VEGETABLE CHEMICAL USE SURVEY |
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OMB No. 0535-0218 Approval Expires: xx/xx/xxxx Project Code: 136 QID: 035219 SMetaKey: 2069
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NATIONAL AGRICULTURAL STATISTICS SERVICE |
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National Agricultural Statistics Service U.S Department of Agriculture NOC Division 9700 Page Avenue, Suite 400 St. Louis, MO 63132-1547 Phone: 1-888-424-7828 Fax: 314-595-9990 E-mail: [email protected] |
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VERSION 01 |
POID ___ ___ ___ ___ ___ ___ ___ ___ ___ |
SUBTRACT ___ ___ |
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CONTACT RECORD |
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DATE |
TIME |
NOTES |
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INTRODUCTION: [Introduce yourself, and ask for the operator. Rephrase in your own words.]
We are collecting information on chemical use and need your help to make the information as accurate as possible. 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 to this survey 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 control number for this information collection is 0535-0218. The time required to complete this information collection is estimated to average 45 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.
We encourage you to refer to your records during the interview. |
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BEGINNING TIME [MILITARY]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
004 __ __ __ __ |
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[Name, address and partners verified and updated if necessary.] |
During the screening phase of the Vegetable Chemical Use Survey conducted in June and July, your operation was found to be growing or intending to grow vegetables this year. I now need to verify some of the information collected during the screening survey. |
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Verify operation name and operator on label and/or screener. |
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CHANGE IN OPERATING STATUS |
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[ENUMERATOR NOTE: Skip this section if there is no change in operation name or operator.] |
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1. Has there been a change in operation name or operator? |
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NO - [Go to Enumerator Note below.] |
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YES - [Enter code 1, complete name and address information below for new operator, and read Enumerator Note.]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
CODE |
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023 |
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______________________________________ |
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Operation Name __________________________________ |
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______________________________________ |
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Operator Name __________________________________ |
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______________________________________ |
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Address ________________________________________ |
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______________________________________ |
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________________________________________ |
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______________________________________ |
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Phone ( ) ________________________________ |
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[ENUMERATOR NOTE: |
If the operation on the face page was in business part of the 20XX crop year, complete this questionnaire for the part of the year during which the operation did business, unless the operation has been taken over by a new operator. If the operator has changed midyear, please conduct this interview start to finish with the new operator after reading “Valid Substitution” rules in section 4 of the Interviewer’s Manual.] |
2. Has the operation printed on this questionnaire been combined or merged with any other farming operations? |
Yes - [Go to "Conclusion".]
No - [Continue.] |
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SCREENING |
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1. Did this operation have any of the target crops during the 20XX crop year? |
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YES - [Continue.] |
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NO - [Write notes explaining situation then go to “Conclusion” on back page.] |
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____________________________________________________________________________________________ |
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____________________________________________________________________________________________ |
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____________________________________________________________________________________________ |
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2. Are the day-to-day
decisions for this operation (name on label) made by
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one individual? [Go to Section A.] |
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a hired manager? [Go to Section A.] |
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partners? [Continue.] |
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3. How many individuals are involved in the day-to-day decisions of this operation? [Enter the number of partners, including the partner named on the label. Identify the other persons in this partnership below, then go to Section A.] (Partners jointly operate land and share in decision making. Do not include landlords and tenants as partners.). . . . . . . . . . |
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4. Please identify the other person(s) in this partnership, then go to Section A. [Verify partners’ names and make necessary corrections if names have already been entered.] |
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PARTNERS |
POID__ __ __ __ __ __ __ __ __ |
PARTNERS |
POID__ __ __ __ __ __ __ __ __ |
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PARTNER NAME |
PARTNER NAME |
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ADDRESS |
ADDRESS |
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CITY |
STATE |
ZIP |
PHONE NUMBER |
CITY |
STATE |
ZIP |
PHONE NUMBER |
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PARTNERS |
POID__ __ __ __ __ __ __ __ __ |
PARTNERS |
POID__ __ __ __ __ __ __ __ __ |
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PARTNER NAME |
PARTNER NAME |
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ADDRESS |
ADDRESS |
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CITY |
STATE |
ZIP |
PHONE NUMBER |
CITY |
STATE |
ZIP |
PHONE NUMBER |
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CALIFORNIA SCREENING |
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1. What ID (pesticide permit number) does this operation use for reporting pesticide applications on the target acres to the County Agricultural Commissioners?. . . . . . . . . . . . . . . . . . . . . . . . . . |
COUNTY |
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NUMBER |
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2. Is this ID used to report pesticide applications for any other operations? |
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YES - [Continue.] |
NO - [Go to item 3.] |
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a. What other operation(s) is this ID used to report for? |
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Name________________________________________ |
Name__________________________________________ |
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Address______________________________________ |
Address________________________________________ |
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Phone ( ) __________________________________ |
Phone ( ) __________________________________ |
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3. Does this operation use any OTHER ID’s to report pesticide applications on the target acres to the County Agricultural Commissioners? |
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YES - [Continue.] |
NO - [Go to Section A.] |
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COUNTY |
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NUMBER |
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a. What are these other ID numbers?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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b. Do you use any of these ID’s to report pesticide applications for any other operation(s)? |
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YES - [Continue.] |
NO - [Go to Section A.] |
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(i) What other operation(s) use this ID for reporting? [Identify operation and ID.] |
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Name________________________________________ |
Name__________________________________________ |
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Reporting ID____________________________________ |
Reporting ID____________________________________ |
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Address______________________________________ |
Address________________________________________ |
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Phone ( ) __________________________________ |
Phone ( ) __________________________________ |
A |
LAND OPERATED |
A |
ACRES OPERATED |
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CODE |
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[Enumerator Action: If acreage on the insert is verified as correct, enter code 1 in box 801, then skip to Section B. If acreage has changed, ask ALL questions.] . . . . . . . . |
801 |
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Now I would like to ask about the total acres operated under this land arrangement. |
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1. How many acres does this operation--- |
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ACRES |
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a. Own?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + |
901 |
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b. Rent or lease from others or use rent free? (Exclude land used on an animal unit month (AUM) basis.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + |
902 |
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c. Rent to others?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - |
905 |
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2. [Calculate item 1a + 1b - 1c.] Then the total acres operated are:. . . . . . . . . . . . . . . . . . . . . . . . . . = |
900 . ___ |
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a. Does this include the farmstead, all cropland, woodland, pasture land, wasteland, and government program land?
YES - [Continue.] NO - [Make corrections, then continue.] |
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The remaining questions in this survey refer to these [item 2] acres. |
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3. Of the total acres operated, how many acres are considered cropland, including land in hay, summer fallow, cropland idle, cropland used for pasture and cropland in government programs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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802 |
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4. Of the total acres operated, how many acres are vegetables? (Include both target and non-target vegetables planted on the operation.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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803 . ___ |
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ADA-ESD SCREENING |
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[ENUMERATOR NOTE: If box is checked, begin with item 1. If box is NOT checked, go to page 6.]. . . . . . . . . . . . . . |
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1. What Pesticide Grower Permit number does this
operation use for reporting Department of Agriculture – Environmental Services Division [ADA-ESD]? . . . . . . . . . . |
PGP 10 NUMBER |
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020 |
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2. Is this permit number used to report chemical applications for acres other than these [Section A, item 2] acres? |
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YES - [Continue.] |
NO - [Go to item 3.] |
OFFICE USE |
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012 |
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a. What other operation(s) is this permit number used to report for? |
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Name __________________________________ |
Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Address ________________________________ |
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Phone ( ) ____________________________ |
Phone ( ) ____________________________ |
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3. Does this operation use any OTHER Pesticide Grower Permit number to report chemical applications to ADA–ESD for these [Section A, item 2] acres? |
OFFICE USE |
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YES - [Continue.] |
NO - [Go to Section B.] |
013 |
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PGP 10 NUMBER |
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a. What are these PGP numbers?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
015 |
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016 |
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017 |
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b. Do you use any of these ID’s to report chemical applications for any other operation(s)? |
018 |
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019 |
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YES - [Continue.] |
NO - [Go to Section B.] |
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(a) What other operation(s) use this Pesticide Grower Permit for reporting? [Identify operation and ID] |
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Name __________________________________ |
Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Reporting ID ____________________________ |
Reporting ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Address ________________________________ |
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Phone ( ) ____________________________ |
Phone ( ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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B |
VEGETABLE ACREAGE |
B |
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1. What target
vegetables were on
these [Section A,
item 2]
acres |
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[Enumerator Note: If no target acreage is present, write notes and skip to “Conclusion” on back page.] |
OFFICE USE LINES IN TABLE |
TABLE 001 |
199 |
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L I N E |
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CROP CODE |
How many acres of [crop] did this operation have?
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Were any commercial fertilizers applied to this crop?
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Were any herbicides, insecticides, fungicides, etc. applied to this crop?
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On what date did you complete harvest of your 20XX crop year on these [crop] acres?
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On what date did you complete harvest of your 20XX crop year [crop]? |
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CROP |
ACRES |
[YES = 1] |
[YES = 1] |
MM DD YY |
MM DD YY |
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11 |
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11 |
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06 |
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11 |
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07 |
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11 |
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10 |
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CALIFORNIA – CROP CODES |
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701 |
ASPARAGUS |
632 |
CARROTS |
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LETTUCE |
759 |
SPINACH |
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613 |
BEANS, SNAP |
715 |
CELERY |
725 |
HEAD |
742 |
SQUASH |
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705 |
BROCCOLI |
766 |
CORN, SWEET |
728 |
OTHER, includes Romaine |
748 |
STRAWBERRIES |
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808 |
CABBAGE |
798 |
CUCUMBERS |
824 |
ONIONS |
770 |
TOMATOES |
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709 |
CANTALOUPE |
723 |
GARLIC |
736 |
PEPPERS, BELL |
752 |
WATERMELONS |
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714 |
CAULIFLOWER |
730 |
HONEYDEW |
738 |
PUMPKINS |
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Other crops |
B |
VEGETABLE ACREAGE |
B |
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L I N E |
CAL – EPA SITE LOCATION NUMBER (If Required)
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01 |
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02 |
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03 |
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04 |
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05 |
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06 |
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07 |
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08 |
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09 |
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10 |
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11 |
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14 |
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INCLUDES AND EXCLUDES |
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INCLUDE: TARGET CROPS ONLY All acreage equal to or greater than one tenth of an acre. All acreage for processing or fresh market. All acreage for roadside stands, farmer’s markets or U-pick sales. Acreage not harvested due to weather, economic or other reasons. Crops planted in the fall of 2013 if they were part of the 20XX crop. Double Cropping. |
EXCLUDE: ALL CROPS GROWN IN ANOTHER STATE. All crops grown in greenhouses and hothouses. All vegetables grown for commercial transplanting. HOME GARDEN vegetable acreage. All mushrooms, potatoes, sweetpotatoes, dry beans. All vegetable acres grown by institutional, experimental, research and university farms. Non-target vegetables. |
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TARGET CROPS & CODES |
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FLORIDA |
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MINNESOTA |
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PENNSYLVANIA |
613 BEANS, SNAP |
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Other crops |
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613 BEANS, SNAP |
808 CABBAGE |
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766 CORN, SWEET |
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Other crops |
766 CORN, SWEET |
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845 PEAS, GREEN (exclude dried) |
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738 PUMPKINS |
798 CUCUMBERS |
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736 PEPPERS, BELL |
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NEW JERSEY |
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SOUTH CAROLINA |
742 SQUASH |
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736 PEPPERS, BELL |
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752 WATERMELONS |
748 STRAWBERRIES (bearing age) |
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742 SQUASH |
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770 TOMATOES |
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Other crops |
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TEXAS |
752 WATERMELONS |
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808 CABBAGE |
Other crops |
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NEW YORK |
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Other crops |
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613 BEANS, SNAP |
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798 CUCUMBERS |
GEORGIA |
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Other crops |
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824 ONIONS, DRY |
613 BEANS, SNAP |
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808 CABBAGE |
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738 PUMPKINS |
808 CABBAGE |
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766 CORN, SWEET |
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766 CORN, SWEET |
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824 ONIONS, DRY |
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WASHINGTON |
798 CUCUMBERS |
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742 SQUASH |
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701 ASPARAGUS |
824 ONIONS, DRY |
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632 CARROTS |
736 PEPPERS, BELL |
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NORTH CAROLINA |
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766 CORN, SWEET |
742 SQUASH |
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798 CUCUMBERS |
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824 ONIONS, DRY |
Other crops |
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Other crops |
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854 PEAS, GREEN (exclude dried) |
752 WATERMELONS |
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736 PEPPERS, BELL |
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742 SQUASH |
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WISCONSIN |
ILLINOIS |
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752 PUMPKINS |
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613 BEANS, SNAP |
Other crops |
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752 WATERMELONS |
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808 CABBAGE |
613 BEANS, SNAP |
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736 PEPPERS, BELL |
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632 CARROTS |
738 PUMPKINS |
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738 PUMPKINS |
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766 CORN, SWEET |
738 PUMPKINS |
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798 CUCUMBERS |
Other crops |
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OREGON |
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824 PEAS, GREEN (exclude dried) |
752 WATERMELONS |
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613 BEANS, SNAP |
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Other crops |
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OTHER STATES |
MICHIGAN |
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766 CORN, SWEET |
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Other crops |
Other Crops |
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824 ONIONS, DRY |
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701 ASPARAGUS |
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854 PEAS, GREEN (exclude dried) |
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798 CUCUMBERS |
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742 SQUASH |
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738 PUMPKINS |
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613 BEAMS, SNAP |
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742 SQUASH |
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ARIZONA – CROP CODES |
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709 |
CANTALOUPES |
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LETTUCE |
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725 |
HEAD |
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728 |
OTHER, includes Romaine |
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752 |
WATERMELON |
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NOTES |
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C |
FERTILIZER APPLICATIONS |
C |
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Enumerator Note--- If
column 4 of the table in Section B is
YES for any crops, continue with item 1. |
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1. I need to record complete information on all commercial fertilizers applied to the target vegetables grown during the 20XX crop year. Include all applications regardless of how they were applied (irrigation water, foliar applications, etc.). [Record amount of analysis of fertilizers applied or pounds of actual plant nutrients applied. Complete the table below (and any necessary supplemental fertilizer tables). Exclude micronutrients, lime, and gypsum.] |
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OFFICE USE LINES IN TABLE |
TABLE 001 |
299 |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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L I N E
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CROP |
CROP CODE |
N I T R O G E N
N |
P H O S P H A T E
P205 |
P O T A S H
K20 |
S U L F U R
S |
How much was applied per acre per application?
[Leave this column blank if actual nutrients were reported.]
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UNIT CODES
1 Pounds 12 Gallons 13 Quarts 15 Liquid Oz. 28 Dry Oz. 19 Actual Nutrients
|
How many acres was this applied to?
ACRES |
How many times was it applied?
NUMBER |
|||||
01 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
02 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
03 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
04 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
05 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
06 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
07 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
08 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
09 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
10 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
11 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
12 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
13 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
14 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
15 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
16 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
|||||
17 |
|
|
31 |
32 |
33 |
34 |
36 |
37 |
40 |
41 |
D |
PESTICIDE APPLICATIONS |
D |
|
|||||||||||||||||
[ENUMERATOR ACTION: If pesticides were reported in Section B, column 5, continue. Otherwise, skip to Section E.] |
|||||||||||||||||
|
|||||||||||||||||
1.
Now I need to get complete information on all of the chemicals
applied, including applications made by you and/or by custom
applicators during the 20XX
crop year to each of the target
vegetable
crops
you grew. Let’s
start with the first application to your [crop]
since the 2013
crop year
harvest. |
|||||||||||||||||
|
|||||||||||||||||
|
OFFICE USE LINES IN TABLE |
TABLE 001 |
399 |
|
|||||||||||||
|
|||||||||||||||||
|
|
1 |
2 |
3 |
4 |
5 |
|||||||||||
CHEMICAL PRODUCT NAME |
L I N E
|
CROP |
CROP CODE |
What products were applied to the [crop]?
[Enter product code.] |
Was this product bought in liquid or dry form?
[Enter L or D.] |
Was this part of a tank mix?
[If tank mix, enter line number of first product in mix.] |
|||||||||||
|
01 |
|
|
61 |
|
63 |
|||||||||||
|
02 |
|
|
61 |
|
63 |
|||||||||||
|
03 |
|
|
61 |
|
63 |
|||||||||||
|
04 |
|
|
61 |
|
63 |
|||||||||||
|
05 |
|
|
61 |
|
63 |
|||||||||||
|
06 |
|
|
61 |
|
63 |
|||||||||||
|
07 |
|
|
61 |
|
63 |
|||||||||||
|
08 |
|
|
61 |
|
63 |
|||||||||||
|
09 |
|
|
61 |
|
63 |
|||||||||||
|
10 |
|
|
61 |
|
63 |
|||||||||||
|
11 |
|
|
61 |
|
63 |
|||||||||||
|
12 |
|
|
61 |
|
63 |
|||||||||||
|
13 |
|
|
61 |
|
63 |
|||||||||||
|
14 |
|
|
61 |
|
63 |
|||||||||||
|
15 |
|
|
61 |
|
63 |
|||||||||||
[For pesticides not listed in Respondent Booklet, specify---] |
|||||||||||||||||
Line No. |
|
Pesticide Type (Herbicide, Insecticide, Fungicide, etc.) |
|
Trade Name and Formulation |
|
Form Purchased (Liquid or Dry) |
|
EPA Reg. No. |
|||||||||
|
|
|
|
|
|
|
|
|
|||||||||
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|
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
D |
PESTICIDE APPLICATIONS |
D |
|
||||||||||||||||
|
||||||||||||||||
|
CODES FOR COLUMN 8 |
|
||||||||||||||
|
1 POUNDS |
30 GRAMS |
|
|||||||||||||
|
12 GALLONS |
40 KILOGRAMS |
|
|||||||||||||
|
13 QUARTS |
41 LITERS |
|
|||||||||||||
|
14 PINTS |
46 SPIRALS |
|
|||||||||||||
|
15 OUNCES, LIQUID |
47 PACKETS |
|
|||||||||||||
|
28 OUNCES, DRY |
50 OTHER (Specify__________________) |
|
|||||||||||||
|
||||||||||||||||
L I N E
|
6 OR 7 |
8 |
9 |
10 |
||||||||||||
How much was applied per acre per application?
|
What was the total amount applied per application?
|
[Enter unit code from above.]
CODE |
How many acres were treated with this product?
ACRES |
When was it applied?
MM DD YY |
||||||||||||
01 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
02 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
03 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
04 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
05 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
06 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
07 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
08 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
09 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
10 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
11 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
12 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
13 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
14 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
15 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
83 |
|||||||||||
[For pesticides not listed in Respondent Booklet, specify---] |
||||||||||||||||
Line No. |
|
Pesticide Type (Herbicide, Insecticide, Fungicide, etc.) |
|
Tradename and Formulation |
|
Form Purchased (Liquid or Dry) |
|
EPA Reg. No. |
||||||||
|
|
|
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|
|
|
|
||||||||
|
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|
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||||||||
|
|
|
|
|
|
|
|
|
D |
PESTICIDE APPLICATIONS |
D |
|
|||||||||||||||||
[ENUMERATOR ACTION: If pesticides were reported in Section B, column 5, continue. Otherwise, skip to Section E.] |
|||||||||||||||||
|
|||||||||||||||||
1.
Now I need to get complete information on all of the chemicals
applied, including applications made by you and/or by custom
applicators during the 20XX
crop year to each of the target
vegetable
crops
you grew. Let’s
start with the first application to your [crop]
since the 2013
crop year
harvest. |
|||||||||||||||||
|
|||||||||||||||||
|
OFFICE USE LINES IN TABLE |
TABLE 001 |
399 |
|
|||||||||||||
|
|||||||||||||||||
|
|
1 |
2 |
3 |
4 |
5 |
|||||||||||
CHEMICAL PRODUCT NAME |
L I N E
|
CROP |
CROP CODE |
What products were applied to the [crop]?
[Enter product code.] |
Was this product bought in liquid or dry form?
[Enter L or D.] |
Was this part of a tank mix?
[If tank mix, enter line number of first product in mix.] |
|||||||||||
|
01 |
|
|
61 |
|
63 |
|||||||||||
|
02 |
|
|
61 |
|
63 |
|||||||||||
|
03 |
|
|
61 |
|
63 |
|||||||||||
|
04 |
|
|
61 |
|
63 |
|||||||||||
|
05 |
|
|
61 |
|
63 |
|||||||||||
|
06 |
|
|
61 |
|
63 |
|||||||||||
|
07 |
|
|
61 |
|
63 |
|||||||||||
|
08 |
|
|
61 |
|
63 |
|||||||||||
|
09 |
|
|
61 |
|
63 |
|||||||||||
|
10 |
|
|
61 |
|
63 |
|||||||||||
|
11 |
|
|
61 |
|
63 |
|||||||||||
|
12 |
|
|
61 |
|
63 |
|||||||||||
|
13 |
|
|
61 |
|
63 |
|||||||||||
|
14 |
|
|
61 |
|
63 |
|||||||||||
|
15 |
|
|
61 |
|
63 |
|||||||||||
[For pesticides not listed in Respondent Booklet, specify---] |
|||||||||||||||||
Line No. |
|
Pesticide Type (Herbicide, Insecticide, Fungicide, etc.) |
|
Trade Name and Formulation |
|
Form Purchased (Liquid or Dry) |
|
EPA Reg. No. |
|||||||||
|
|
|
|
|
|
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
D |
PESTICIDE APPLICATIONS |
D |
|
CODES FOR COLUMN 8 |
|
||||||||||||||||
|
1 POUNDS |
14 PINTS |
30 GRAMS |
46 SPIRALS |
|
|||||||||||||
|
12 GALLONS |
15 OUNCES, LIQUID |
40 KILOGRAMS |
47 PACKETS |
|
|||||||||||||
|
13 QUARTS |
28 OUNCES, DRY |
41 LITERS |
50 OTHER (Specify_____________) |
|
|||||||||||||
|
|
|
|
|||||||||||||||
|
||||||||||||||||||
L I N E
|
6 OR 7 |
8 |
9 |
10 |
||||||||||||||
How much was applied per acre per application?
|
What was the total amount applied per application?
|
[Enter unit code from above.]
CODE |
How many acres were treated with this product?
ACRES |
How many times was it applied?
NUMBER |
||||||||||||||
01 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
02 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
03 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
04 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
05 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
06 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
07 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
08 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
09 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
10 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
11 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
12 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
13 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
14 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
15 |
65 . ___ ___ |
73 . ___ ___ |
74 |
77 . ___ |
79 |
|||||||||||||
[For pesticides not listed in Respondent Booklet, specify---] |
||||||||||||||||||
Line No. |
|
Pesticide Type (Herbicide, Insecticide, Fungicide, etc.) |
|
Tradename and Formulation |
|
Form Purchased (Liquid or Dry) |
|
EPA Reg. No. |
||||||||||
|
|
|
|
|
|
|
|
|
||||||||||
|
|
|
|
|
|
|
|
|
||||||||||
|
|
|
|
|
|
|
|
|
E |
PEST MANAGEMENT PRACTICES |
E |
Now I have some questions
about pest management practices on this operation. (Include both target and non-target vegetable crops grown.) By pests, we mean insects, weeds, and diseases. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
1. [Enumerator Action: Were PESTICIDE APPLICATIONS reported in Section B, column 5 on page 5?] |
||||||
YES - [Continue.] |
No - [Go to item 5.] |
|||||
|
||||||
2. Was weather data used to
assist in determining either the need or |
|
CODE |
||||
YES = 1 |
600 |
|||||
|
|
|
||||
3. Were any biological
pesticides such as Bt (Bacillus thuringiensis), |
|
|
||||
YES = 1 |
601 |
|||||
|
|
|
||||
4. Were pesticides with
different mechanisms of action rotated or tank |
|
|
||||
YES = 1 |
602 |
|||||
|
|
|||||
5. In 20XX, how were your vegetable acres primarily scouted for insects, weeds, diseases and/or beneficial organisms? . . . . . . . . . . . . . . . . |
1 By deliberately going to the vegetable acres specifically for scouting activities. (Enter code 1 and go to item 6.) 2 By conducting general observations while performing routine tasks. (Enter code 2 and go to item 8.) 3 The vegetable acres were not scouted. (Enter code 3 and go to item 11.) |
. . . . . . . . . . . . . |
|
|||
608 |
||||||
|
|
|||||
6. Was an established
scouting process used (systemic sampling, |
|
|
||||
YES = 1 |
609 |
|||||
|
|
|||||
7. Was scouting for pests done on these vegetable acres due to--- |
|
|||||
a. a pest advisory warning?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
610 |
||||
b. a pest development model?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
611 |
|
||
1 |
2 |
|
8. Were your vegetable acres scouted for –-- |
[If column 1 is YES, ask---]
Who did the majority of the scouting for [column 1]—
1 Operator, partner or family member 2 An employee 3 Farm supply or chemical dealer 4 Independent crop consultant or commercial scout 5 Processor 6 Other (specify: __________________________ ) |
|
|
YES = 1 |
CODE |
a. weeds?. . . . . . . . . . . . . . . . . . . . . . . . . . |
612 |
614 |
b. insects and mites?. . . . . . . . . . . . . . . . . |
615 |
617 |
c. disease?. . . . . . . . . . . . . . . . . . . . . . . . . |
618 |
620 |
E |
PEST MANAGEMENT PRACTICES |
E |
9.
Were written or electronic records kept to track the activity or
|
|
CODE |
|||||||||
YES = 1 |
623 |
||||||||||
10.
Was scouting data compared to published information on
infestation |
|
|
|||||||||
YES = 1 |
624 |
||||||||||
|
|
|
|||||||||
11. Was field mapping data used for making pest management decisions?. . . . . . . . . . . . . . . . . |
YES = 1 |
625 |
|||||||||
12.
Were the services of a diagnostic laboratory used for pest
identification or |
|
|
|||||||||
YES = 1 |
626 |
||||||||||
|
|
|
|||||||||
13. Were crop residues plowed down or removed to manage pests?. . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
627 |
|||||||||
|
|
|
|||||||||
14. Were crops rotated during the past three years for the purpose of managing pests?. . . . . . . |
YES = 1 |
628 |
|||||||||
15.
Were ground covers, mulches, or other physical
barriers |
|
|
|||||||||
YES = 1 |
629 |
||||||||||
|
|
|
|||||||||
16. Was a crop variety chosen because it had resistance to a specific pest?. . . . . . . . . . . . . . . . |
YES = 1 |
630 |
|||||||||
|
|
|
|||||||||
17. Was no-till or minimum till used to manage pests?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
631 |
|||||||||
|
|
|
|||||||||
18. Were planting locations planned to avoid infestation of pests?. . . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
632 |
|||||||||
|
|
|
|||||||||
19. Were planting or harvesting dates adjusted to manage pests?. . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
633 |
|||||||||
|
|
|
|||||||||
20. Were row spacing or plant density adjusted to manage pests?. . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
634 |
|||||||||
|
|
|
|||||||||
21. Was a trap crop grown to help manage insects?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
635 |
|||||||||
22.
Were any beneficial organisms (insects,
nematodes, fungi) |
|
|
|||||||||
YES = 1 |
636 |
||||||||||
23.
Were floral lures, attractants, repellants, pheromone traps
or |
|
|
|||||||||
YES = 1 |
637 |
||||||||||
|
|
|
|||||||||
24. Were any vegetable acres cultivated for weed control during the growing season?. . . . . . . . . |
YES = 1 |
640 |
|||||||||
25.
Were field edges, lanes, ditches, roadways or fence lines
chopped, |
|
|
|||||||||
YES = 1 |
642 |
||||||||||
26.
Were equipment and implements cleaned after completing |
|
|
|||||||||
YES = 1 |
643 |
||||||||||
|
|
|
|||||||||
27. Were any vegetable acres irrigated for the 20XX crops?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
644 |
|||||||||
a. [If item 27 = YES, ask---]
Were
water management practices (excluding chemigation) |
|
|
|||||||||
YES = 1 |
645 |
||||||||||
|
|||||||||||
|
COMPLETION
CODE for |
|
COMPLETION
CODE for |
|
COMPLETION CODE for PEST MANAGEMENT PRACTICES |
|
|||||
|
1 Incomp/R 3 Valid Zero |
200 |
|
1 Incomp/R 3 Valid Zero |
300 |
|
1 Incomp/R
|
500 |
|
|
CONCLUSION |
|
SURVEY RESULTS |
||
1. To receive the complete results of this survey on the release date, go to www.nass.usda.gov/results/. Would you rather have a brief summary mailed to you at a later date? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
|
CODE |
YES = 1 |
9990 |
|
[Thank the respondent, then review this questionnaire.] |
||
|
|
|
ENDING TIME [MILITARY]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
005
___ ___ ___ ___ |
|
|
OFFICE USE TIME IN HOURS |
|
|
006
. ___ |
RECORD USE |
CODE |
|
Did respondent use operation records to report pesticide data?. . . . . . . . . . . . . . . . . . . . . . . . |
YES = 1 |
064 |
|
SUPPLEMENT USE |
|
Record the total number of supplements used to complete this interview. |
NUMBER |
Fertilizer Supplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
067 |
Pesticide Supplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
068 |
|
|
|
|
|
||
Reported by: ________________________________ |
9910
___ ___ ___ ___ ___ ___ M M D D Y Y |
9911
Telephone: ________________________ |
OFFICE USE |
||||||||||||||||
R. Unit |
Ptr 1 Str |
Ptr 2 Str |
Ptr 3 Str |
Ptr 4 Str |
OPS |
SSO 1 |
ADJ |
Optional Use |
||||||||
9921 |
9922 |
9923 |
9927 |
9928 |
923 |
9907 |
922 |
9906 |
9916 |
|||||||
Response |
Respondent |
Mode |
Enum. |
POID |
||||||||||||
1-Comp 2-R 3-Inac 4-Office Hold
|
9901 |
1-Op/Mgr 2-Sp 3-Acct/Bkpr 4-Partner 9-Other |
9902 |
2-Tel 3-Face-to-Face |
9903 |
9998 |
9989 ___ ___ ___ ___ ___ ___ ___ ___ ___ |
|||||||||
Eval. |
Change |
|||||||||||||||
9900 |
9985 |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | millbr |
File Modified | 0000-00-00 |
File Created | 2021-01-16 |