QID 051050 Seed Potato Price Inquiry - Northwest Region

Project 171 QID 051050 - ID, OR, WA			OMB No. 0535-0003 Approval Expires 05/31/16
	SEED POTATO PRICE INQUIRY 2016					NATIONAL AGRICULTURAL STATISTICS SERVICE
					Northwest Regional Field Office 112 Henry St NE, Ste 202 Olympia, WA 98506-0609 Phone 800-435-5883 Fax 855-270-2721 [email protected]
	The prices paid for seed potatoes are an influential factor in computing the U.S. Index of Prices Paid by Farmers. Please report the prices received or to be received for seed potatoes used for 2016 plantings. The information you provide will be used for statistical purposes only. In accordance with the Confidential Information Protection provisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal laws, your responses will be kept confidential and will not be disclosed in identifiable form to anyone other than employees or agents. By law, every employee and agent has taken an oath and is subject to a jail term, a fine, or both if he or she willfully discloses ANY identifiable information about you or your operation. Response is voluntary.
Please make corrections to name, address and Zip Code, if necessary. PLEASE MAIL BY: March 18, 2016

Average price received or to be received by you for seed potatoes purchased or contracted for future delivery. (Exclude transportation, handling charges and sales tax.)
VARIETY	DESTINATION STATE	DOLLARS PER CWT	QUANTITY PURCHASED (CWT)
		$ .______	Cwt.
		$ .______	Cwt.
		$ .______	Cwt.
		$ .______	Cwt.
		$ .______	Cwt.

Average Transportation Charges per Cwt. (do not include in the price above) ...…… ________.___ $/Cwt.

Average Treatment and Cutting Charges per Cwt. (do not include in the price above) ________.___ $/Cwt.

Reported by: _________________________________ Phone: ____________________ Date: __________________

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 number is 0535-0003. The time required to complete this information collection is estimated to average 15 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