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pdfFERAL SWINE SURVEY - 2021
OMB No. 0535-0256
Approval Expires: 5/31/2022
Project Code: 931
Survey ID: 3784
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
E-mail: [email protected]
Animal and Plant Health Inspection Service
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 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 control number is 0535-0256. The time required to complete this information
collection is estimated to average 30 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.
SECTION 1 - GENERAL
For purposes of this study, "wild pig" refers to any pig or hog that is roaming free and does not have an owner. Other names
for "wild pig" include feral hog, wild boar, feral pig, and feral swine.
1. On June 1, 2021, how many acres did your operation:
Acres
a. Own?...............................................................................................................................................
+
b. Rent or lease from others or use rent free? (Exclude land used on an animal unit month (AUM)
basis, Bureau of Land Management (BLM) and Forest Service land.)............................................
+
c. Rent to others?................................................................................................................................
-
2. Calculate item 1a + 1b - 1c. Then the total acres operated on June 1, 2021 was...............................
=
100
101
102
103
3. In what state and county is the majority of your operation located?
State
County
OFFICE USE
55
60
2
SECTION 1 - GENERAL (continued)
4. To the best of your knowledge, during the last three years, have wild pigs been present in the county reported in item
3?
106 1
3
2
Yes
No - Go to Section 3
Don't Know
5. To the best of your knowledge, how has the wild pig population changed (if at all) over the past three years in the county
reported in item 3 ?
xxx 1
2
3
4
5
6
7
Substantially increased
Somewhat increased
No real change
Somewhat decreased
Substantially decreased
Eliminated completely
Don't Know
6. During the last three years, have wild pigs been present on your operation?
107 1
3
2
Yes
No - Go to Item 8
Don't Know - Go to Item 8
7. To the best of your knowledge, how has the wild pig population changed (if at all) over the past three years on your
operation?
xxx 1
2
3
4
5
6
7
Substantially increased
Somewhat increased
No real change
Somewhat decreased
Substantially decreased
Eliminated completely
Don't Know
3
SECTION 1 - GENERAL (continued)
8. Which animals do you think have experienced a decline in population on this operation in the last three years that you
attribute to wild pigs? Check all that apply.
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
Deer
Pheasants and/or Quail
Waterfowl
Turkeys
Doves
Other
None of these
Don't know
9. The following questions are about things that you do, or allow other people to do on your property.
xxx
a.
Do you use feed to attract game animals, such as deer?...............................
b.
Do you hunt wild pigs, or allow others to hunt wild pigs, on your property?
Include recreational hunting such as aerial hunting, ground hunting, or
hunting with dogs...........................................................................................
1
Yes
3
No
1
Yes
3
No
1
Yes
3
No
1
Yes
3
No
xxx
xxx
c.
d.
Do you take measures, other than hunting, to control the presence of wild
pigs on your property?....................................................................................
Other than any crops on your land, are there any features on your property
that may serve as a safe haven or otherwise attract wild pigs? (For
example, a pond, river, forested area, and/or low-lying land.)........................
xxx
10. The following questions are about things that are done on properties surrounding your operation, not including your
property.
xxx
a. Do surrounding property owners nearby use feed to attract game
animals, such as deer?......................................................................................
3
No
2
Don't Know
3
No
2
Don't Know
3
No
2
Don't Know
xxx
d. Do surrounding properties take measures, other than hunting, to control
Yes
the presence of wild pigs on their property?...............................................................
1
3
No
2
Don't Know
xxx
e. Do surrounding property owners transport and release wild pigs on their
Yes
property?....................................................................................................................
1
3
No
2
Don't Know
xxx
Do surrounding property owners intentionally attract or provide a “safe
Yes
haven” for wild pigs on their property?.......................................................................
1
3
No
2
Don't Know
xxx
g. Are there public parks, wildlife refuges, or other public land nearby that
Yes
serve as a safe haven for wild pigs?..........................................................................
1
3
No
2
Don't Know
1
Yes
b. Do surrounding properties nearby employ farming or livestock ranching xxx
practices that may attract wild pigs, whether intentionally or
Yes
unintentionally? (For example, certain crops grown or livestock feed
1
supplements.).............................................................................................................
c. Do surrounding property owners hunt wild pigs, or allow others to hunt
xxx
wild pigs, on their property? Include recreational hunting such as aerial
Yes
hunting, ground hunting, or hunting with dogs............................................................
1
f.
4
SECTION 2 - PROPERTY
1. Please complete the following table regarding the damage to your property on this operation attributed to wild pigs in
2020.
None
If you did not have any wild pigs on your property in 2020, please mark this box and move to Section 3.
Damage Type
If you repaired
What was the
the damage
cost of materials
Did this type of damage
yourself, how
and the amount
occur on this operation
many hours did
paid for other
in 2020?
you spend
people's labor to
repairing the
repair the
damage?
damage?
166
1
3
a. Building damage
2
169
1
3
b. Fence damage
c. Livestock waterers,
water pumps, and/or
irrigation equipment
damage
2
172
1
3
2
175
d. Vehicle, tractor, and/or
farm equipment
damage
1
3
2
xxx
1
3
e. Residential property
damage
2
181
1
3
f. Road damage
g. Damage to storage for feed,
grain, and/or hay
2
184
1
3
2
195
3
h. Fecal contamination of
water
i. Damage to livestock
water sources
specifically from wild pig
wallowing (exclude fecal
contamination of water)
1
2
xxx
1
3
2
j. Damage to terraces,
187
stream banks, or ponds
(exclude wallowing or fecal
contamination)
189
1
3
2
1
3
k. Loss of wildlife habitat
and non-crop trees
2
191
1
3
l. Field topsoil erosion
2
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
167
How much damage occurred? Check one per row
Mild
Damage
168
Moderate
Damage
Severe
Damage
Unsure
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
$
170
171
$
173
174
$
176
177
$
xxx
xxx
$
182
183
$
185
186
$
xxx
196
$
xxx
xxx
xxx
$
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
xxx
188
$
xxx
190
$
xxx
$
192
5
SECTION 2 - PROPERTY (continued)
Damage Type
If you repaired
What was the
the damage
cost of materials
Did this type of damage
yourself, how
and the amount
occur on this operation
many hours did
paid for other
in 2020?
you spend
people's labor to
repairing the
repair the
damage?
damage?
193
1
3
m. Loss of trees
2
197
1
3
n. Fecal contamination of
crops
2
199
o. Other damage
1
3
2
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
Yes
No
Don't Know
xxx
xxx
How much damage occurred? Check one per row
Mild
Damage
Unsure
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
198
$
200
Severe
Damage
194
$
xxx
Moderate
Damage
201
$
(Specify:1007______________)
SECTION 3 - LIVESTOCK
1. Were any livestock raised on your operation in 2020?
1
□ Yes - Continue
3
□ No - Go to Section 3
108
2. How many of each of the following types of livestock were on your operation on December 31, 2020?
None
Head
109
□
a. Cattle and Calves (Beef)........................................................................................................................
XXX
□
b. Cattle and Calves (Dairy).......................................................................................................................
□ 110
c. Domestic Hogs and Pigs........................................................................................................................
□ 111
d. Sheep and Lambs..................................................................................................................................
□ 112
e. Goats and Kids.......................................................................................................................................
f.
□ 113
Poultry....................................................................................................................................................
□ 114
g. Horses, Ponies, and Mules.....................................................................................................................
□
h. Other livestock, specify: 1003______________________________________________________________________
115
3. How concerned are you about the potential spread of diseases from wild pigs to livestock? Check one only.
121 1
2
3
4
Not concerned
Slightly concerned
Moderatly concerned
Very concerned
6
SECTION 3 - LIVESTOCK (continued)
4. Did you have pasture on your operation in 2020?
xxx
1
□ Yes - Continue
3
□ No - Go to Item 10
Acres
xxx
a. How many acres of pasture were on your operation in 2020?........................................................................
b. In 2020, did you attribute damage on your pasture to wild pigs?
xxx
1
□ Yes - Continue 3□ No - Go to Item 10
Acres
xxx
c. How many acres of pasture were damaged by wild pigs in 2020?.................................................................
5. As a result of pasture acreage lost due to wild pigs, did you have to reduce your livestock stocking levels?
xxx
1
□ Yes - Continue
3
□ No - Go to Item 7
6. If yes, by how much did you have to reduce your livestock stocking levels due to pasture acreage lost?
xxx
1
2
3
4
5
Reduced by 100 to 76%
Reduced by 75 to 51%
Reduced by 50 to 26%
Reduced by 25 to 1%
Don't Know
7. Did you incur any costs or labor to repair the damage to your pasture from wild pigs?
xxx
1
□ Yes - Continue
3
□ No - Go to Item 8
Hours
xxx
a. How many hours of your own time did you spend repairing damage to your pasture from wild pigs
in 2020?..........................................................................................................................................................
Dollars
xxx
b. How much money did you spend on repairing damage to your pasture from wild pigs in 2020?
Examples of costs may be sod or seed, equipment purchased or rented for pasture repairs, or
hired labor. Do not include the value of the land damaged.............................................................................
8. As a result of pasture damaged by wild pigs, did you have to buy supplemental feed?
xxx
1
□ Yes - Continue
3
□ No - Go to Item 9
Dollars
xxx
a. How much money did you spend on supplemental feed as a result of pasture damaged by wild
pigs in 2020?..................................................................................................................................................
9. As a result of pasture damaged by wild pigs, was your livestock's weight impacted (for example, the livestock lost weight
or did not gain as much weight as expected)?
xxx
1
□ Yes
3
□ No
7
SECTION 3 - LIVESTOCK (continued)
10. Please report for up to two livestock raised in 2020 with the highest value of production in 2020.
Livestock with Highest Value of
Production
Unit
a.
b.
c.
In 2020, which livestock on
your operation produced the
highest value of production?
Report for up to two livestock.
Head
How many total head of this
livestock were sold?
Head
ii.
What was the average
price received (or
expected to be received)
per head for this
livestock sold in 2020?
Were these livestock
certified as organic?
122
123
124
125
126
127
128
129
Animal
How many head of this
livestock were on this
operation, on average, in
2020?
i.
Dollars
per head
___ ___/head
$
Code
Which type of facility is used
for the majority of this
livestock?
131
In 2020, which of the
following feed sources used
for these livestock on this
operation: Check all that
apply.
g.
h.
In 2020, how often did you
see evidence that wild pigs
entered areas where livestock
are kept?
Code
In 2020 was there evidence
that wild pigs entered or
gained access to
livestock feed, grain, or hay?
Acres
In 2020, was there evidence
that wild pigs had gained
access to any discarded
remains of this livestock?
Code
In 2020, how often did you
see evidence that wild pigs
wallowed in water sources
used by this operation?
Building with no outside access
Open building with outside access
3
Fenced area with or without shelter
3
Fenced area with or without shelter
4
Animals roam free with no fence
4
Animals roam free with no fence
xxx xxx
Home-raised sources
Home-raised sources
xxx
Purchased commercial feed
xxx
Purchased commercial feed
xxx
Slaughter by-products
xxx
Slaughter by-products
Non-meat Commercial food
waste (including restaurants)
xxx
Non-meat Commercial food
waste (including restaurants)
xxx
Table food waste
xxx
Table food waste
xxx
Crops in fields
xxx
Crops in fields
xxx
Wildlife carcasses
xxx
Wildlife carcasses
139 1
Daily
Daily
2
Weekly
2
Weekly
3
About once a month
3
About once a month
4
Less than once a month
4
Less than once a month
5
Never in 2020
5
Never in 2020
6
Don't Know
6
Don't Know
1
Yes
3
No
2
Don't Know
1
Yes
3
No
2
Don't Know
140
141
1
Yes
3
No
2
Don't Know
1
Yes
3
No
2
Don't Know
142
Code
No
2
143
xxx 1
i.
xxx 1
3
Open building with outside access
138 1
f.
Yes
1
2
xxx
Code
No
3
Building with no outside access
xxx xxx
e.
Yes
1
Code
___ ___/head
$
130
xxx 1
d.
Livestock with Second Highest Value of
Production
Daily
xxx 1
Daily
2
Weekly
2
Weekly
3
About once a month
3
About once a month
4
Less than once a month
4
Less than once a month
5
Never in 2020
5
Never in 2020
6
Don't Know
6
Don't Know
8
SECTION 3 - LIVESTOCK (continued)
Livestock with Highest Value of
Production
Unit
j.
In 2020 did you attribute any
livestock deaths on your
operation to predation by wild
pigs? (If Yes, continue. If No,
go to item k.)
i.
ii.
k.
In 2020, how many head
of these livestock were
lost to wild pig
predation?
What was the total
market value of these
livestock lost to wild pig
predation?
In 2020 did you attribute any
livestock deaths on your
operation to disease from
wild pigs? (If Yes, continue. If
No, go to item l.)
xxx
Code
ii.
iii.
l.
In 2020, which of these
livestock diseases did
you attribute to wild
pigs? Check all that
apply.
In 2020, how many head
of these livestock that
you lost to disease were
attributed to wild pigs?
What was the total
market value of these
livestock that were lost to
disease attributed to wild
pigs?
In 2020 did you attribute any
livestock deaths on your
operation to other causes of
wild pigs? (If Yes, continue. If
No, go to Item m.)
i.
ii.
Yes 3
No 2
Don't Know
144
___ ___ ___head
n.
___ ___ ___head
147
146
___ ___ ___ ___ ___ ___
$
xxx
Code
Yes 3
No 2
Don't Know
xxx xxx
No 2
Don't Know
Swine Brucellosis
xxx
Pseudorabies (Aujeszky's disease)
xxx
Pseudorabies (Aujeszky's disease)
xxx
Porcine Reproductive and
Respiratory Syndrome (PRRS)
xxx
Porcine Reproductive and
Respiratory Syndrome (PRRS)
xxx
Swine influenza
xxx
Swine influenza
xxx
Leptospirosis
xxx
Leptospirosis
xxx
Q fever
xxx
Q fever
xxx
Other/unknown disease
xxx
Other/unknown disease
xxx
Swine Brucellosis
xxx
Number
___ ___ ___head
Dollars
___ ___ ___head
xxx
xxx
$
$
___ ___ ___ ___ ___ ___
xxx
Code
Dollars
What was the total cost
of these services?
Yes 3
1
xxx
___ ___ ___ ___ ___ ___
xxx
Yes 3
1
No
Don't Know
2
xxx
Yes
1
___ ___ ___head
xxx
___ ___ ___ ___ ___ ___
xxx
Dollars
Yes
___ ___ ___ ___ ___ ___
$
3
1
Yes
3
No
xxx
___ ___ ___ ___ ___ ___
$
___ ___ ___ ___ ___ ___
$
xxx
1
$
___ ___ ___head
No
xxx
Dollars
Don't Know
2
xxx
1
Code
No
xxx
$
Code
3
xxx
Yes
3
No
xxx
i.
___ ___ ___ ___ ___ ___
$
xxx
1
Number
What was the total
market value of these
livestock?
In 2020, did you use any
medical treatments on
livestock due to the presence
of or contact with wild pigs?
Don't Know
Dollars
Number
What was the total cost
of these services?
No 2
145
xxx
i.
Yes 3
1
Number
In 2020, how many head
of these livestock were
lost to wild pigs due to
other/unknown causes?
m. In 2020, did you seek
veterinary services due to the
presence of or contact with
wild pigs?
xxx
1
xxx
i.
Livestock with Second Highest Value of
Production
1
Yes
3
No
xxx
___ ___ ___ ___ ___ ___
$
___ ___ ___ ___ ___ ___
9
SECTION 4 - CONTROL
1. Please answer below for your operation in 2020.
Organization, Group, or People
a. Federal, state, or county agency
b. University outreach services
c. Private company
d. Hunters (not including yourself)
e. Yourself or someone that lives on
your property
In 2020, did someone from the group
listed in the first column come to this
operation to assist with reducing or
preventing damage from wild pigs?
In 2020, how
many days did
someone from
this group come
to this operation
to help you
reduce or prevent
damage from wild
pigs?
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
1
Yes
3
No
1
Yes
3
No
1
Yes
3
No
1
Yes
3
No
1
Yes
3
No
xxx
xxx
xxx
xxx
In 2020, on
average, how
many people
from this group
came to your
operation?
2. Please list the agencies, universities, or private companies that you reported in Item 1a, 1b, or 1c.
1010
__________________________________________________________________________________________________________________________
1011
__________________________________________________________________________________________________________________________
10
SECTION 4 - CONTROL (continued)
3. Please fill out the table below, regarding methods that were used on your property to reduce or prevent damage from
wild pigs.
Control Method
a. Shooting wild pigs on sight
b. Hunting wild pigs with dogs
c. Hunting wild pigs without dogs
d. Aerial hunting
e. Trapping wild pigs
How
much was
spent on
How
materials
many
and/or
Was this
unpaid services,
method
hours of including
used on the
your time paid labor
operation in
was
for
2020?
spent in yourself
2020?
and
others, in
2020?
(Dollars)
203
206
209
212
215
f. Repellents for wild pigs
(excluding poison)
218
g. Other, excluding fencing
(Specify 1008____________)
221
□ Yes
3□ No
1□ Yes
3□ No
1□ Yes
3□ No
1□ Yes
3□ No
1□ Yes
3□ No
1□ Yes
3□ No
1□ Yes
3□ No
1
xxx
xxx
How effective was the control method?
Check one per row
Not
Effective
205
$
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
xxx
$
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
1
□
2
□
3
□
4
□
220
$
xxx
□
217
$
xxx
2
214
$
xxx
□
211
$
Moderately
Very
Effective Effective
1
208
$
Slightly
Effective
223
11
SECTION 4 - CONTROL (continued)
5. In 2020, did you use electric fencing on your operation for the primary purpose of reducing damage by wild pigs?
1
□ Yes - Continue
3
□ No - Go to Item 6
224
Year
a. In what year did you install the electric fencing?.....................................................................................
xxx
Dollars
225
b. Approximately how much did it cost to install this electric fencing (including material and labor)?.........
Years
c. At the time of installation, how many years was the expected useful life of this electric fencing?...........
226
6. In 2020, did you use non-electric fencing on your operation for the primary purpose of reducing damage by wild pigs?
1
□ Yes - Continue
3
□ No - Go to Item 7
227
Year
a. In what year did you install the non-electric fencing?...........................................................................
xxx
Dollars
b. Approximately how much did it cost to install this non-electric fencing (including material and
labor)?...................................................................................................................................................
228
Years
c. At the time of installation, how many years was the expected useful life of this non-electric fencing?.
229
None
7. In 2020, how many wild pigs were killed on your operation?.......................................................
□
Head
230
None
8. In 2020, how many live wild pigs were removed from your operation?.......................................
□
Head
231
[If Item 8 is zero, go to Item 9; otherwise continue]
a. Of the (Item 8) live wild pigs removed from your operation in 2020, were any sold?
1
□ Yes - Continue
3
□ No - Go to Item 9
272
Dollars/Head
b. What was average price per head you received for the live wild pigs removed from your operation in
2020?.....................................................................................................................................................
233
$
12
SECTION 4 - CONTROL (continued)
9. In 2020, did you take measures to limit the introduction and spread of infectious diseases on your operation?
xxx
1
□ Yes - Continue
3
□ No - Go to Item 10
a. Which of the following measures did you take to limit the introduction and/or spread of infectious diseases on your
operation?
xxx
1
□ Limiting visitors
2
□ Restricting access to livestock and poultry
3
□ Keeping food storage area or water sources inaccessible to wildlife
4
□ Cleaning equipment, shoes, and clothing
5
□ Other, specify___________________________________________________________________________
b. In 2020, did you increase these measures in response to disease findings in wild pigs reported in your areas?
xxx
1
□ Yes
3
□ No
10. If the federal and/or state governments approved a toxic bait to control wild pigs, would you use it on your land?
xxx
1
□ Definitely not
2
□ Probably not
3
□ Possibly
4
□ Probably
5
□ Definitely
13
SECTION 5 - HUNTING
1. In 2020, did you or anyone else hunt on your operation?
235 1
3
2
Yes - Continue
No - Go to Section 6
Don't Know - Go to Section 6
2. Please answer the following items regarding hunting of wildlife on your operation in 2020. Check all that apply.
Hunting
None
a. Which animals did you or your
immediate family hunt on your
operation in 2020?
xxx
b. Which animals did anyone other than
your immediate family hunt on your
operation in 2020 without paying?
xxx
c. Which animals did anyone pay to be
allowed to hunt on your operation in
2020?(Exclude guide or outfitting
services that you provided)
xxx
d. For which animals did you provide a
guide or outfitting service to paying
hunters on your operation in 2020?
xxx
Wild
Pigs
236
□
237
□
242
□
□
□
□
xxx
243
248
□
□
□
□
□
□
3. During 2020, what was your net income from:
□
241
xxx
258
Other
241
xxx
252
257
□
□
□
□
xxx
246
251
xxx
□
□
□
□
240
245
xxx
255
□
□
□
□
239
xxx
249
254
□
Deer
Pheasants
and/or
Quail
Waterfowl Turkeys Doves
□
253
□
xxx
□
□
259
□
None
Dollars
a. Wild pig hunting on your operation?.............................................................................................
□
265
b. All other hunting activities on your operation?..............................................................................
□
266
□
14
SECTION 6 - DEMOGRAPHICS
Years
1. What was your age on December 31, 2020?..............................................................................................
267
2. What is your gender?
278 1
3
Male
Female
3. At which occupation did you spend the majority of your work time in 2020?
279 1
Farm or ranch work
Other
2
4. Do you make the majority of the decisions about farming/ranching for your operation?
280 1
Yes
No
3
5. Are you a hired manager for this operation?
281 1
Yes
No
3
6. Do you currently live on this operation?
282 1
Yes
No
3
Year
(YYYY)
7. In what year did you begin to make day-to-day decisions for a farm or ranch operation?..........................
283
8. In 2020, what was your total household income before taxes, including farm and non-farm income? Check only one.
284
4□
Less than $10,000
$10,000 to $24,999
6□ $25,000 to $49,999
7□ $50,000 to $99,999
8□ $100,000 to $249,999
9□ $250,000 to $499,999
10□ $500,000 to $999,999
11□ $1,000,000 or more
5□
9. In 2020, what percent of your total household income came from farming and/or ranching? Check only one.
285 1□
None
1% to 25%
3□ 26% to 50%
4□ 51% to 75%
5□ 76% to 99%
6□ 100%
2□
15
Skip to next page
OR
Space for Notes and Comments
16
SECTION 7 - CONCLUSION
Operation Email
Operation Phone:
9937
9936
check if
cell phone
_______________________________________________
(
)
________________________________________________
Respondent Name:
Respondent Phone (if different from above)
9912
9911
____________________________________________(
check if
cell phone
)
MM
9910
Date:
______________________________
DD
YY
__ __ __ __ __ __
Thank you for your time. Please return this questionnaire in the enclosed envelope.
OFFICE USE ONLY
Response
1-Comp
9901
2-R
3-Inac
4-Office Hold
5-R – Est
6-Inac – Est
7-Off Hold – Est
S/E Name
Respondent
1-Op/Mgr
2-Spouse
3-Acct/Bkpr
4-Partner
9-Other
9902
Mode
1-PASI (Mail)
2-PATI (Tel)
3-PAPI (Face-toFace)
6-Email
7-Fax
19-Other
Enum.
9903
9998
Eval.
9900
Change
9985
Office Use for POID
9989
__ __ __ - __ __ __ - __ __ __
R. Unit
9921
Optional Use
9907
9908
9906
9916
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2021-03-24 |