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pdf2020 JUNE AREA SURVEY SCREENING FORM - VERSION C
OMB No. 0535-0213
Approval Expires: 10/31/2022
Project Code: 124
Survey ID: 3838
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: 1-855-415-3687
Email: [email protected]
KS, NE, NM, OK, TX
State
Stratum
Segment
___ ___
___ ___ ___ ___
000___ ___ ___ ___ ___ ___
Part _____
of ______
County______________________
INTRODUCTION
[Introduce yourself and ask for the operator. Rephrase in your own words.]
I am working on the June Agricultural Survey. This is a national survey where agricultural producers are asked to provide information on
crops and livestock.
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 is
voluntary.
The area of land shown on this photo (map) has been selected for this survey.
[Show respondent photo or map. Point out segment boundaries, houses and other identifying landmarks to help the respondent become
familiar with the segment.]
1. On June 1, did you operate land inside these red lines?
□ Yes - [Continue with item 2.]
□ No - [Determine who the tract operators are inside the segment. Thank respondent and conclude interview.]
2. What were the boundaries of land operated inside these red lines?
[Verify or draw tract boundaries in blue, then continue with item 3.]
3. Was any of this land (inside these blue lines) operated by someone else?
□ Yes - [Correct boundaries, then continue with item 4.]
□ No - [Continue with item 4.]
4. Was any land inside these blue lines administered or controlled by a public agency, industrial corporation, or grazing association for
use on a fee per head or animal unit month (AUM) basis?
□ Yes - [Correct boundaries and assign a separate tract code to the PIGA land, then go to page 2.]
□ No - [Go to page 2.]
C
2
5
6
T
R
A L
C E Line 1 – Full Name (First, Middle, Last)
T T Line 2 – Mailing Address
T
Line 3 – City, State, ZIP Code
E
Line 4 – Telephone Number
R
7
8
9
10
11
On the total
On the total
Has this
acres
On the total
acres operated
operation
operated on
acres
Is this tract
on June 1, have
owned or
June 1, have
operated on
Public,
there been or will you sold or will June 1, are any raised any hogs
Industrial, or
you sell
or pigs
there be
crops now
any crops grown,
Grazing
agricultural
in the past
in
storage
hay cut,
Association
products or
12 months, or
or will there
land used on livestock, poultry,
receive
does it expect
be
any
crops
honey bees or
an AUM
government
to own or raise
stored
aquaculture
basis?
payments
any this
before
raised
this
year?
June 1, 2021?
this year?
year?
Name:
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
□ Yes – Enter □ Yes – Go to
acres in col.21 Questionnaire
and conclude
interview.
□ DK – Go to
Questionnaire
Phone: (_______) ________-____________________________ □ No
Name:
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
□ Yes – Enter □ Yes – Go to
acres in col.21 Questionnaire
and conclude
interview.
□ DK – Go to
Questionnaire
Phone: (_______) ________-____________________________ □ No
Name:
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
acres in col.21 Questionnaire
and conclude
interview.
□ DK – Go to
Questionnaire
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
acres in col.21 Questionnaire
and conclude
interview.
□ DK – Go to
Questionnaire
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
acres in col.21 Questionnaire
and conclude
interview.
□ DK – Go to
Questionnaire
□ No
□ Yes – Enter □ Yes – Go to
acres in col.21 Questionnaire
and conclude
interview.
□ DK – Go to
Questionnaire
Phone: (_______) ________-____________________________ □ No
C
□ No
□ Yes – Enter □ Yes – Go to
Phone: (_______) ________-____________________________ □ No
Name:
□ No
□ Yes – Enter □ Yes – Go to
Phone: (_______) ________-____________________________ □ No
Name:
□ No
□ Yes – Enter □ Yes – Go to
Phone: (_______) ________-____________________________ □ No
Name:
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
3
13
14
15
Excluding home
On June 1,
Excluding
use, have there
were there any
home use,
been or
horses, ponies, have there been
will there be
or other equine, or will there be
any nursery,
regardless of any vegetables,
greenhouse,
ownership, on
melons, fruit,
floriculture, sod,
the total acres nuts or berries,
cut Christmas
operated?
grown on this
trees or other
operation
woody crops
this year?
grown on this
16
On June 1, did
this operation
have any idle
cropland or more
than 99 acres of
pasture?
operation this
year?
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
17
O
F
U
F
S
I
E
C
E
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ DK – Go to
□ DK – Go to
□ DK – Go to
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
20a
Enter acres and
land use, then
continue
Does this tract
have potential
for agriculture
before
June 1, 2021?
What best
describes this
nonagricultural
tract?
Enter code
Enter code
818
783
21
PIGA
Acres of
Public,
Industrial,
or
Grazing
Association
land used on
AUM basis.
Enter acres
849
•
__ __
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
•
846
818
783
849
•
__ __
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
-
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
•
846
818
783
849
•
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
•
846
818
783
849
783
849
•
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
•
846
818
•
__ __
□ DK – Go to
How many acres
are inside
these
blue lines?
846
__ __
Questionnaire
20
NON-AGRICULTURAL TRACTS
__ __
□ DK – Go to
18
LAND USE
AA - 27
BB - 28
CC - 29
DD - 30
EE - 31
FF - 32
GG - 33
HH - 34
II - 35
JJ - 36
KK - 37
LL - 38
MM - 39
NN - 40
OO - 41
PP - 42
QQ - 43
RR - 44
SS - 45
TT - 46
UU - 47
VV - 48
WW- 49
XX - 50
YY - 51
ZZ - 52
AAA - 53
Etc...
□ YES = 1
□ DK = 2
□ NO = 3
00
•
846
818
783
849
•
__ __
00
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
•
C
4
[Complete this check list when enumeration of segment is completed.]
1. Total tract letters listed in Column 5, page 2 (sum of all Screening Forms for this segment)..............................
2. Number of tract letters listed on photo or map.............................................................................................
(Item 1 must equal item 2.)
3. Number of Area Version questionnaires completed...................................................................................
4. Number of tracts with acreage listed in Column 18, page 3.......................................................................
+
5. Number of tracts with acreage listed in Column 21, page 3.......................................................................
+
6. Total of items 3 + 4 + 5................................................................................................................................
=
5326
(Item 6 must equal items 1 and 2.)
Worksheet
Ag Tract Acres
Non-Ag Tract Acres
PIGA Tract Acres
[Comment on any enumerating problems caused by segment
boundaries, split fields, aerial photo coverage, etc.]
OFFICE USE
Activity
________________________________________________________
Date
Initials
OFFICE USE
Digitized
Acres
RA / DA
________________________________________________________ Received
________________________________________________________ Clerical Edit
________________________________________________________ OL/NOL Check
st
________________________________________________________ 1 Manual Edit
nd
________________________________________________________ 2 Manual Edit
________________________________________________________ Keyed
________________________________________________________ Verified
________________________________________________________ Interactive Edit
________________________________________________________ Submitted for processing
________________________________________________________ ELMA updates completed
ENUMERATOR:_____________________________________
DATE:_____________________________________________
C
Reported Acres
(RA)
| File Type | application/pdf |
| Author | Davis, Ramonia - NASS |
| File Modified | 2020-03-19 |
| File Created | 2020-03-19 |