OMB 0581-0169
Expiration July 31, 2022
For
the purposes of USDA Food Hub Directory, a food hub is a business or
organization that actively manages the aggregation, distribution, and
marketing of source-identified food products to multiple buyers from
multiple producers, primarily local and regional producers, to
strengthen the ability of these producers to satisfy local and
regional wholesale, retail, and institutional demand.
1. Does this operation qualify as a food hub as defined above?
(_) Yes
(_) No
2. Based on the above definition of “local”, does your food hub sell local products?
Local food is defined as a food product that is raised, produced, aggregated, stored, processed, and distributed in the locality or region in which the final product is marketed, so that the total distance the product is transported is less than 400 miles from the origin of the product, or within the State in which the product is produced.
(_) Yes
(_) No
3. Does this food hub have its own pre-determined trade area (e.g., by mileage, within a county, state, etc.) where most or all of the products it sells are raised, and/or produced?
(_) Yes
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.
Which best describes this area?
(_) Within ........ miles of the food hub
___________________________________________
(_) Single county where the food hub is located or single county that is within 400 miles of food hub
(_) Collection of counties within 400 miles of the food hub
(_) State where the food hub is located
(_) Multiple states located within 400 miles of the food hub
(_) No
(_) Do not know
4. Does this food hub operate in [current year]?
(_) Yes
(_) No
Food hub name appears in the USDA National Food Hub 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Information listed in this section is for internal purposes only and will NOT be published in the USDA Local Food Directory.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 food hub?
(_) Food hub director
(_) Food hub manager
(_) Contact person/ public liaison for the food hub
(_) Food hub supplier
(_) Food hub customer
(_) Other
___________________________________________
All information you provide from this point forward will be published in the USDA Local Food Directory.
2. Mailing address for this food hub
[_] 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 food hub
[_] Check if the same as the contact person's information
Contact name
___________________________________________
Contact title
___________________________________________
___________________________________________
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. In what year was this food hub established?
___________________________________________
6. What is the legal status of this food hub?
(_) Non-Profit
(_) Producer Cooperative
(_) Consumer Cooperative
(_) Producer-Consumer Cooperative
(_) S Corp
(_) C Corp
(_) B Corp
(_) LLC
(_) L3C
(_) Publicly owned
(_) No formal legal structure
(_) Other
___________________________________________
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 food hub.
Location description and driving directions:
___________________________________________
List in which months this food hub will be in operation 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 do you expect to be sold at this food hub in [current year]?
[_] Fresh fruits
[_] Fresh vegetables
[_] 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
[_] Fresh and/or dried herbs
[_] Grains and/or flour
[_] Green household products: bio-degradable detergent, products made from 100% recycled materials, etc.
[_] Honey
[_] Juices and/or non-alcoholic ciders
[_] Maple syrup and/or maple products
[_] Mushrooms
[_] Nuts
[_] Pet food
[_] Poultry/fowl meat and products
[_] 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
[_] Other produces/products
_________________________________________
Does this food hub offer products certified as "organic" by the USDA?
(_) Yes
(_) No
(_) I don't know
Indicate the locality of each product this food hub will sell in [current year]
Using 400-mile radius from the hub or sourcing products within the same state as a definition of “local”.
Fresh fruits
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Fresh vegetables
(_) Exclusively non-local
(_) Exclusively local
(_) Both local and non-local
Baked goods: breads, pies, etc.
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Canned or preserved fruits/ vegetables: jams, jellies, preserves, salsas, pickles, dried fruit, etc.
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Coffee and/or tea
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Cut flowers
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Dairy products: milk, cheese, etc.
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Dry beans
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Eggs
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Fish and/or seafood
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Fresh and/or dried herbs
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Grains and/or flour
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Green household products: bio-degradable detergent, products made from 100% recycled materials, etc.
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Honey
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Juices and/or non-alcoholic ciders
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Maple syrup and/or maple products
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Mushrooms
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Nuts
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Pet food
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Poultry/fowl meat and products
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Red and other non-poultry meat and products
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Soap and/or body care products
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Tofu and/or non-animal protein
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Wild harvested forest products: mushrooms, medicinal herbs, edible fruits and nuts, etc.
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Wine, spirits, beer, hard cider
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
Other
(_) Exclusively local
(_) Both local and non-local
(_) Exclusively non-local
List all required practices utilized by producers/suppliers
[_] USDA Certified Organic
[_] Certified Naturally Grown
[_] Integrated pest management
[_] Non-Certified, but Practicing Organic
[_] Free Range/Pasture Raised
[_] Grass Fed
[_] Antibiotic Free
[_] Marine Stewardship Council Certified
[_] Chemical Free
[_] Good Agricultural Practices (GAP)-Certified
Which GAP-certifying entity/entities these practices must be certified to be accepted by this food hub.
(_) USDA
(_) USDA and other certifying entity/ entities
(_) Other (non-USDA) certifying entity/ entities
[_] Good Handling Practices (GHP)-Certified
[_] Certified Humane
[_] Animal Welfare Approved
[_] Fair Trade
[_] Other 1
___________________________________________
[_] Other 2
___________________________________________
[_] Other 3
___________________________________________
[_] Not utilize any practices
List all market channels to wholesale buyers in [current year]
[_] Large supermarkets or supercenters
[_] Small independent grocery stores
[_] Corner stores, bodegas
[_] Food retail cooperatives
[_] Restaurants
[_] Caterers, bakeries
[_] Distributors
[_] Food processors
[_] Pre-K food service
[_] K-12 school food service
[_] Colleges/Universities
[_] Hospitals
[_] Senior care facilities
[_] Government or corporate cafeterias
[_] Other 1
___________________________________________
[_] Other 2
___________________________________________
[_] Other 3
___________________________________________
[_] Not expect any market channels to wholesale buyers
List all market channels directly to customers in [current year]
[_] Buying clubs
[_] On-line store
[_] Your own retail storefront
[_] Community-supported agriculture (CSA) shares
[_] Farmers markets
[_] Mobile retail units/ food trucks
[_] Farm stands
[_] Other 1
___________________________________________
[_] Other 2
___________________________________________
[_] Other 3
___________________________________________
[_] Not expect any market channels to customers
List all procurement arrangement with this food hub's suppliers in [current year]
[_] We take ownership of the product by buying from suppliers and then reselling the products to our customers.
[_] We sell on a consignment basis, i.e., we do not take ownership of the product - we sell the supplier’s products to our customers and take a commission on products sold.
[_] Other procurement arrangements
[_] No procurement arrangement with its suppliers
List all operational services or activities offered by this food hub in [current year]
[_] Aggregation
[_] Production such as operating a farm or ranch (including incubator or demonstration farms)
[_] Distribution services
[_] Brokering services
[_] Shared use kitchen
[_] Packaging/Repackaging
[_] Product storage
[_] Canning
[_] Freezing
[_] Cutting
[_] Other 1
___________________________________________
[_] Other 2
___________________________________________
[_] Other 3
__________________________________________
[_] Not offer any operational services or activities
List all producer support services or activities offered by this food hub in [current year]
[_] Marketing and promotional services for producers
[_] Branding or labeling products to indicate origin of product or other attributes
[_] Demonstration/Incubator farm
[_] Production and post-harvest handling training
[_] Business management services or guidance
[_] Paid consulting
[_] Food safety and/or GAP Training
[_] Liability insurance that you offer producers
[_] Transportation services for producers such as picking up product from the farm for distribution
[_] Other 1
___________________________________________
[_] Other 2
___________________________________________
[_] Other 3
___________________________________________
[_] Not offer any producer support services or activities
List all services or activities offered by this food hub to the community in [current year]
[_] Paid employment opportunities for youth
[_] Accepting SNAP benefits
[_] Accepting WIC or FMNP benefits
[_] Matching programs for SNAP benefits
[_] Nutrition or cooking education
[_] Meal preparation
[_] Health screenings
[_] Transportation services for customers to access your operation
[_] Operating a mobile market
[_] Subsidized farm shares
[_] Education programs for institutions (e.g., at schools, colleges/ universities, hospitals)
[_] Other education or community awareness programs
[_] Food donations to local food pantries/ banks
[_] Other 1
___________________________________________
[_] Other 2
___________________________________________
[_] Other 3
___________________________________________
[_] Not offer services and activities to the community
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. Please provide the total gross product sales for this food hub in last year ([previous year])
(_) $500,000 or less
(_) $500,001 to $2,000,000
(_) $2,000,001 to $5,000,000
(_) $5,000,001 to $10,000,000
(_) Over $10,000,000
(_) Did not operate in last year ([previous year])
(_) I don't know
2. List the number of staff, including volunteers, consultants, and interns, this food hub expects to have in the following categories in [current year].
Full-time year-round paid employees
___________________________________________
Part-time year-round paid employees
___________________________________________
Seasonal paid employees
___________________________________________
Unpaid interns/ apprentices
___________________________________________
Cooperative member volunteers
___________________________________________
Regular volunteers
___________________________________________
Occasional volunteers
___________________________________________
Consultants
___________________________________________
Other
___________________________________________
3. Total square footage that this hub’s facility currently owns or leases from others?
___________________________________________
4. Do you know from how many local and non-local producers/suppliers this hub is expected to purchase or procure products in [current year]?
Using 400-mile radius from the hub or sourcing products within the same state as a definition of "local"
(_) Yes, I know expected number of local and non-local producers
Number of non-local producers/suppliers
___________________________________________
Number of local producers/suppliers
___________________________________________
(_) Yes, but only expected number of local producers
Number of local producers/suppliers
___________________________________________
(_) Yes, but only expected number of non-local producers
Number of non-local producers/ suppliers
___________________________________________
(_) No
5. From how many small and mid-sized producers you expect this hub to directly purchase or procure products in [current year]
Generally-speaking, farms and ranches with gross annual sales less than $500,000.
(_) All of our products will be purchased/procured from small and mid-sized producers
(_) Most of our products will be purchased/procured from small and mid-sized producers
(_) Some of our products will be purchased/procured from small and mid-sized producers
(_) Few of our products will be purchased/procured from small and mid-sized producers
(_) I don't know
6. Using 400-mile radius from the hub or sourcing products within the same state as a definition of “local”, what percentage of this hub's sales will be local in [current year]?
(_) Less than or equal to 50%
(_) Greater than 50%
1. Why do you want to delete?
(_) This food hub is closed
Why was it closed?
[_] Lack of demand for locally-grown farm products
[_] Mismatch between production capability of local suppliers and volume needs of buyers
[_] Competition from alternative suppliers of locally-grown farm products
[_] Customer dissatisfaction with product range/quality
[_] Lack of success in recruiting farm product suppliers
[_] Inability to retain farm suppliers in food hub network
[_] Price resistance from customers
[_] Excessive fluctuation in product availability
[_] Other
___________________________________________
(_) Other reasons
Please specify:
___________________________________________
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 food hub?
(_) Food hub director
(_) Food hub manager
(_) Contact person/ public liaison for the food hub
(_) Food hub supplier
(_) Food hub customer
(_) Other
___________________________________________
4. Any comments:
___________________________________________
Thank you for informing us that you no longer manage/represent this food hub.
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 |