Respondents

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

                                                                                                                                                 OMB 0581-0169
                                                                                                                                                 Expiration July 31, 2022

On-Farm Markets

Section 1: Qualifying Questions for the Directory

For the purposes of this Directory, an on-farm market is a single farm operation that sells agricultural and/or horticultural products directly to customers on its farm property or on property adjacent to its farm. The majority of products sold at the on-farm market are either grown on the proprietor’s farm or are sourced from neighboring farms.
 1. Does your market qualify as an on-farm market as defined above?
 
 (_) Yes 
 (_) No 

 2. Does your market 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.

Section 2: Business Name

 Market name appears in the USDA National On-farm Market Directory
 
___________________________________________


Section 3: Business Profile

Information listed in this section is for internal purposes only and will NOT be published in the USDA Local Food Directory.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 on-farm market?
 
 (_) Market manager 
 (_) Farm owner 
 (_) Contact person/public liaison for market 
 (_) Market employee 
 (_) Volunteer 
 (_) Other 
 
___________________________________________

 2. Mailing address for this on-farm market
 [_] 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
 ___________________________________________

All information you provide from this point forward will be published in the USDA Local Food Directory.

 3. Contact information for this on-farm market
 [_] Check if the same as the contact person's information 

 Market Manager’s name 
 ___________________________________________

 Market email
___________________________________________

 Market phone
___________________________________________

 4. Media channels
 To ensure accuracy, please copy the full address from the appropriate website/social media site.
 Website
 ___________________________________________

 Facebook
___________________________________________

 Twitter
___________________________________________

 Instagram 
 ___________________________________________

 Snapchat
___________________________________________

 Pinterest
___________________________________________

 Blog
___________________________________________

 Other 1
___________________________________________

 Other 2
___________________________________________


 5. How may customers find out when your products are available?
 [_] Check on-farm market's web site 
 [_] Call for product availability 
 [_] Get on a notification list to receive email updates 
 [_] Friend our Facebook page 
 [_] Follow us on Twitter 
 [_] Join us on our other social media page 
 [_] From signs by the road, posters in public places 
 [_] None 

 6. Introduce your business
 This will be a part of the promotional message about this market that will appear in the directory.
 
___________________________________________


Section 4: Location 

State

See Appendix A

City
 ___________________________________________

 Physical street address
___________________________________________

 5-digit ZIP Code
___________________________________________

If there is not a street address or ZIP code for this location, or you do not know it, please provide the state, city/town, a description of the location with the nearest road intersection listed and short driving directions. The Directory will include this description to assist customers in locating your on-farm market.

 Location description and driving directions:

___________________________________________


Section 5: Operation Schedule and Products

1. Season Name
 
___________________________________________

 2. Season Start and End Date
 Start Date
___________________________________________

 End Date
___________________________________________

 3. Operation Date and Time
For each operation date, click on the start time slot and then move mouse down to the end time, click again to finish the selection. Click on the selected slot to unselect it.
 
 4. Produce and products that are sold at your operation on a regular basis
 [_] Fresh fruits 
 [_] Fresh vegetables 
 [_] Baked goods: breads, pies, etc. 
 [_] Bedding plants
 [_] Canned or preserved fruits/vegetables: jams, jellies, preserves, salsas, pickles, dried fruit, etc. 
 [_] Coffee and/or tea
 [_] Crafts and/or woodworking items 
 [_] Cut flowers
 [_] Dairy products: milk, cheese, etc. 
 [_] Dry beans 
 [_] Eggs 
 [_] Fish and/or seafood 
 [_] Fresh and/or dried herbs 
 [_] Grains and/or flour 
 [_] Honey 
 [_] Juices and/or non-alcoholic ciders 
 [_] Maple syrup and/or maple products 
 [_] Mushrooms 
 [_] Nursery stock (trees, shrubs) 
 [_] Nuts 
 [_] Pet food 
 [_] Poultry/fowl meat and products 
 [_] Prepared foods (for immediate consumption 
 [_] Red and other non-poultry meat and products
 [_] Soap and/or body care products 
 [_] Tofu and/or non-animal protein 
 [_] Trees (e.g., Christmas trees) 
 [_] Wild harvested forest products: mushrooms, medicinal herbs, edible fruits and nuts, etc. 
 [_] Wine, spirits, beer, hard cider 

 5. What kind of activities and/or services will be offered, on a regular basis, to the public at your farm in [current year]?
 [_] Celebrations/corporate events 
 [_] Educational tours/classes 
 [_] Farm meals (lunches, dinners, etc.) 
 [_] Family/youth activities 
 [_] Pick Your Own/U-Pick operation 
 [_] Tours of manufacturing facilities (creamery, cider mill, maple syrup, etc.) 
 [_] Pumpkin shooting
 [_] Hay rides
 [_] Corn maze 
 [_] Petting zoo
 [_] Pony rides 
 [_] Other agri-tourism activities 
 
___________________________________________
 [_] No activities [13]

 6. Descriptions of this season
 __________________________________________

 7. Farm products and other items that will be sold during this season.
 [_] Fresh fruits 
 [_] Fresh vegetables 
 [_] Baked goods: breads, pies, etc. 
 [_] Bedding plants 
 [_] Canned or preserved fruits/vegetables: jams, jellies, preserves, salsas, pickles, dried fruit, etc. 
 [_] Coffee and/or tea
 [_] Crafts and/or woodworking items 
 [_] Cut flowers 
 [_] Dairy products: milk, cheese, etc. 
 [_] Dry beans 
 [_] Eggs 
 [_] Fish and/or seafood 
 [_] Fresh and/or dried herbs 
 [_] Grains and/or flour 
 [_] Honey 
 [_] Juices and/or non-alcoholic ciders 
 [_] Maple syrup and/or maple products 
 [_] Mushrooms 
 [_] Nursery stock (trees, shrubs) 
 [_] Nuts 
 [_] Pet food 
 [_] Poultry/fowl meat and products 
 [_] Prepared foods (for immediate consumption) 
 [_] Red and other non-poultry meat and products 
 [_] 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 

 8. Activities and/or services will be offered to the public during this season.
 
 [_] Celebrations/corporate events 
 [_] Educational tours/classes 
 [_] Farm meals (lunches, dinners, etc.) 
 [_] Family/youth activities 
 [_] Pick Your Own/U-Pick operation 
 [_] Tours of manufacturing facilities (creamery, cider mill, maple syrup, etc.) 
 [_] Pumpkin shooting 
 [_] Hay rides 
 [_] Corn maze 
 [_] Petting zoo 
 [_] Pony rides 
 [_] Other agri-tourism activities 
 
 ___________________________________________
 [_] No activities 

 9. Other than during the regular days and hours, how may customers purchase your products?
 [_] By appointment 
 [_] By coming to the farm 
 [_] By special order to be picked up 
 [_] By special order to be delivered 
 __________________________________________
 [_] Other method 
 [_] No other ways 

 10. Does your on-farm store provide shipping of products to the customers’ homes?
 (_) Yes 
 (_) No 

 11. Does your on-farm market offer products certified as organic by the USDA?
 (_) Yes 
 (_) No 
 (_) I don't know 

 12. List the facilities that are available to public at your farm.
 [_] Hand washing station(s) 
 [_] Flush toilets 
 [_] Picnic areas without tables 
 [_] Picnic areas with tables 
 [_] None of the above 

 13. What form of payment will be accepted at your on-farm market in [current year]?
 [_] Cash 
 [_] Debit/Credit card(s) 
 [_] Checks 
 [_] SNAP/EBT (formerly called "food stamps") 
 [_] Other 
 
___________________________________________
Section 6: Remove the Market from the Listing 

 1. Why do you want to delete?
 
(_) This on-farm market is closed 

 Why was this market closed?
 
___________________________________________
 (_) 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 on-farm market?
 
 (_) Market manager 
 (_) Farm owner 
 (_) Contact person/public liaison for market 
 (_) Market employee
 (_) Volunteer 
 (_) Other 
 
___________________________________________

 4. Any comments:
  
 __________________________________________

Section 7: No Longer Manage This Listing 

Thank you for informing us that you no longer manage/represent this on-farm market. 
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.