OMB 0581-0169
Expiration July 31, 2022
For the purposes of this Directory, a community-supported agriculture (CSA) enterprise is defined as a farm or network/association of multiple farms that offer customers regular (usually weekly) deliveries of locally-grown farm products during one or more harvest season(s) on a subscription or membership basis. Customers have access to a selected share or range of farm products offered by a single farm or group of farmers based on partial or total advance payment of a subscription or membership fee.
1. Does this enterprise qualify as a CSA enterprise as defined above?
(_) Yes
(_) No, this enterprise does not qualify as a CSA enterprise
2. Does your CSA operate in [current year]?
(_) Yes
(_) No
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 0581-0169. The time required to complete this information collection is estimated to average 8 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.
CSA name appears in the USDA CSA Enterprise Directory
___________________________________________
Information listed in this section is for internal purposes only and will NOT be published in the USDA Local Food Directory. This information will be kept confidential.
1. What is your primary relationship with this CSA enterprise?
(_) CSA manager/owner
(_) Contact person/public liaison for this CSA enterprise
(_) Head of CSA enterprise association
(_) CSA enterprise employee
(_) CSA shareholder
(_) Other
___________________________________________
All information you provide from this point forward will be published in the USDA Local Food Directory.
2. Address of the headquarters of this CSA enterprise
[_] Check if the same as the contact person's mailing address
State
See Appendix A
City
___________________________________________
Street name and number or P.O. Box number
___________________________________________
5-digit ZIP Code
___________________________________________
3. Contact information for this CSA enterprise
[_] Check if the same as the contact person's information
Manager’s name
___________________________________________
___________________________________________
Phone
___________________________________________
4. Media channels
To ensure accuracy, please copy the full address from the appropriate website/social media site.
Website
___________________________________________
___________________________________________
___________________________________________
___________________________________________
Snapchat
___________________________________________
___________________________________________
Blog
___________________________________________
Other 1
___________________________________________
Other 2
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5. How many individual farms (including your/family farm) will supply products to your CSA enterprise in [current year]?
___________________________________________
6. How long has this CSA enterprise been in continuous operation?
(_) This is the first year
(_) 2 - 3 years
(_) 4 - 5 years
(_) 6 - 10 years
(_) 11 - 15 years
(_) 16 - 20 years
(_) 21 years or longer
(_) Do not know
7. Introduce your business
This will be a part of the promotional message about your CSA that will appear in the directory.
___________________________________________
During which months will your CSA enterprise have products available to its customer members in [current year]?
[_] Year round
[_] January
[_] February
[_] March
[_] April
[_] May
[_] June
[_] July
[_] August
[_] September
[_] October
[_] November
[_] December
[_] Not sure yet
Which farm products and other items will be included in member shares or available for purchase from your CSA enterprise in [current year]?
[_] Fresh fruits
Types of fresh fruits
[_] Apples
[_] Apricots
[_] Avocados
[_] Blackberries, raspberries
[_] Blueberries
[_] Cantaloupes
[_] Cherries (sweet, tart, etc.)
[_] Cranberries
[_] Currants
[_] Dates
[_] Figs
[_] Gooseberries
[_] Grapefruit (red, white, etc.)
[_] Grapes (black, green, red, etc.)
[_] Honeydew melons
[_] Kiwi
[_] Lemons, limes
[_] Mangos, papayas, pineapples and other tropical fruit
[_] Nectarines
[_] Oranges, clementine, mandarins, tangerines, tangelos
[_] Peaches (yellow, white, etc.)
[_] Pears
[_] Persimmons
[_] Plums (black, green, red, etc.)
[_] Strawberries
[_] Watermelons
[_] Other fruits
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[_] Fresh vegetables
Types of fresh vegetables
[_] Alfalfa sprouts
[_] Artichoke
[_] Arugula
[_] Asparagus
[_] Beans (string)
[_] Beans, other (lima, etc.)
[_] Beets
[_] Bok Choy
[_] Broccoli
[_] Broccoli rabe
[_] Broccolini/baby broccoli
[_] Brussels sprouts
[_] Cabbage
[_] Carrots
[_] Cauliflower
[_] Celery
[_] Collard Greens
[_] Corn (sweet)
[_] Cucumbers
[_] Eggplant (Italian, Japanese, etc.)
[_] Endives
[_] Garlic
[_] Green beans
[_] Green onions/scallions
[_] Kale
[_] Kohlrabi
[_] Leeks
[_] Lettuce (head, leaf, etc.)
[_] Mache/lambâ™s lettuce
[_] Mixed leafy greens
[_] Mizuna
[_] Mustard Greens
[_] Okra
[_] Onions (pearl, red, white, etc.)
[_] Parsnips
[_] Peanuts
[_] Peas
[_] Peppers, hot
[_] Peppers, sweet
[_] Potatoes (new, red, russet, etc.)
[_] Pumpkin
[_] Radicchio
[_] Radishes
[_] Rhubarb
[_] Rutabaga
[_] Shallots
[_] Soybeans
[_] Spinach: baby, regular
[_] Squash, summer: zucchini, etc.
[_] Squash, winter: butternut, etc.
[_] Sweet potatoes
[_] Swiss chard
[_] Tomatillo
[_] Tomatoes (cherry, grape, etc.)
[_] Tomatoes (plum, round, etc.)
[_] Turnip greens
[_] Turnips
[_] Other fresh vegetables
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[_] Baked goods: breads, pies, etc.
[_] Canned or preserved fruits/vegetables: jams, jellies, preserves, salsas, pickles, dried fruit, etc.
[_] Coffee and/or tea
[_] Cut flowers
[_] Dairy products: milk, cheese, etc.
[_] Dry beans
[_] Eggs
[_] Fish and/or seafood
Types of fish and seafood
[_] Crab
[_] Lobster
[_] Mussels
[_] Oysters
[_] Salmon
[_] Shrimp/prawns
[_] Trout
[_] Tuna
[_] Other fish/seafood
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[_] Fresh and/or dried herbs
[_] Grains and/or flour
[_] Honey
[_] Juices and/or non-alcoholic ciders
[_] Maple syrup and/or maple products
[_] Mushrooms
[_] Nuts
[_] Pet food
[_] Poultry/fowl meat and products
Types of poultry/fowl
[_] Chicken
[_] Cornish game hens
[_] Duck
[_] Goose
[_] Ostrich
[_] Pheasant
[_] Quail
[_] Squab (Pigeon)
[_] Turkey
[_] Other poultry/fowl
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[_] Red and other non-poultry meat and products
Types of red and non-poultry meat
[_] Beef/veal (cold cuts)
[_] Beef/veal (ground)
[_] Beef/veal (sausage)
[_] Beef/veal (steaks, roasts)
[_] Bison (ground)
[_] Bison (steaks, roasts)
[_] Elk
[_] Goat
[_] Lamb (chops, roasts)
[_] Lamb (ground)
[_] Lamb (sausage)
[_] Pork (bacon)
[_] Pork (chops, roasts)
[_] Pork (cold cuts)
[_] Pork (ham)
[_] Pork (sausage)
[_] Rabbit
[_] Venison
[_] Other meat items
___________________________________________
[_] Soap and/or body care products
[_] Tofu and/or non-animal protein
[_] Wild harvested forest products: mushrooms, medicinal herbs, edible fruits and nuts, etc.
[_] Wine, spirits, beer, hard cider
[_] Other produces/products
___________________________________________
Does your CSA enterprise offer products certified as "organic" by the USDA?
(_) Yes
(_) No
(_) I don't know
Which types of production method or practice claims will your CSA enterprise use to market and promote its food (including product packages and labels) in [current year]?
Only check those production methods and practice claims that are used to market/promote foods for the CSA portion of your business, not your farm enterprise(s) as a whole.
[_] No pesticides
[_] No antibiotics
[_] No hormones
[_] Fair Labor practices
[_] Humane treatment of animals
[_] Pasture-raised/free range animals
[_] Certified Naturally Grown
[_] Non-Certified, but Practicing Organic
[_] Other farming practices
___________________________________________
[_] No farming practices
In total, how many CSA shares/subscriptions does your CSA enterprise have in [current year]?
___________________________________________
List the types of subscription/membership choices your CSA enterprise is offering in [current year].
[_] Full shares
[_] Half shares
[_] Other
___________________________________________
How are the product items in your CSA share box selected?
[_] CSA decides product assortment of shares/delivery boxes based entirely on supply availability; customer does not influence product selection
[_] CSA offers separate subscription options for specific product categories (e.g., vegetables, meat, eggs,) that customers select at the beginning of the delivery season
[_] CSA customers order specific items from a list of available farm products in advance of each delivery
[_] Other
___________________________________________
When do your CSA’s shares first become available for purchase in [current year]?
___________________________________________
What types of payment will be accepted by your CSA enterprise in [current year]?
[_] Barter
[_] Cash
[_] Checks
[_] Debit/Credit cards
[_] Online payments ( e.g., PayPal, Amazon payments, Dwolla, WePay, etc.)
[_] SNAP benefits (Bridge cards/EBT)
[_] Other
___________________________________________
Which types of payment options does your CSA enterprise offer to its subscribers/members?
[_] One advance payment prior to the beginning of the delivery season
[_] Payments in installments over the course of each delivery season
[_] Reduced subscription/membership fees in exchange for labor
[_] Reduced subscription/membership fees based on household income
[_] Other
___________________________________________
In [current year], how will your CSA enterprise deliver products to its subscribers/members?
[_] Deliver directly to subscribers/members’ homes (by truck or express mail)
[_] Deliver to subscribers/members’ workplaces
[_] Subscribers/members pick up merchandise from CSA farm(s)
[_] Deliver to one or more neighborhood sites that are located close to subscribers/members
State
See Appendix A
City
___________________________________________
Street
___________________________________________
Location Description
___________________________________________
Drop off date for this location
(_) Select a date
(_) Mon
(_) Tue
(_) Wed
(_) Thu
(_) Fri
(_) Sat
(_) Sun
Drop off Time (e.g., 3pm to 5pm)
___________________________________________
Dropoff State
State
See Appendix A
City
___________________________________________
Street
___________________________________________
Location Description
___________________________________________
Drop off Date
(_) 1 [Mon]
(_) 2 [Tue]
(_) 3 [Wed]
(_) 4 [Thu]
(_) 5 [Fri]
(_) 6 [Sat]
(_) 7 [Sun]
Drop off Time (e.g., 3pm to 5pm)
___________________________________________
1. Why do you want to delete?
(_) This CSA is closed (or temporarily suspended operation).
Why was it closed (or temporarily suspended operation)?
[_] Insufficient production (e.g., due to weather conditions)
[_] Shrinking customer base (e.g., due to changing customers’ dietary preferences and cooking habits, difficulty to incorporate the items customers receive into their weekly meal plans)
[_] Customer dissatisfaction with product range/quality
[_] Lack of success in recruiting new CSA customer members
[_] Lack of success in recruiting new CSA farm members
[_] Inability to retain farm members in CSA network
[_] CSA farm(s) decided to pursue other marketing arrangements (e.g., with a food hub)
[_] Not enough flexibility in product/share options for customers
[_] Share fees set too low to sustain profitable business operation
[_] Share fees too high for targeted customer base
[_] Inconvenient delivery sites
[_] Land/expansion constraints
[_] Other
___________________________________________
(_) Other reasons
___________________________________________
2. Please verify the contact information of the person completing this form
Contact Name
___________________________________________
Contact Email
___________________________________________
Contact Phone
___________________________________________
3. What is your primary relationship with this CSA enterprise?
(_) CSA manager/owner
(_) Contact person/public liaison for this CSA enterprise
(_) Head of CSA enterprise association
(_) CSA enterprise employee
(_) CSA shareholder
(_) Other
___________________________________________
4. Any comments:
___________________________________________
Thank you for informing us that you no longer manage/represent this community supported agriculture program.
If you know the new contact person's information, please provide his/her information below and click the "submit" button:
Name:
___________________________________________
Email address:
___________________________________________
Any comments:
___________________________________________
If you do not know the new contact person's information, please click the "submit" button directly.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ragland, Edward - AMS |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |