QID 082001 2018 Integrated Screening Form

2018 INTEGRATED SCREENING SURVEY
	OMB No. 0535-0218 Approval Expires: 7/31/2018 Project Code: 905 QID: 082001 SMetaKey: 3102
			NATIONAL AGRICULTURAL STATISTICS SERVICE

U.S Department of Agriculture National Operations Division 9700 Page Avenue, Suite 400 St. Louis, MO 63132-1547 Phone: 1-888-424-7828 Fax: 855-415-3687 E-mail: [email protected]

The information you provide will be used for statistical purposes only. Your responses will be kept confidential and any person who willfully discloses ANY identifiable information about you or your operation is subject to a jail term, a fine, or both. This survey is conducted in accordance with the Confidential Information Protection provisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal laws. Response to this survey is voluntary. For more information on how we protect your information please visit: https://www.nass.usda.gov/confidentiality.

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 0535-0218. 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.

1. Please make any needed corrections to the name, including the correct operation name, and mailing address on the label.
2. During 2018, will this operation (name on label): grow any crops, including field crops, fruits, vegetables, nursery/greenhouse, or other specialty crops; or cut any hay; or have any livestock, poultry, or bees; or sell any agricultural products; or receive government payments (CRP, WRP, etc.); or have more than 19 acres of idle cropland or more than 99 acres of pastureland? Exclude crops planted on land rented/leased to others.
	YES – [Continue on next page.]
	NO – [Complete items a and b, then go to CONCLUSION on back page.]
	a. Has the operation name on the label been sold, rented, or turned over to someone else?
	YES	NO				Will the land be used for any agricultural purpose by you (the individual listed on the label), or anyone else in the next year?
						YES NO DON’T KNOW
	b. What is the name and address of the new operator?					Please explain, then go to CONCLUSION on back page.
	Operation Name: ____________________________________				__________________________________________________
	Operator Name: ____________________________________				__________________________________________________
	Address: __________________________________________				__________________________________________________
	City: ________________		State: ________	Zip: ______	__________________________________________________
	Phone: ( ) ________________________				__________________________________________________

SECTION 1 - 2018 TOTAL ACRES OPERATED

1. Including the farmstead, all cropland, woodland, pasture land, wasteland, and government program land, how many total acres does this operation –		Acres
a. own? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	901
b. rent or lease from others, including for cash, shares or rent free? (Exclude land used on an animal unit month (AUM) or fee per head basis under a grazing permit.) . . . . . . . . . . .	+	902
c. rent to others, including for cash, shares or rent free? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	–	905
2. Total Acres Operated: [item 1a + 1b - 1c] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	=	900
3. Of the total [item 2] acres operated, how many acres are considered cropland? (Include hay land, summer fallow, idle cropland, cropland used for pasture, and cropland in government programs.) . . . . .		802

SECTION 2 - 2018 CROPS

1. For the crop listed below, please report acres planted and to be planted for all purposes for the 2018 crop year. (Include acres planted and to be planted, even if the crop will not be harvested (for instance, used for cover crop, plowed under or abandoned). Also report acres harvested and to be harvested for grain in the 2018 crop year. Exclude crops planted on land rented/leased to others.)
	Check Here if NONE	Corn Acres Planted and to be Planted for All Purposes	Corn Acres Harvested and to be Harvested for Grain
Corn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		530	531

2. For the crop listed below, please report acres planted and to be planted for harvest in 2018. Also, report the acres to be harvested in 2018. (Include acres planted and to be planted, even if the crop will not be harvested (for instance, used for cover crop, plowed under or abandoned). Exclude crops planted on land rented/leased to others.)
	Check Here if NONE	Peanut Acres Planted and to be Planted for All Purposes	Peanut Acres Harvested and to be Harvested
Peanuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		650	1650

3. For the crop listed below, please report acres planted and to be planted for all purposes for the 2018 crop year. (Include acres planted and to be planted, even if the crop will not be harvested (for instance, used for cover crop, plowed under or abandoned). Also report acres harvested and to be harvested for beans in the 2018 crop year. Exclude crops planted on land rented/leased to others.)

	Check Here if NONE	Soybean Acres Planted and to be Planted for All Purposes	Soybean Acres Harvested and to be Harvested for Beans
Soybeans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		590	591

SECTION 3 - 2018 VEGETABLE CROPS

1. In 2018, did or will this operation grow vegetable crops in any of the following states?
Arizona	Georgia	Michigan	New York	Oregon	Texas
California	Illinois	Minnesota	North Carolina	Pennsylvania	Washington
Florida	Indiana	New Jersey	Ohio	South Carolina	Wisconsin
Yes – [Continue] No – [Go to SECTION 4]

		ACRES
2. Of the total cropland acres reported, how many acres are or will be planted to vegetable crops? (Include double or other multiple croppings.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		803	.____
3. For each vegetable crop named, please give the total acres planted or intended to plant during the 2018 crop year. (Include any acres already planted and harvested in the 2018 crop year. For double or other multiple croppings, count each planting. Exclude “home garden”.)

	Check here if NONE	ACRES				Check here if NONE	ACRES
Asparagus. . . . . . . . . . . .		300	.____		Lettuce, Head. . . . . . . . . .		420	.____
Beans, Snap. . . . . . . . . .		321	.____		Lettuce, Other. . . . . . . . .		423	.____
Broccoli. . . . . . . . . . . . . .		339	.____		Onions. . . . . . . . . . . . . . .		101	.____
Cabbage. . . . . . . . . . . . .		202	.____		Pea, Green. . . . . . . . . . . .		551	.____
Cantaloupes. . . . . . . . . .		354	.____		Peppers, Bell. . . . . . . . . .		453	.____
Carrots. . . . . . . . . . . . . . .		363	.____		Pumpkins. . . . . . . . . . . . .		456	.____
Cauliflower. . . . . . . . . . . .		366	.____		Spinach. . . . . . . . . . . . . .		715	.____
Celery. . . . . . . . . . . . . . .		369	.____		Squash. . . . . . . . . . . . . . .		474	.____
Corn, Sweet. . . . . . . . . . .		381	.____		Strawberries. . . . . . . . . . .		477	.____
Cucumbers. . . . . . . . . . .		390	.____		Tomatoes. . . . . . . . . . . . .		486	.____
Garlic. . . . . . . . . . . . . . . .		396	.____		Watermelons. . . . . . . . . .		489	.____
Honeydews. . . . . . . . . . . .		414	.____

SECTION 4 - 2018 BEEF CATTLE

1. Is this operation in any of the following states?
Alabama	Florida	Kansas	Montana	Oklahoma	Texas
Arkansas	Georgia	Kentucky	Nebraska	Oregon	Virginia
California	Idaho	Mississippi	New Mexico	South Dakota	Wyoming
Colorado	Iowa	Missouri	North Dakota	Tennessee
Yes – [Continue] No – [Go to SECTION 5]

	Check here if NONE	Number
2. During 2018, what was or will be the peak number of beef cows and beef heifers on this operation, regardless of ownership? Exclude dairy cattle and feedlot cattle.. . . . . . . . . . . . .		255

SECTION 5 - 2017 VALUE OF SALES

1. Considering:

• sales of all crops, livestock, poultry, and livestock products (milk, eggs, etc.) sold in 2017;

• the value of product removed for all crops, livestock, and poultry produced under contract in 2017;

• sales of all miscellaneous agricultural products in 2017;

• all government agricultural payments received in 2017; and

• exclude dollars received on land rented to others.

a. What code represents the total gross value of sales, including government agricultural payments?

Total Value					GVS Code
‘None’ during 2017. . . . . . . . . . . . .						99
$ $ $ $ $ $ $ $ $ $ $ $	1 1,000 2,500 5,000 10,000 25,000 50,000 100,000 250,000 500,000 1,000,000 2,500,000	– – – – – – – – – – – –	$ $ $ $ $ $ $ $ $ $ $ $	999 ….. 2,499 ….. 4,999 ….. 9,999 ….. 24,999 ….. 49,999 ….. 99,999 ….. 249,999 ….. 499,999 ….. 999,999 ….. 2,499,999 ….. 4,999,999 …..		1 2 3 4 5 6 7 8 9 10 11 12				GVS Code
										860
$	5,000,000 and over. . . . . . . . . . . .					13
b. Is the GVS Code in box 860 equal to ‘1’ or ‘99’? YES – [Continue] NO – [Go to item 2.]

SECTION 5 - 2017 VALUE OF SALES (Continued)

c. Record all 2018 crops, land uses, and livestock or poultry now on the total acres operated.

Land Use	ACRES	Field Crops Intended For Harvest	ACRES	Other Crops		ACRES
CRP/WRP. . . . . . . . . . . . .		_______________. . . .		Cut Christmas Trees. . . . . . . . . . . . . .
Idle Cropland. . . . . . . . . . .		_______________. . . .		Nursery & Greenhouse. . . . . . . . .
Summer Fallow. . . . . . . . .		_______________. . . .		_______________. . . .
_________________. . . . .		_______________. . . .		_______________. . . .
Government Payments	WHOLE DOLLARS	Fruits/Nuts	ACRES	Livestock		NUMBER
CRP/WRP Payments. . . . .		_______________. . . .		Cattle - Dairy. . . . . . . .
Other Gov’t Payments. . . .		_______________. . . .		Cattle - Other. . . . . . . .
		_______________. . . .		Chickens. . . . . . . . . . .
Pasture/Rangeland	ACRES	_______________. . . .		Hogs. . . . . . . . . . . . . . .
Cropland Used Only For Pasture. . . . . . . . . .		_______________. . . .		Horses. . . . . . . . . . . . .
Permanent Pasture. . . . . .				Mules/Burros. . . . . . . .
Woodland Pasture. . . . . . .		Vegetables/Melons	ACRES	Sheep & Goats. . . . . . .
		_______________. . . .		_______________. . . .
Aquaculture	NUMBER	_______________. . . .		_______________. . . .
Acres of Ponds in Use. . . .		_______________. . . .
Foodsize/Stockers. . . . . . .		Berries	ACRES		OFFICE USE
Fingerlings/Broodfish. . . . .		_______________. . . .			Total Points	Pasture Points
Trout Eggs. . . . . . . . . . . . .		_______________. . . .			861	869
Other Aquaculture. . . . . . .		_______________. . . .

SECTION 5 - 2017 VALUE OF SALES (Continued)

2. Which of these categories represents the largest portion of the gross income from the operation in 2017? Farm Type Code
1 Grains, Oilseeds, Dry Beans, and Dry Peas ……………….…………………..…….. (corn, flaxseed, grain silage and forage, grains and oilseeds, popcorn, rice, small grains, sorghum, soybeans, sunflowers, straw, etc.) 2 Tobacco ………………………………………………………………….……………...….. 3 Cotton and Cottonseed ……………………………………………………….…...…….. 4 Vegetables, Melons, Potatoes, and Sweet Potatoes ……………………………….. (beets, cabbage, cantaloupes, pumpkins, sweet corn, tomatoes, watermelons, vegetable seeds, etc.) 5 Fruit, Tree Nuts, and Berries ……………………………………………………...….. (almonds, apples, blueberries, cherries, grapes, hazelnuts, kiwifruit, oranges, pears, pecans, strawberries, walnuts, etc.) 6 Nursery, Greenhouse, Floriculture, and Sod ……………………………….............. (bedding plants, bulbs, cut flowers, flower seeds, foliage plants, mushrooms, nursery potted plants, shrubbery, sod, etc.) 7 Cut Christmas Trees and Short Rotation Woody Crops ……………………….….. 8 Other Crops, Hay, CRP, and Pasture …………………………………….................. (grass seed, hay and grass silage, hops, maple syrup, mint, peanuts, sugarcane, sugarbeets, CRP, etc.) 9 Hogs and Pigs …………………………………………………………………….……….. 10 Milk and Other Dairy Products from Cows …………………………………………… 11 Cattle and Calves ………………………………………………………………................ (beef and dairy cattle for breeding stock, fed cattle, beef and dairy cull animals, stockers and feeders, veal calves, etc.) 12 Sheep, Goats, and their Products …………………………………………………..…. (wool, mohair, milk and cheese) 13 Horses, Ponies, and Mules ………………………………………………………...……. (burros and donkeys) 14 Poultry and Eggs ………………..……………………………………………...……….... (broilers, chickens, turkeys, ducks, eggs, emus, geese, hatchlings, ostriches, pigeons, pheasants, quail, poultry products, etc.) 15 Aquaculture ………………………..…………..………………………………………...... (catfish, trout, ornamental and other fish, mollusks, crustaceans, etc.) 16 Other Animals and Other Animal Products ………………..………………............... (bees, honey, rabbits, fur-bearing animals, semen, manure, other animal specialties, etc.)	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16			Farm Type Code
				862

SECTION 6 – ARIZONA PESTICIDE GROWER PERMITS

1. Is this operation in Arizona?

Yes - [Continue] NO - [Go to SECTION 7]

2. Does this operation have a Pesticide Grower Permit number from the National Department of

Agriculture Environmental Services Division?

Yes - [Continue] NO - [Go to SECTION 7]

3. What Pesticide Grower Permit number does this operation use for reporting chemical applications on these [item 2] acres to the National Department of Agriculture – Environmental Services Division? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PGP 10 NUMBER

810

4. Is this permit number used to report chemical applications for acres other than these [item 2] acres?

OFFICE USE

YES - [Continue]

NO - [Go to SECTION 7]

012

a. What other operation(s) is this permit number used to report for?

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone ( ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone ( ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Does this operation use any OTHER Pesticide Grower Permit number to report chemical applications to ADA–ESD for these [item 2] acres?

YES - [Continue]

NO - [Go to SECTION 7]

PGP 10 NUMBER

a. What are these PGP numbers?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

811

812

813

b. Do you use any of these ID’s to report chemical applications for any other operation(s)?

814

815

YES - [Continue]

NO - [Go to SECTION 7]

OFFICE USE

(i) What other operation(s) use this Pesticide Grower Permit for reporting? [Identify operation and ID]

013

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reporting ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reporting ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone ( ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone ( ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SECTION 7 - OPERATION TYPE

1. Are the day-to-day decisions for this operation made by one individual, a hired manager, or partners? [Check one] One individual – [Go to CONCLUSION.] A hired manager – [Go to CONCLUSION.] Partners – [Complete items a and b, then go to CONCLUSION.]
		Number
How many individuals, including the operator, are involved in the day-to-day decisions for this operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o
b. Please record partners’ names and addresses, then go to SECTION 8. [Enter names and addresses of partners, including partners who jointly operate land and share in decision making. Do not include landlords and tenants as partners.]
PARTNER 1				PARTNER 2
Partner name: ________________________________________				Partner name: ________________________________________
Address: ____________________________________________				Address: ____________________________________________
City: ________________	State: ________		Zip: ________	City: ________________	State: ________		Zip: ________
Phone: (______) __________________________				Phone: (______) __________________________     
PARTNER 3				PARTNER 4
Partner name: ________________________________________				Partner name: ________________________________________
Address: ____________________________________________				Address: ____________________________________________
City: ________________	State: ________	Zip: ________		City: ________________	State: ________	Zip: ________
Phone: (______) __________________________				Phone: (______) __________________________

SECTION 8 - CONCLUSION

1. Do you (the operator named on the label) make any day-to-day decisions for another farm or ranch?

YES – Please list the other operation(s):__________________________________________________________

NO – [Continue.]

This completes the survey. Thank you for your help.

Reported by: __________________________________	9910 ____ ____ ____ ____ 18 M M D D	9911 Telephone: ________________

OFFICE USE

R. Unit

Ptr 1 Str

Ptr 2 Str

Ptr 3 Str

Ptr 4 Str

OPS

SSO 1

ADJ

Optional Use

9921

9922

9923

9927

9928

923

9907

922

9906

9916

Response

Respondent

Mode

Enum.

POID

1-Comp 2-R 3-Inac 4-Office Hold 5-R – Est 6-Inac – Est 7-Off Hold – Est

9901

1-Op/Mgr 2-Sp 3-Acct/Bkpr 4-Partner 9-Other

9902

1-PASI (Mail) 2-PATI (tel) 3-PAPI (Face-to- Face) 4-CATI 5-Web 6-E-mail 7-Fax 8-CAPI 19-Other

9903

9998

9989  ___ ___ ___ ___ ___ ___ ___ ___ ___

Eval.

Change

9900

9985