QID Out of Business Screener

List Sampling Frame Surveys

0140 - Out of Business Screener -HQ

List Sampling Frame Surveys

OMB: 0535-0140

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Project Code 633


OMB No. 0535-0140 Approval Expires XX/XX/XXXX


OUT OF BUSINESS SCREENER

(Telephone Only)

NATIONAL

AGRICULTURAL

STATISTICS

SERVICE



Survey Name

OR

Census/Survey ID: _____________________________________________________

National Field Office

U.S. Department of Agriculture,

Rm 5030, South Building

1400 Independence Ave., S.W.

Washington, DC 20250-2000

Phone: 1-800-727-9540

Fax: 202-690-2090

Email: [email protected]



FIPS

POID

TRACT

SUBTRACT




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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 and Statistical Efficiency Act of 2018, Title III of Pub. L. No. 115-435, codified in 44 U.S.C. Ch. 35 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.


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 0535-0140. 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.



Operator Name:______________________________________________________



(Enumerator Note: For the target on the above POID, fill out the following information.)


1. I would like to ask you a few questions about your involvement in agriculture.

a. Will you grow any field crops, hay or specially crops such as fruits, vegetables or floriculture?


Yes [Check all that apply]





No [Continue]






Field Crops

Vegetables




Hay

Mushrooms



Fruit/Nut Trees

Maple Syrup



Berries

Other agricultural land use



Floriculture/Nursery/Greenhouse

Specify:_________________________



Bison/LLamas/Alpacas




b. Do you own or raise any: livestock or poultry?




Yes [Check all that apply]





No [Continue]





Beef Cattle

Chickens/Broilers

Ostriches


Dairy Cattle

Turkeys

Bee Colonies


Hogs

Equine

Other Livestock Specify:______________


Sheep

Mink

Other Poultry Specify:________________


Goats

Aquaculture

Equine/Horses/Mules


[Enumerator: If any commodity in 1a. or 1b. is checked, Go to Item 5. If nothing is checked continue to 1c..]

c. Do you have facilities for storing whole grains, pulse crops, or oilseeds?




Yes [Go to Item 5]





No [Continue]





d. Do you have own or operate any CRP/WRP, pasture, woodland, idle land?



Yes [Go to Item 5]





No [Continue)







2. Do you plan to operate a farm or ranch in the future?




Yes [Continue]




No[Continue]




Don’t Know [Continue]








3. What is the reason the operator is not currently farming or ranching? Check reason below.

What is the name and address of the new operator that has taken over the day-to-day decisions on this operation?



Shape1

The operator is deceased?

Operation Name:______________________________________



The operator is retired?

Operator Name:_________________________________________



The operation was out of business or sold?

Address:____________________________________________



The operator is a landlord? (rents entire farm out

to someone else)

City:_____________ State_________ Zip:________________



The operator moved out of state?

[Specify:__________________]

Phone:_________________________________



The operation was on leased land?

(Operator gave up lease) [Go to Item 4]




The operation was never a farm. [Go to Item 5]





Other Reason?

[Explain:__________________] [Go to Item 4]

















4. When did this change occur? . . . . . . . . . . . . . . . . . . . . . . . . . . .






MM

YYYY




5. This Completes the Survey. Thank you for your help.




Respondent Name: _____________________ Phone ( )__________________

Date ___/______/__________




Please leave any notes that might help the List Frame Section.

















Enumerator Name:

______________________________________

Enum ID:








List Frame Action Taken: ______________________________________







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleOMB No
AuthorSandra A Long
File Modified0000-00-00
File Created2022-04-13

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