OMB 0581-0169
Expiration July 31, 2022
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.
Market name appears in the USDA National On-farm Market 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Information listed in this section is for internal purposes only and will NOT be published in the USDA Local Food Directory.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 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
___________________________________________
___________________________________________
___________________________________________
___________________________________________
Snapchat
___________________________________________
___________________________________________
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.
___________________________________________
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:
___________________________________________
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
___________________________________________
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:
__________________________________________
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.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ragland, Edward - AMS |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |