QID Crop or Livestock Loss Survey

Crop or Livestock Loss Survey
			OMB No. 0535-0213 Approval Expires: 6/30/2020 Project Code: xxx QID: xxxxxx SMetaKey: xxxx
				United States Department of Agriculture
				NATIONAL AGRICULTURAL STATISTICS SERVICE

						USDA/NASS National Operations Division 9700 Page Avenue, Suite 400 St. Louis, MO 63132–1547 Phone: 1–888–424–7828 Fax: 1–855–515–1328 E-mail: [email protected]

Please make corrections to name, address, and ZIP Code, if necessary.

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. For more information on how we protect your information please visit: https://www.nass.usda.gov/confidentiality. Response to this survey is voluntary.

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 0535-0213. The time required to complete this information collection is estimated to average 10 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.

PLEASE REPORT FOR THE TOTAL ACRES YOU OPERATE

Crops

Acres

xxx

1. Due to recent weather conditions (flooding, drought, freezes, hurricanes, etc.), natural

disasters (earthquakes, landslides, etc.), environmental accidents (pipeline rupture, oil tanker

leakage, chemical spill, etc.) or political unrest (act of war or terrorism, etc.), how many of your

____________ (corn, soybean, wheat, small grains, etc.) acres were damaged or destroyed? . . . . .

Acres

xxx

[If Item 1 is zero, go to Item 4; otherwise continue]

2. How many of these (item 1) acres were or will be replanted for harvest this year? . . . . . . . . . . . . . . .

Crop

xxx

3. What crop was or will be used to replant these (item 2) acres? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Livestock

4. Were any livestock or poultry lost due to recent disease outbreaks (brucellosis, Avian flu, etc.),

natural disasters, environmental accidents or political unrest?

Animal Species	Number of Head Lost
xxx	xxx
xxx	xxx

^xxx ₁ Yes – Continue ₃ No – Go to Item 6

5. Please report the type and number of livestock or poultry lost.

Stocks

6. Were any of your on-farm storage facilities damaged due to natural disasters, environmental

accidents, or political unrest?

Bushels

xxx

^xxx ₁ Yes – Continue ₃ No – Go to Item 9

7. How many bushels of your on-farm storage capacity were lost? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Commodity	Bushels Lost
xxx	xxx
xxx	xxx

8. Please report the type and amount of grain and oil seed stocks

that were destroyed.

9. Survey Results: To receive the complete results of this survey on the release date, go to www.nass.usda.gov/results/.
Would you rather have a brief summary mailed to you at a later date? Yes = 1 No = 3
	099

Please comment on the back of this page, the effects this disaster had on your operation over the last few months.

Respondent Name:

9911 Phone:

9910 MM DD YY Date:

OFFICE USE ONLY
	Response		Respondent		Mode		Enum.	Eval.	Change 785		Office Use for POID
	1-Comp 2-R 3-Inac 4-Office Hold 5-R – Est 6-Inac – Est 7-Off Hold – Est 8-Known Zero	9901	1-Op/Mgr 2-Sp 3-Acct/Bkpr 4-Partner 9-Oth	9902	1-Mail 2-Tel 3-Face-to-Face 4-CATI 5-Web 6-E-mail 7-Fax 8-CAPI 19-Other	9903	098	100	785		789 __ __ __ - __ __ __ - __ __ __
								R. Unit			Optional Use
								921			407	408		9906	9916
	S/E Name