not involved in agricultural activity.
2. During the past 12 months, did you…
a. Grow crops, including field crops, vegetables, fruits, nuts,
1 ☐ Yes
nursery or other specialty crops?..............................................................

3

☐

No

b. Own or raise any type of livestock, including cattle, hogs,
1 ☐ Yes
sheep, goats, equine, poultry, honey bees, or aquaculture.......................

3

☐

No

Yes

3

☐

No

3. Do you intend to grow crops, raise livestock, or have other
Yes
1
agricultural activity in the next 12 months?................................................☐

3

☐

No

c. Receive any Federal or State agricultural payments?
· Include Federal Farm Program, CRP, WRP, FWP, and
1
CREP payments....................................................................

☐

If answered no to
questions 2 and 3, skip
to question 11 on page
2, otherwise continue.

During the past 12 months:
4. Did you grow any of the following?
a. Hay or forage crops............................................................................................................................
1 ☐ Yes

3

☐

No

b. Field crops such as corn, soybeans, wheat, etc.................................................................................
1 ☐ Yes

3

☐

No

c. Fruit, berries, or nuts..........................................................................................................................
1 ☐ Yes

3

☐

No

d. Vegetables, potatoes, or melons........................................................................................................
1 ☐ Yes

3

☐

No

3

☐

No

3

☐

No

3

☐

No

a. Cattle and calves................................................................................................................................
1 ☐ Yes

3

☐

No

b. Hogs and pigs....................................................................................................................................
1 ☐ Yes

3

☐

No

c. Sheep, lambs, goats or kids...............................................................................................................
1 ☐ Yes

3

☐

No

d. Horses, ponies, mules, donkeys or burros.........................................................................................
1 ☐ Yes

3

☐

No

e. Chickens, turkeys, or other fowl.........................................................................................................
1 ☐ Yes

3

☐

No

Aquaculture........................................................................................................................................
1 ☐ Yes

3

☐

No

g. Honey bees........................................................................................................................................
1 ☐ Yes

3

☐

No

h. Other livestock (Alpaca Llamas, Bison, Mink, Rabbits, etc.)..............................................................
1 ☐ Yes

3

☐

No

e. Nursery, greenhouse, floriculture, sod, mushrooms, propagative materials, or aquatic
1 ☐ Yes
plants..................................................................................................................................................
f. Cultivated Christmas trees, short rotation woody crops, or maple syrup............................................
1 ☐ Yes
5. Did you have any grain storage capacity?.........................................................................................
1 ☐ Yes
6. Did you own or raise any of the following livestock?

f.

7. During the past 12 months:
a. On how many acres did you grow crops or raise livestock?
· Include cropland, pastureland, woodland, ponds, and land that is in government
programs
· Include all structures (residences on the farm, livestock and storage facilities,
greenhouses, etc.)
·

Acres

.__

Exclude land rented to others........................................................................................

b. Were any of the acres reported in question 7a rented from others?.........................................
1 ☐ Yes

3

☐

No

8. In the next 12 months:
a. On how many acres do you intend to grow crops or raise livestock?
· Include cropland, pastureland, woodland, ponds, and land that is in government
programs
· Include all structures (residences on the farm, livestock and storage facilities,
greenhouses, etc.)
·

Acres

.__

Exclude land rented to others.......................................................................................

b. Were any of the acres reported in question 8a rented from others?.........................................
1 ☐ Yes

3

☐

No

9. Please indicate below which code best describes the expected total gross value of sales in 2018, including landlord's
share, Federal Farm Payments, and value of products for all crops, livestock, poultry produced under contract.
(Exclude cash rent received or share of crops received for land rented to others.)
2

☐ 'None'

9

☐ $50,000 - $99,999

3

☐ $1 - $999

10

☐ $100,000 - $149,999

4

☐ $1,000 - $2,499

11

☐ $150,000 - $249,999

5

☐ $2,500 - $4,999

12

☐ $250,000 - $349,999

6

☐ $5,000 - $9,999

13

☐ $350,000 - $499,999

7

☐ $10,000 - $24,999

14

☐ $500,000 - $999,999

8

☐ $25,000 - $49,999

15

☐ $1,000,000 - over

10. Please provide the physical address where the largest value of your agricultural products are raised or produced.
Street Address_________________________________________________________________________________
Street Address Line 2____________________________________________________________________________
City___________________________________

State__________________

Zip Code__________________

11. Please provide the name and phone number of the person completing this form.

Name:_______________________________________

9911

9910

MM

DD

YY

Phone: (_____) _______________

Date:

__ __

__ __

__ __

12. Please return this form in the postage-paid envelope provided. Thank you for your cooperation!

OFFICE USE ONLY
Response
1-Comp
9901
2-R
3-Inac
4-Office Hold
5-R – Est
6-Inac – Est
7-Off Hold – Est
S/E Name

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

9902

Mode
1-PASI (Mail)
2-PATI (Tel)
3-PAPI (Face-toFace)
6-Email
7-Fax
19-Other

Enum.
9903

9998

Eval.
9900

Change
9985

Office Use for POID
9989

R. Unit
9921

__ __ __ - __ __ __ - __ __ __

Optional Use
9907

9908

9906

9916