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pdf2020 JUNE AREA SURVEY SCREENING FORM - VERSION B
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]
AL, AR, DE, FL, GA, IL, IN, IA, KY, LA,
MD, MI, MN, MS, MO, NH, NJ, NY, NC,
OH, PA, SC, TN, VA, WV, WI
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 page 2.]
□ No - [Continue with page 2.]
B
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
8
9
On the total
On the total
acres
acres operated on
operated on June June 1, have you
1, have there been
sold or will you
or will there be
sell agricultural
any crops grown,
products or
hay cut, livestock,
receive
poultry, honey
government
bees or
payments
aquaculture raised
this
this year?
year?
10
11
On the total
acres
operated on
June 1, are any
crops now
in storage
or will there
be any crops
stored
before
June 1, 2021?
Has this
operation owned
or raised any
hogs or pigs
in the past
12 months, or
does it expect
to own or raise
any 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
Phone: (_______) ________-____________________________
□ No
□ No
□ No
□ No
Name:
□ 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
Phone: (_______) ________-____________________________
□ No
□ No
□ No
□ No
Name:
□ 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
Phone: (_______) ________-____________________________
□ No
□ No
□ No
□ No
Name:
□ 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
Phone: (_______) ________-____________________________
□ No
□ No
□ No
□ No
Name:
□ 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
Phone: (_______) ________-____________________________
□ No
□ No
□ No
□ No
Name:
□ 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
Name:
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Address:
_____________________________________________________
_____________________________________________________
Phone: (_______) ________-____________________________
B
3
13
14
15
16
Excluding home Excluding home
use, have there
use, have there
been or
been or will there
will there be
be any
any nursery,
vegetables,
greenhouse,
melons, fruit, nuts
or berries, grown floriculture, sod,
cut Christmas
on this operation
trees or other
this year?
woody crops
grown on this
operation this
year?
On June 1, did this
operation have any
idle cropland or
more than 99 acres
of pasture?
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
□ Yes – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
On June 1,
were there any
horses, ponies,
or other equine,
regardless of
ownership, on
the total acres
operated?
□ 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
□ 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
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
□ DK – Go to
Questionnaire
Questionnaire
Questionnaire
Questionnaire
□ No
□ No
□ No
□ No
Does this tract
have potential for
agriculture before
June 1, 2021?
What best
describes this
nonagricultural
tract?
Enter acres and
land use, then
continue
Enter code
Enter code
818
783
•
__ __
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
846
818
783
•
__ __
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
•
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
846
818
783
•
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
00
846
818
783
•
__ __
Questionnaire
20a
How many acres
are inside
these
blue lines?
846
__ __
□ DK – Go to
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
•
__ __
00
LAND USE
□ YES = 1
□ DK = 2
□ NO = 3
B
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. Total of items 3 + 4 .....................................................................................................................................
=
5326
(Item 5 must equal items 1 and 2.)
Worksheet
Ag Tract Acres
Non-Ag 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:_____________________________________________
B
Reported Acres
(RA)
| File Type | application/pdf |
| Author | Davis, Ramonia - NASS |
| File Modified | 2020-03-19 |
| File Created | 2020-03-19 |