QID Vegetable Chemical Use Survey - AZ Version for 2020

Non-substantive change request to Maryland Pesticide Use Survey

0218 - Vegetable Chemical Use - AZ version Rev

Agricultural Resource Management, Chemical Use, and Contractor Expense Surveys

OMB: 0535-0218

Document [docx]
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2020 VEGETABLE CHEMICAL USE SURVEY


OMB No. 0535-0218

Approval Expires: 07/31/2021

Project Code: 136 QID: 035219

SMetaKey: 2069





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: 1-855-415-3687

E-mail: [email protected]



Arizona Enterprise

VERSION

01

POID

___ ___ ___ ___ ___ ___ ___ ___ ___

SUBTRACT

___ ___



CONTACT RECORD

DATE

TIME

NOTES










































INTRODUCTION:

[Introduce yourself, and ask for the operator. Rephrase in your own words.]


We are collecting information on chemical use and need your help to make the information as accurate as possible. 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. We encourage you to refer to your records during the interview.


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 60 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.


BEGINNING TIME [MILITARY]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

004

__ __ __ __

[Name, address and partners verified and updated if necessary.]









































During the screening phase of the Vegetable Chemical Use Survey conducted in June and July, your operation was found to be growing or intending to grow vegetables this year. I now need to verify some of the information collected during the screening survey.



Verify operation name and operator on label and/or screener.

  • If no changes, go to Section A, page 4.

  • If changed, continue to “Change in Operating Status”.


CHANGE IN OPERATING STATUS


[ENUMERATOR NOTE: Skip this section if there is no change in operation name or operator.]


1. Has there been a change in operation name or operator?

NO - [Go to Enumerator Note below.]

YES - [Enter code 1, complete name and address information below for new operator,

and read Enumerator Note.]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CODE

023




Operation Name __________________________________



Operator Name __________________________________



Address ________________________________________



________________________________________



Phone ( ) ________________________________


[ENUMERATOR NOTE:

If the operation on the face page was in business part of the 2020 crop year, complete this questionnaire for the part of the year during which the operation did business, unless the operation has been taken over by a new operator. If the operator has changed midyear, please conduct this interview start to finish with the new operator after reading “Valid Substitution” rules in section 4 of the Interviewer’s Manual.]

2. Has the operation printed on this questionnaire been combined or merged with any other farming operations?

Yes - [Go to "Conclusion".]


No - [Continue.]


























SCREENING



1. Did this operation have any of the target crops during the 2020 crop year?

YES - [Continue.]

NO - [Write notes explaining situation then go to “Conclusion” on back page.]

Notes: ______________________________________________________________________________________







2. Are the day-to-day decisions for this operation (name on label) made by –
[Check one.]


one individual? [Go to Section A.]


a hired manager? [Go to Section A.]


partners? [Continue with questions 3 and 4.]


3. How many individuals are involved in the day-to-day decisions of this operation?

[Enter the number of partners, including the partner named on the label.

Identify the other persons in this partnership below, then go to Section A.]

(Partners jointly operate land and share in decision making. Do not include landlords and tenants as partners.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NUMBER






















4. Please identify the other person(s) in this partnership, then go to Section A.

[Verify partners’ names and make necessary corrections if names have already been entered.]


PARTNERS

POID__ __ __ __ __ __ __ __ __

PARTNERS

POID__ __ __ __ __ __ __ __ __

PARTNER NAME

PARTNER NAME

ADDRESS

ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

CITY

STATE

ZIP

PHONE NUMBER

PARTNERS

POID__ __ __ __ __ __ __ __ __

PARTNERS

POID__ __ __ __ __ __ __ __ __

PARTNER NAME

PARTNER NAME

ADDRESS

ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

CITY

STATE

ZIP

PHONE NUMBER




A

LAND OPERATED

A

ACRES OPERATED

[Enumerator Action: If acreage on the insert is verified as correct, enter code 1 in box 801,

then skip to Section B. If acreage has changed, ask ALL questions.]. . . . . . . . . . . . . . . . . . . .

801

Now I would like to ask about the total acres operated under this land arrangement.

1. How many acres does this operation---


ACRES

a. Own?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +

901


. ___



b. Rent or lease from others or use rent free?

(Exclude land used on an animal unit month (AUM) basis.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +

902


. ___



c. Rent to others?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -

905


. ___



2. [Calculate item 1a + 1b - 1c.] Then the total acres operated are:. . . . . . . . . . . . . . . . . . . . . . . . . . =

900

. ___

a. Does this include the farmstead, all cropland, woodland, pasture land,

wasteland, and government program land?


YES - [Continue.] NO - [Make corrections, then continue.]




The remaining questions in this survey refer to these [item 2] acres.


3. Of the total acres operated, how many acres are considered cropland, including

land in hay, summer fallow, cropland idle, cropland used for pasture and cropland

in government programs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


802

.___

4. Of the total acres operated, how many acres are vegetables?

(Include both target and non-target vegetables planted on the operation.). . . . . . . . . . . . . . . . . . . . . . . . . . . .


803

. ___





ADA-ESD SCREENING






















[ENUMERATOR NOTE: If box is checked, begin with item 1.

If box is NOT checked, go to page 6.]. . . . . . . . . . . . . .





1. What Pesticide Grower Permit number does this operation use for reporting
chemical applications on these [Section A, item 2] acres to the Arizona

Department of Agriculture – Environmental Services Division [ADA-ESD]? . . . . . . . . . .

PGP 10 NUMBER

020






2. Is this permit number used to report chemical applications

for acres other than these [Section A, item 2] acres?



YES - [Continue.]

NO - [Go to item 3.]

OFFICE USE


012

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




Name __________________________________

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



Address ________________________________

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



Phone ( ) ____________________________

Phone ( ) ____________________________



3. Does this operation use any OTHER Pesticide Grower Permit number

to report chemical applications to ADA–ESD for these [Section A, item 2] acres?

OFFICE USE

YES - [Continue.]

NO - [Go to Section B.]

013


PGP 10 NUMBER

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

015







016







017






b. Do you use any of these ID’s to report chemical applications

for any other operation(s)?

018






019






YES - [Continue.]

NO - [Go to Section B.]


(a) What other operation(s) use this Pesticide Grower Permit for reporting?

[Identify operation and ID]




Name __________________________________

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



Reporting ID ____________________________

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



Address ________________________________

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



Phone ( ) ____________________________

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





B

VEGETABLE ACREAGE

B


1. What target vegetables were on these [Section A, item 2] acres
during the 
2020 crop year? (Exclude new plantings

of vegetables not intended for harvest in 2020.)


[ENUMERATOR NOTE: If no target acreage is present, write notes

and skip to “Conclusion” on back page.]

OFFICE USE

LINES IN TABLE

TABLE

001

199





1

2

3

4

5



L

I

N

E




How many acres

were PLANTED

for harvest in the 2020 crop year?

(Include 2020 acres

which were planted

in other years.)

Were any commercial fertilizers applied to this crop?

Were any herbicides,

insecticides fungicides, etc. applied to this crop?



INCLUDE:

TARGET CROPS ONLY.


All acreage of TARGET CROPS

for processing or fresh market.


All acreage equal to or greater than

one tenth of an acre.


All bearing acreage of TARGET

CROPS for roadside stands, farmer’s

markets or U-pick sales.


Acreage not harvested due to weather,

economic or other reasons.


Crops planted in the fall of 2019

if they were part of the 2020 crop.


Double Cropping



CROP

CROP CODE

ACRES

[YES = 1]

[YES = 1]



01



11

.___

12

13


02



11

.___

12

13


03



11

.___

12

13


04



11

.___

12

13





EXCLUDE:

05



11

.___

12

13


EXCLUDE:


ALL CROPS GROWN

IN ANOTHER STATE.


All crops grown in greenhouses,

hothouses and home gardens.


Plantings of crops not intended

for harvest in 2020.


New plantings and other plantings

which are not yet bearing

(asparagus & strawberries)


All vegetables grown for commercial

transplanting.


All mushrooms, potatoes, dry beans,

sweet potatoes.


All vegetable acreage grown

for seed only.


All vegetable acres grown by

institutional, experimental, research

and university farms.


Non-target vegetables.


06



11

.___

12

13



07



11

.___

12

13


08



11

.___

12

13


09



11

.___

12

13


10



11

.___

12

13


11



11

.___

12

13


12



11

.___

12

13


13



11

.___

12

13


14



11

.___

12

13


15



11

.___

12

13



ARIZONA – CROP CODES


NOTES:


709

CANTALOUPES




LETTUCE



725

HEAD



728

OTHER



759

SPINACH








D

PESTICIDE APPLICATIONS

D


[ENUMERATOR ACTION: If pesticides were reported in Section B, column 5, continue. Otherwise, skip to Section E.]


1. Now I need to get complete information on all of the chemicals applied, including applications made by you and/or by custom applicators during the 2020 crop year to each of the target VEGETABLE crops you grew. Let’s start with the first application to your [crop] since the 2019 crop year harvest.
[Complete the table for all chemical applications to the target VEGETABLE crops. Use supplemental tables if necessary. ]
(Include herbicides, insecticides, nematicides, miticides, fungicides, chemical thinners, growth regulators, microbial agents, pheromones, rodenticides, and soil fumigants. Exclude seed treatments, foliar applications of nutrients, and applications made to VEGETABLE after harvest.)



OFFICE USE

LINES IN TABLE

TABLE

001

399





1

2

3

4

5

CHEMICAL

PRODUCT NAME

L

I

N

E




CROP

CROP

CODE

What products

were applied

to the [crop]?





[Enter product code.]

Was this

product

bought in

liquid or

dry form?



[Enter L or D.]

Was this

part of a

tank mix?


[If tank mix, enter line number

of first product

in mix.]


01



61


63


02



61


63


03



61


63


04



61


63


05



61


63


06



61


63


07



61


63


08



61


63


09



61


63


10



61


63


11



61


63


12



61


63


13



61


63


14



61


63


15



61


63

[For pesticides not listed in Respondent Booklet, specify---]

Line No.


Pesticide Type

(Herbicide, Insecticide, Fungicide, etc.)


Trade Name

and Formulation


Form Purchased

(Liquid or Dry)


EPA Reg. No.































D

PESTICIDE APPLICATIONS

D


CODES FOR COLUMN 8



1 POUNDS

14 PINTS

30 GRAMS

46 SPIRALS



12 GALLONS

15 OUNCES, LIQUID

40 KILOGRAMS

47 PACKETS



13 QUARTS

28 OUNCES, DRY

41 LITERS

50 OTHER (Specify_____________)





L

I

N

E


6 OR 7

8

9

10

How much

was applied

per acre per

application?



What was the

total amount

applied per

application?



[Enter unit code

from above.]




CODE

How many acres

were treated

with this product?



ACRES

How many times

was it applied?




NUMBER

01

65

. ___ ___

73

. ___ ___

74

77

. ___

79

02

65

. ___ ___

73

. ___ ___

74

77

. ___

79

03

65

. ___ ___

73

. ___ ___

74

77

. ___

79

04

65

. ___ ___

73

. ___ ___

74

77

. ___

79

05

65

. ___ ___

73

. ___ ___

74

77

. ___

79

06

65

. ___ ___

73

. ___ ___

74

77

. ___

79

07

65

. ___ ___

73

. ___ ___

74

77

. ___

79

08

65

. ___ ___

73

. ___ ___

74

77

. ___

79

09

65

. ___ ___

73

. ___ ___

74

77

. ___

79

10

65

. ___ ___

73

. ___ ___

74

77

. ___

79

11

65

. ___ ___

73

. ___ ___

74

77

. ___

79

12

65

. ___ ___

73

. ___ ___

74

77

. ___

79

13

65

. ___ ___

73

. ___ ___

74

77

. ___

79

14

65

. ___ ___

73

. ___ ___

74

77

. ___

79

15

65

. ___ ___

73

. ___ ___

74

77

. ___

79

[For pesticides not listed in Respondent Booklet, specify---]

Line No.


Pesticide Type

(Herbicide, Insecticide, Fungicide, etc.)


Tradename

and Formulation


Form Purchased

(Liquid or Dry)


EPA Reg. No.































D

PESTICIDE APPLICATIONS

D












1

2

3

4

5

CHEMICAL

PRODUCT NAME

L

I

N

E



CROP

CROP

CODE

What products

were applied

to the [crop]?





[Enter product code.]

Was this

product

bought in

liquid or

dry form?



[Enter L or D.]

Was this

part of a

tank mix?


[If tank mix, enter line number

of first product

in mix.]


16



61


63


17



61


63


18



61


63


19



61


63


20



61


63


21



61


63


22



61


63


23



61


63


24



61


63


25



61


63


26



61


63


27



61


63


28



61


63


29



61


63


30



61


63


31



61


63


32



61


63


33



61


63

[For pesticides not listed in Respondent Booklet, specify---]

Line No.


Pesticide Type

(Herbicide, Insecticide, Fungicide, etc.)


Trade Name

and Formulation


Form Purchased

(Liquid or Dry)


EPA Reg. No.































D

PESTICIDE APPLICATIONS

D


CODES FOR COLUMN 8



1 POUNDS

14 PINTS

30 GRAMS

46 SPIRALS



12 GALLONS

15 OUNCES, LIQUID

40 KILOGRAMS

47 PACKETS



13 QUARTS

28 OUNCES, DRY

41 LITERS

50 OTHER (Specify_____________)





L

I

N

E


6 OR 7

8

9

10

How much

was applied

per acre per

application?



What was the

total amount

applied per

application?



[Enter unit code

from above.]




CODE

How many acres

were treated

with this product?



ACRES

How many times

was it applied?




NUMBER

16

65

. ___ ___

73

. ___ ___

74

77

. ___

79

17

65

. ___ ___

73

. ___ ___

74

77

. ___

79

18

65

. ___ ___

73

. ___ ___

74

77

. ___

79

19

65

. ___ ___

73

. ___ ___

74

77

. ___

79

20

65

. ___ ___

73

. ___ ___

74

77

. ___

79

21

65

. ___ ___

73

. ___ ___

74

77

. ___

79

22

65

. ___ ___

73

. ___ ___

74

77

. ___

79

23

65

. ___ ___

73

. ___ ___

74

77

. ___

79

24

65

. ___ ___

73

. ___ ___

74

77

. ___

79

25

65

. ___ ___

73

. ___ ___

74

77

. ___

79

26

65

. ___ ___

73

. ___ ___

74

77

. ___

79

27

65

. ___ ___

73

. ___ ___

74

77

. ___

79

28

65

. ___ ___

73

. ___ ___

74

77

. ___

79

29

65

. ___ ___

73

. ___ ___

74

77

. ___

79

30

65

. ___ ___

73

. ___ ___

74

77

. ___

79

31

65

. ___ ___

73

. ___ ___

74

77

. ___

79

32

65

. ___ ___

73

. ___ ___

74

77

. ___

79

33

65

. ___ ___

73

. ___ ___

74

77

. ___

79

[For pesticides not listed in Respondent Booklet, specify---]

Line No.


Pesticide Type

(Herbicides, Insecticides, Fungicides, etc.)


Trade name

and Formulation


Form Purchased

(Liquid or Dry)


EPA Reg. No.































E

PEST MANAGEMENT PRACTICES

E

Now I have some questions about pest management practices you may have used on any of the total vegetable acres on this operation. (Include both target and non-target vegetable crops grown.)

By pests, we mean insects, weeds, and diseases.














[Enumerator Action: Were PESTICIDE APPLICATIONS reported in Section B, column 5 on page 6?]

YES - [Continue.]

No - [Go to item 4.]


1. Was weather data used to assist in determining either the need or
when to make pesticide applications?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


CODE

YES = 1

600




2. Were any biological pesticides such as Bt (Bacillus thuringiensis),
insect growth regulators (Courier, intrepid, etc.), neem or other
natural/biological based products sprayed or applied to manage pests?. . . . . . . . . . . . . . . . .



YES = 1

601




3. Were pesticides with different mechanisms of action rotated or tank
mixed for the primary purpose of keeping pests from becoming
resistant to pesticides?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

602



4. In 2020, how were your vegetable acres primarily scouted for insects, weeds, diseases and/or

beneficial organisms?. . . . . . . . .

1 By deliberately going to the vegetable acres specifically

for scouting activities. (Enter code 1 and go to item 5.)

2 By conducting general observations while performing

routine tasks. (Enter code 2 and go to item 7.)

3 The vegetable acres were not scouted.

(Enter code 3 and go to item 10.)

. . . . . . . . . . . . .


608



5. Was an established scouting process used (systemic sampling,
recording counts, insect traps, etc.) on any vegetable acres?. . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

609



6. Was scouting for pests done on these vegetable acres due to---


a. a pest advisory warning?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

610

b. a pest development model?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

611






















1

2

7. Were your vegetable acres scouted for –--

[If column 1 is YES, ask---]


Who did the majority

of the scouting for [column 1]—


1 Operator, partner or family member

2 An employee

3 Farm supply or chemical dealer

4 Independent crop consultant or commercial scout

5 Processor

6 Other (specify: __________________________ )


YES = 1

CODE

a. weeds?. . . . . . . . . . . . . . . . . . . . . . . . . .

612

614

b. insects and mites?. . . . . . . . . . . . . . .

615

617

c. disease?. . . . . . . . . . . . . . . . . . . . . . . . .

618

620




E

PEST MANAGEMENT PRACTICES

E

8. Were written or electronic records kept to track the activity or
numbers of weeds, insects or diseases?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


CODE

YES = 1

623

9. Was scouting data compared to published information on infestation
thresholds to determine when to take measures to manage pests?. . . . . . . . . . . . . . . . . . . . .



YES = 1

624




10. Was field mapping data used for making pest management decisions?. . . . . . . . . . . . . . . . .

YES = 1

625

11. Were the services of a diagnostic laboratory used for pest identification or
soil or plant tissue pest analysis?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

626




12. Were crop residues plowed down or removed to manage pests?. . . . . . . . . . . . . . . . . . . . . .

YES = 1

627




13. Were crops rotated during the past three years for the purpose of managing pests?. . . . . . .

YES = 1

628

14. Were ground covers, mulches, or other physical barriers
maintained to manage pest problems?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

629




15. Was a crop variety chosen because it had resistance to a specific pest?. . . . . . . . . . . . . . . .

YES = 1

630




16. Was no-till or minimum till used to manage pests?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

631




17. Were planting locations planned to avoid infestation of pests?. . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

632




18. Were planting or harvesting dates adjusted to manage pests?. . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

633




19. Were row spacing or plant density adjusted to manage pests?. . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

634




20. Was a trap crop grown to help manage insects?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

635

21. Were any beneficial organisms (insects, nematodes, fungi)
applied or released to manage pests?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

636

22. Were floral lures, attractants, repellants, pheromone traps or
other biological pest controls used on any vegetable acres?. . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

637




23. Were any vegetable acres cultivated for weed control during the growing season?. . . . . . . . .

YES = 1

640

24. Were field edges, lanes, ditches, roadways or fence lines chopped,
mowed, plowed, or burned to manage pests on any vegetable acres?. . . . . . . . . . . . . . . . . .



YES = 1

642

25. Were equipment and implements cleaned after completing
field work to reduce the spread of pests?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

643




26. Were any vegetable acres irrigated for the 2020 crops?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

644

a. [If item 26 = YES, ask---]

Were water management practices (excluding chemigation)
such as irrigation scheduling, controlled drainage, or treatment
of retention water used to manage pests?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



YES = 1

645



COMPLETION CODE for
FERTILIZER APPLICATIONS


COMPLETION CODE for
PESTICIDE APPLICATIONS


COMPLETION CODE for

PEST MANAGEMENT PRACTICES



1 Incomp/R

3 Valid Zero

200


1 Incomp/R

3 Valid Zero

300


1 Incomp/R


500













E-1 PEST MANAGEMENT PRACTICES E-1

Enumerator Note: For the remaining questions, primary target crop is defined as the largest target crop by acres planted for harvest in 2020, as reported in Section B, Question 1.


The primary target crop on this operation is: crop / crop code.


1. Were any of the following pesticide spraying practices or activities used on this operation for [insert primary target crop] in 2020? Pesticides include insecticides, fungicides, herbicides, bactericides, nematicides, and plant growth regulators (PGR).




1

2

3

4




Pesticide Spraying Practice or Activity




Was this used in 2020?

Was it specifically used to keep pesticide application(s) on target (i.e., reduce pesticide drift)?



[Complete column for every Yes in Column 1.] Considering labor, training, capital expenditures, and other costs, how easy or difficult was it to implement this practice or activity?



[Complete column for every No in Column 1.]

Why was this practice or activity not used?

List all that apply.


1 Yes

3 No

99 Don't

Know

1 Yes

3 No

99 Don't Know

  1. Very Easy

  2. Somewhat Easy

  3. Somewhat Difficult

  4. Very Difficult

  1. Cost of labor/training

  2. Cost of associated equipment/products

  3. Incompatible with current production practices (e.g., topography, equipment limitations)

  4. General time management issue/too busy

  5. Unfamiliar with activity or practice

  6. Other, specify:

a. Altering spray time(s) depending on weather conditions (e.g., wind speed, wind direction)

5170

5171

5172

5173

5174

Specify:


b. Calibrate sprayer before the season

5190

5191

5192

5193

5194

Specify:


c. Calibrate sprayer during the season

5195

5196

5197

5198

5199

Specify:

d. Manually altering sprayer settings to improve the spray precision (e.g., altering spray pressure, ground speed, and/or boom height)

5200

5201

5202

5203

5204

Specify:

e. Electronic eye/infra-red

5165

5166

5167

5168

or other sensor-based




5169

technology (e.g., sonar)




Specify:

f. Other technologies to improve the spray precision (e.g., on/off nozzle spray technology, GPS technology, variable-rate technology)

5205

5206

5207

5208

5209

Specify:

g. Pulse Width Modulation (PWM) (e.g., Aim Command, Raven's Hawk Eye, John Deere's Exact Apply)

5215

5216

5217

5218

5219

Specify:

h.

Other - Specify:

5220

5221

5222

5223


5225




5224






Specify:

2. Which of the following spraying practices resulted in a sprayer re-calibration for [insert primary target crop] in 2020? Check all that apply.

Shape2 5261 Computer calibration alert system

Shape3 5262 Change in product being applied

Shape4 5263 Observed change in spray pattern (e.g., from worn nozzles)

Shape5 5264 Scheduled calibration (e.g., daily, monthly, annually)

Shape6 5265 When moving to a different block or crop

Shape7 Shape8 5266 Other, specify: 5268 5267 None of the above

Shape9 Shape10 Shape11 Shape12 3. Excluding application of herbicides, which of the following methods of spraying did this operation use to apply insecticide/ fungicide/bactericides/nematicides/plant growth regulator for [insert primary target crop] in 2020? Check all that apply.


5405

Ground boom sprayer(s)

5406

Aerial application(s)

5407

Spot treatments (e.g., backpack sprayers)

5410

Chemigation (such as through drip irrigation or micro-sprinklers)


xxxx

Shape13

Air blast / Air-assisted sprayer(s)


5413

Other, specify: 5400







Shape14 Shape15 Shape16


4. Pre-emergence pesticide applications are pesticides that are applied both prior to planting and/or before the emergence of the vegetables for early-season pest management. Pesticides include insecticides, fungicides, herbicides, bactericides, nematicides, and plant growth regulators (PGR). Did this operation make any pre-emergence pesticide applications using air blast sprayer and/or ground boom sprayers for [insert primary target crop] in 2020?


Shape17 0000

0000

0000

Yes, made pre-emergence pesticide applications using air blast / air-assisted sprayer(s) - Complete Column 1 Yes, made pre-emergence pesticide applications using ground boom sprayers - Complete Column 2

No, did not make pre-emergence pesticide applications - Go to item 5

Shape18




    1. What pesticide type(s) were used in this [insert

systems type] pre-emergence in 2020? Check all that apply.





    1. What is the typical spray volume, in Gallons per Acre (GPA), for pesticide applications pre-emergence in 2020? Select one item only.







    1. What is the typical operating pressure, in PSI, for pesticide applications pre-emergence in 2020? Select one item only.






    1. What is the typical nozzle used when spraying pesticide applications pre-emergence in 2020? Select one item only.





    1. What is the typical ground speed when spraying pesticide applications pre-emergence in 2020? Select one item only.


    1. What is the typical boom height above the ground when spraying pesticide applications pre-emergence in 2020? Select one item only.

1

For Air blast / Air-assisted sprayer(s)

systems

Shape19








5420 Insecticides

5421 Fungicides

5422 Herbicides

5423 Bactericides

xxxx Nematicides

5424 Plant Growth Regulators (PGRs)

5425 Other: specify: 5426

Shape20









5434

1 Less than 25 GPA

2 25 to <50 GPA

3 50 to <75 GPA

4 75 to <100 GPA

5 100 to <200 GPA

6 200 or greater GPA

99 Don't Know


Shape21









5436

1 Less than 50 PSI

2 50 to <75 PSI

3 75 to <100 PSI

4 100 to <150 PSI

5 150 to <200 PSI

6 200 or greater PSI

99 Don't Know




Shape22

1 Hollow Cone

Shape23

2 Full Cone

Shape24

3 Disc/Core Nozzle

Shape25 4 Flat fan

Shape26

5 Air-inclusion (AI) Air-induction

Shape27

Shape28 6 Other, specify: xxxx_____________

99 Don’t Know



Shape29









5440

1 Less than 1 mph

2 1 to <2 mph

3 2 to <3 mph

4 3 to <4 mph

5 4 to <5 mph

6 5 mph or greater

99 Don't Know

Shape33 Shape32 Shape31 Shape30

Shape34

1 <24 inches

2 24 to <36 inches

3 36 inches or greater

4 Don’t know


2

For Ground Boom systems

Shape35








5427 Insecticides

5428 Fungicides

5429 Herbicides

5430 Bactericides

Xxxx Nematicides

5431 Plant Growth Regulators (PGRs)

5432 Other: specify: 5433

Shape36










5435

1 Less than 5 GPA

2 5 to <7.5 GPA

3 7.5 to <10 GPA

4 10 to <15 GPA

5 15 to <20 GPA

6 20 to <25 GPA

7 25 or greater GPA

99 Don't Know

Shape37













5437

1 Less than 10 PSI

2 10 to <20 PSI

3 20 to <30 PSI

4 30 to <40 PSI

5 40 to <50 PSI

6 50 to <60 PSI

7 60 to <70 PSI

8 70 to <80 PSI

9 80 to <90 PSI

10 90 PSI or greater

99 Don't know

Shape38









5438

1 Hollow Cone

2 Full Cone

3 Disc/Core Nozzle

4 Flat fan

5 Air-inclusion (Al)/Air-induction/Venturi

6 Other, specify: 5439

99 Don't Know

Shape39











5441

1 Less than 1 mph

2 1 to <2 mph

3 2 to <3 mph

4 3 to <4 mph

5 4 to <5 mph

6 5 to <6 mph

7 6 to <7 mph

8 7 mph or greater

99 Don't know

Shape40






5442

1 <24 inches

2 24 to <36 inches

3 36 inches or greater

99 Don't know

19

Shape41
E-1 PEST MANAGEMENT PRACTICES E-1


Shape42







    1. What is the typical target droplet size spectrum for pesticide applications pre-emergence in 2020? Select one item only.







    1. For which of the following reasons did this operation change the airspeed (in revolutions per minute, or RPM) pre-emergence in 2020? Check all that apply.

For Air blast / Air-as1sisted sprayer(s) systems

Shape43 5443

Shape44







1 Less than 106 microns (Extremely Fine or Very Fine)

2 106-235 microns (Fine)

3 236-340 microns (Medium)

4 341-403 microns (Coarse)

5 404-502 microns (Very Coarse)

Shape45 6 503-665 microns (Extremely Coarse)

7 Greater than 665 microns (Ultra Coarse)

99 Don't Know

Shape46





5445 Crop stage

5446 Change of product(s)

5447 Use of specialty Plant Growth Regulator (PGR) applications (e.g., for thinning or fruit finish)

Shape47






5448 Moving between blocks

5449 Wind speed or wind direction

5450 Other, specify:5451

5452 Never

Shape48

2

For Ground Boom systems

Shape49 5444

Shape50







1 Less than 106 microns (Extremely Fine or Very Fine)

2 106-235 microns (Fine)

3 236-340 microns (Medium)

4 341-403 microns (Coarse)

5 404-502 microns (Very Coarse)

Shape51 6 503-665 microns (Extremely Coarse)

7 Greater than 665 microns (Ultra Coarse)

99 Don't Know

    1. Which of the following practices were used pre-emergence in 2020? Check all that apply.




5453 Drift reducing adjuvant(s)

Shape52 5454 Drift reducing nozzle(s)

Shape53 5454 Shielded sprayers

Shape54 Xxxx Don’t know



5453

5454

5455

0000

Drift reducing adjuvant(s) Drift reducing nozzle(s) Shielded sprayers

Shape55






Don't know












5. Post-emergence pesticide applications are made to control pests that occur after emergence of the vegetables.

Pesticides include insecticides, fungicides, herbicides, bactericides, nematicides, and plant growth regulators (PGR). Did this operation make any post-emergence pesticide applications using air blast sprayers and/or ground boom sprayers for [insert primary target crop] in 2020?

Shape56

-------------

For vegetables, copy the response options into this column for air-blast too.


Shape57 5241

5240

5242

Yes, made post-emergence pesticide applications using air-assisted sprayer(s) - Complete Column 1 Yes, made post-emergence pesticide applications using ground boom sprayers - Complete Column 2 No, did not make post-emergence pesticide applications - Go to item 6

For Air blast / systems

1

Air-assisted

sprayer(s)

2

For Ground Boom systems

Shape58


A. What pesticide type(s) were used in this [insert

systems type] post-emergence in 2020? Check all that apply.





B. What is the typical spray volume, in Gallons per Acre (GPA), for pesticide applications post-emergence in 2020? Select one item only.







C. What is the typical operating pressure, in PSI, for pesticide applications post-emergence in 2020? Select one item only.





D. What is the typical nozzle used when spraying herbicide applications post-emergence in 2020? Select one item only.




E. What is the typical ground speed when spraying pesticide applications post emergence in 2020? Select one item only.


Shape61 Shape60 Shape59

1

2

3

4

F. What is the typical boom height above the ground or plant canopy when spraying herbicide applications post-emergence in 2020? Select one item only.

5420

Shape62








5421

5422

xxxx

5423

5424

5425


Shape63









5434

1

2

3

4

5

6

99



Shape64









5436

1

2

3

4

5

6

99






Shape65 1

Shape66 2

Shape67 Shape68 3

Shape69 4

5

Shape70 Shape71

6

99




Shape72









5440

1

2

3

4

5

6

99

Insecticides Fungicides Herbicides Bactericides

Nematicides

Plant Growth Regulators (PGRs) Other: specify: 5426


Less than 25 GPA 25 to <50 GPA

50 to <75 GPA

75 to <100 GPA

100 to <200 GPA

200 or greater GPA Don't Know



Less than 50 PSI 50 to <75 PSI

75 to <100 PSI

100 to <150 PSI

150 to <200 PSI

200 or greater PSI Don't Know






Hollow Cone

Full Cone

Disc/Core Nozzle

Flat fan

Air-inclusion (Al)/Air-induction/Venture

Other, specify: xxxx_________

Don’t Know




Less than 1 mph 1 to <2 mph

  1. to <3 mph

  2. to <4 mph

  3. to <5 mph

  4. mph or greater Don't Know

Shape73 Shape75 Shape74

< 24 inches

24 to <36 inches

36 inches or greater

Don’t know

5427

Shape76








5428

5429

5430

xxxx 5431

5432


Shape77










5435

1

2

3

4

5

6

7

99

Shape78













5437

1

2

3

4

5

6

7

8

9

10

99

Shape79









5438

1

2

3

4

5

6

99

Shape80











5441

1

2

3

4

5

6

7

8

99

Shape81






5442

1

2

3

99

Insecticides Fungicides Herbicides Bactericides

Nematicides

Plant Growth Regulators (PGRs) Other: specify: 5433


Less than 5 GPA 5 to <7.5 GPA

7.5 to <10 GPA 10 to <15 GPA 15 to <20 GPA 20 to <25 GPA

25 or greater GPA Don't Know


Less than 10 PSI 10 to <20 PSI

20 to <30 PSI

30 to <40 PSI

40 to <50 PSI

50 to <60 PSI

60 to <70 PSI

70 to <80 PSI

80 to <90 PSI

90 PSI or greater Don't know


Hollow Cone Full Cone

Disc/Core Nozzle Flat fan

Air-inclusion (Al)/Air-induction/Venturi Other, specify: 5439 Don't Know


Less than 1 mph 1 to <2 mph

  1. to <3 mph

  2. to <4 mph

  3. to <5 mph

  4. to <6 mph

  5. to <7 mph

  6. mph or greater Don't know


<24 inches

24 to <36 inches

36 inches or greater Don't know


For Air Blast / Air-as1sisted sprayer(s)

systems

Shape86 5443

2

Shape87 For Ground Boom systems

Shape88 5444




G. What is the typical target droplet size spectrum for pesticide applications post-emergence in 2020? Select one item only.







H. For which of the following reasons did this operation change the airspeed (in revolutions per minute, or RPM) post-emergence in 2020? Check all that apply.


    1. Which of the following practices were used post-emergence in 2020? Check all that apply.




1


2

3

4

5

6


7


99

5445

5446

5447



5448

5449

5450

Shape89

5453 Drift reducing adjuvant(s)

5454 Drift reducing nozzle(s)

5455 Shielded sprayers

xxxx Don’t Know

5452






Less than 106 microns (Extremely Fine or Very Fine)

Shape90







106-235 microns (Fine)

236-340 microns (Medium)

341-403 microns (Coarse)

Shape91 404-502 microns (Very Coarse) 503-665 microns (Extremely Coarse)

Greater than 665 microns (Ultra Coarse)

Don't Know

Shape92





Crop stage

Change of product(s)

Shape93






Use of specialty Plant Growth Regulator (PGR) applications (e.g., for thinning or fruit finish) Moving between blocks

Wind speed or wind direction Other, specify:5451 Never


Shape94


Shape95




1


2

3

4

5

6


7


99















5453

5454

5455

0000

Less than 106 microns (Extremely Fine or Very Fine)

Shape96







106-235 microns (Fine)

236-340 microns (Medium)

341-403 microns (Coarse)

Shape97 404-502 microns (Very Coarse) 503-665 microns (Extremely Coarse)

Greater than 665 microns (Ultra Coarse)

Don't Know











Shape98






Drift reducing adjuvant(s) Drift reducing nozzle(s) Shielded sprayers

Don't know

Shape99 Shape100 Shape101 Shape102 Shape103 Shape104 Shape105 Shape106 Shape107 Shape108























6.Now we are going to ask a few questions about spray equipment maintenance in 2020.





a. How often did this operation clean the system(s) in 2020? Check all that apply.


[If the never box is checked for Item 5464 in Column 1 or 5276 in Column 2, then skip item 25b and go to 25c; otherwise go to 24b.]

1

For Air Blast / Air-assisted systems

2

For Ground Boom systems

5457 Before the season

5458 After the season

5459 Depended on the product(s)

5460 When switching from USDA certified organic to conventional blocks

5461 Regularly scheduled cleaning

5432 Other: specify:

5463

5464 Never

5271 Before the season

5272 After the season

5273 Depended on the product(s)

5278 When switching from USDA certified organic to conventional blocks

5274 Regularly scheduled cleaning

5275 Other: specify:

5277

5276 Never


b. For each time that the system(s) was cleaned, how often was a tank cleaner used?

5473

1 Always (100%)

2 Often (51% or more)

3 Sometimes (50% or less)

4 Never (0%)

99 Don't know

5279

1 Always (100%)

2 Often (51% or more)

3 Sometimes (50% or less)

4 Never (0%)

99 Don't know













c. What were the most common reasons for replacing the nozzles on the sprayers in 2020? Check all that apply.

5481 Regularly scheduled calendar based replacement (i.e., annually, twice annually, monthly, etc.)

5482 Regularly scheduled replacement based on operating time (I.e., sprayer operating hours)

5483 Sporadic replacement based on area covered or general intuition (i.e., it feels like the right time to change nozzles)

5484 Calibration problems (i.e.,

too high or too low a flow rate)

5485 Observed nozzle damage (e.g., change in spray pattern or leaks)

5486 Availability of new nozzle technologies

5487 Expert and/or consultant recommendations (e.g., Cooperative Extension, crop consultants, etc.)

5488 Other, please specify:

5480

5489


None of the above

5491 Regularly scheduled calendar based replacement (i.e., annually, twice annually, monthly, etc.)

5492 Regularly scheduled replacement based on operating time (I.e., sprayer operating hours)

5493 Sporadic replacement based on area covered or general intuition (i.e., it feels like the right time to change nozzles)

5494 Calibration problems (i.e., too high or too low a flow rate)

5495 Observed nozzle damage (e.g., change in spray pattern or leaks)

5496 Availability of new nozzle technologies

5497 Expert and/or consultant recommendations (e.g., Cooperative Extension, crop consultants, etc.)

5498 Other, please specify:

5490

5499



None of the above

Shape109 Shape110 Shape111 Shape112 Shape113 Shape114 Shape115 Shape116 Shape117 Shape118 Shape119 Shape120 Shape121 Shape122 Shape123 Shape124 7.On what proportion of fields did this operation wind-breaking structures, such as hedge rows, that are at least one and a half times the height of the crop canopy in 2020?

Shape125 Shape126 Shape127 Shape128

1

0%

2

1% to 25%

3

26% to 50%


4

51% to 75%


5

76% to 100%


99

Don't know


5300

Shape129
Shape130
Shape131


Shape132

8.How often were the following sources of information used to inform pest management decisions in 2020?






Sources





of





Information

1

How often was this source of information used?

  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

Code

a. Pesticide product labels...........................................................

5301

b. University and/or Agricultural Cooperative Extension resources/recommendations...................................................

5303

c. Non-university literature, such as trade magazines, catalogues,newspapers, etc....................

5305

d. Commodity/trade groups..........................................................

5307

e. Pesticide sales representatives and/or farm supply distributors...............................................................................

5309

f. Independent crop consultants paid for by the operation.........

5311

g. Crop consultants employed by pesticide companies or other

distributors.......................................................................................


xxxx

h. Other grower(s). 5

..3.1..3..

i. Commercial or other non-university decision tools.........................

5315

j. Weather forecasting tools.........................................................

5317

k.

Other, Specify:5319

..........

5320

Shape133

9.[If 8b, column 1 equals 1, 2, 3, ask--] Which of the following types of services offered by the University and/or Agricultural Cooperative Extension were most often used as sources of pest management decisions in 2020?




University and/or Agricultural Cooperative Extension Services



.......

How often was this source of information used?

  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

... Code

.......

a. Formal presentations (e.g., annual meetings, educational trainings)....

.5..322

.......

b. Field days/demonstration workshops....................................................

.5..323

.......

c. Farm visits and/or one-on-one consultation..........................................

.5..324

....... d. Email lists..............................................................................................

.5..325

...... e. Newsletters and blogs...............................................................................

..5.3. 26

.......

f. Crop and/or Pest Protection Handbook.................................................

..5.3.27

......

g. Other publications (e.g., fact sheets)....................................................

..5.3. 28

......

h. Decision tools........................................................................................

..5.3. 29

i. Other, Specify:5330 .............................

5331

Shape138 resistance in 2020?



Only complete if operation uses herbicides

Only complete if operation uses fungicides

Only complete if operation uses insecticides

Practice to Manage Resistance for Herbicide, Fungicide and Insecticide

How often was each practice used on this operation to manage herbicide resistance?

How often was each practice used on this operation to manage fungicide resistance?

How often was each practice used on this operation to manage insecticide resistance?


  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

a. Scouting........................................................

5510

5511

5512

b. Field mapping weeds and/or keeping records of field history and pesticide use to assist pesticide decisions..............................

5332

5333

5334

c. Field Management/Sanitation Practices.......




i. For weed control (e.g., managing weeds in field borders, tillage, preventing field-to-field and within field movement of weed seed).......................

5335



ii. For disease control (e.g., removing or incorporating unharvested material, cleaning transplant trays, sanitizing process or wash water)




5336


iii. For insect control (e.g., removing or incorporating unharvested vegetables and/or other field litter).............................



5337

d. Planting disease-resistant cultivars and/or rootstock.......................................................


5338


e. Use of pest diagnostic tools (e.g., Integrated Pest Management (IPM) treatment thresholds, predictive weather models (e.g., degree day models), pest forecasting systems, and/or assistance from diagnostic networks).............................


5342

5343


f. Pesticide Mode of Action (MOA) rotation......

5344

5345

5346

g. Pesticide Mode of Action (MOA) combination (i.e., tank mix or pre-mix product).........................................................

5347

5348

5349

h.

Rotating crops

0000

0000

0000

11. In an effort to reduce off-target impacts to plants, pollinators, and/or beneficial insects, did this operation communicate with or consult any of the following sources in 2020? Check all that apply.

Shape139 5351 Neighboring crop producers

Shape140 5352 Nearby beekeepers

Shape141 5353 A local expert, such as an Agricultural Cooperative Extension agent

Shape142 5354 State managed pollinator protection plans, or MP3s (MP3s are state-developed efforts that intend to reduce pesticide exposure through timely communication and coordination among beekeeper growers, pesticide applicators, and landowners)

Shape143 5355 Driftwatch - Driftwatch is a voluntary communication tool that enables crop producers, beekeeper and pesticide applicators to work together to protect crops and apiaries through the use of mapping programs.

Shape144 Shape145 5356 Other communication tool(s), Specify: 5358 5357 Other, Specify:5359


Shape150

12. How often were the following Best Management Practice (BMPs) used during the season in 2020?



1

2





Best Management Practices



How often was this practice used?


  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

[Only answer if column 1 = 1, 2, or 3]

Was this practice specifically used to prevent exposure to bees?


  1. Always (100%)

  2. Often (51% or more)

  3. Sometimes (50% or less)

  4. Never (0%)

99 Don't know

a.

Avoid crop bloom time applications.....................................

5520

5521

b.

Make applications when temperatures are below 50°F...........................................................................

5522

5523

c. Maintain buffer between known beehive locations.....

5524

5525

d.

Select pesticides that have the lowest residual toxicity to bees...........................................................

5526

5527

e.

Use alternative application methods of an active ingredient to prevent bee exposure (e.g., non-foliar applications when bees are foraging).........................

5528

5529

f.

Avoid applications when dew is forecast....................

5530

5531

g.

Manage blooming plants on the orchard floor before applying pesticides that are acutely toxic to bees (e.g., mowing)............................................................

5532

5533

h.

Make application(s) at nighttime or no more than two hours prior to sunset............................................

5534

5535


i.

Other, Specify:5536 ....

5537

5538


13.Which of the following auditing systems, if any, did this operation participate in during 2020? Check all that apply.

Shape151 5361 GLOBAL G.A.P.

Shape152 5362 State Quality Food (SQF) Program

Shape153 5363 Other, Specify:5365

Shape154 5364 The operation did not participate in an auditing system

Shape155 5369 Don't know





CONCLUSION


SURVEY RESULTS

1. To receive the complete results of this survey on the release date, go to http://www.nass.usda.gov/Surveys/Guide_to_NASS_Surveys/



To have a brief summary emailed to you at a later date,

please enter your email address.

1095




Would you rather have a brief summary mailed to you at a later date?. . . . . . . . . . . . . . . . . .


CODE

YES = 1

9990

[Thank the respondent, then review this questionnaire.]



ENDING TIME [MILITARY]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

005


___ ___ ___ ___


OFFICE USE

TIME IN HOURS


006


. ___

RECORD USE

CODE

Did respondent use operation records to report pesticide data?. . . . . . . . . . . . . . . . . . . . . . . .

YES = 1

064

SUPPLEMENT USE

Record the total number of supplements used to complete this interview.

NUMBER

Fertilizer Supplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

067

Pesticide Supplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

068






Reported by: ________________________________

9910


___ ___ ___ ___ ___ ___

M M D D Y Y

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


9901

1-Op/Mgr

2-Sp

3-Acct/Bkpr

4-Partner

9-Other

9902

2-PATI (tel)

3-PAPI (Face-to-

Face)

9903

9998

9989


___ ___ ___ ___ ___ ___ ___ ___ ___

Eval.

Change

9900

9985



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMiller, Brenda - NASS
File Modified0000-00-00
File Created2021-01-12

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