Survey ID: 1241 2023 Fruit Chemical Use Survey (US Version) - Rev July 2

Agricultural Resource Management Phase 1 & 2 and Chemical Use Surveys

0218 - 2023 Fruit Chemical Use Survey - US Version - Draft - 07-05-2023

OMB: 0535-0218

Document [pdf]
Download: pdf | pdf
2023 FRUIT CHEMICAL USE SURVEY
OMB No. 0535-0218
Approval Expires: 6/30/2026
Project Code: 141
SurveyID: 1241

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: 855-415-3687
Email: [email protected]

ENTERPRISE
VERSION
01

POID
___ ___ ___ ___ ___ ___ ___ ___ ___

SUBTRACT
___ ___
CONTACT RECORD

DATE

TIME

NOTES

The information you provide will be used for statistical purposes only. Your response 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 0535-0218. The time required to
complete this information collection is estimated to average 45 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]........................................................................................................

H H M M
004
___ ___ ___ ___

☐ Name, address, and partners verified and updated if necessary.
1. During 2023, were any crops, including new
plantings, livestock or poultry on the total acres
operated? EXCLUDE crops produced by a tenant if
☐ Yes – [Go to item 1, page 2]
target operator is landlord only.

☐ No – [Continue]

2. During 2023, did this operation sell any agricultural
products or receive government agricultural
payments? EXCLUDE crops produced by a tenant if
☐ Yes – [Go to item 1, page 2]
target operator is landlord only.

☐ No – [Continue]

3. During 2023, were any crops stored on the total
acres operated? EXCLUDE crops produced by a
tenant if target operator is landlord only.

☐ Yes – [Go to item 1, page 2]

☐ No – [Continue]

4. During 2023, did this operation have any fruit acres
which were operated by a management firm?

☐ Yes – [Go to item 1, page 2]

☐ No – [Go to page 4]

2

SCREENING
1. Did this operation have any of the target crops during the 2023 crop year? [See page 3 for target crops.]
Yes – [Continue]
No – [Write notes explaining the situation then go to "Conclusion" on back page.]

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]
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

Partners: POID ___ ___ ___ ___ ___ ___ ___ ___ ___

Partners: POID ___ ___ ___ ___ ___ ___ ___ ___ ___

PARTNER NAME

PARTNER NAME

ADDRESS

ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

CITY

STATE

ZIP

Partners: POID ___ ___ ___ ___ ___ ___ ___ ___ ___

POID ___ ___ ___ ___ ___ ___ ___ ___ ___

PARTNER NAME

PARTNER NAME

ADDRESS

ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

CITY

STATE

ZIP

PHONE NUMBER

PHONE NUMBER

3

TARGET CROPS & CODES

FLORIDA

NEW YORK

320

Grapefruit

301

Apples

335

Oranges, All

314

Cherries, Tart

748

Strawberries

349

Tangerines/Tangelos

SOUTH CAROLINA
340

TEXAS
NORTH CAROLINA
309

320

Blueberries

340

Peaches

MICHIGAN
301

Apples

309

Blueberries

314

Cherries, Tart

340

Peaches

NEW JERSEY
309

Blueberries

340

Peaches

Grapefruit

Blueberries

GEORGIA
309

Peaches

WASHINGTON
OREGON

301

Apples

301

Apples

309

Blueberries

309

Blueberries

312

Cherries, Sweet

312

Cherries, Sweet

314

Cherries, Tart

520

Pears

624

Grapes, Wine

520

Pears

345

Raspberries

PENNSYLVANIA
301

Apples

340

Peaches

4

CHANGE IN OPERATOR STATUS
[Enumerator Note: Skip this section if there is no change in operation name or operator.]
Code
Yes=1 023

No=3
1. Has there been a change in operation name or operator?..................................................................

[If item 1 = 1, complete name and address information below for new operator and continue.
If item 1 = 3, go to Enumerator Note below.]

Operation Name _____________________________
Operator Name ______________________________
Address ___________________________________
__________________________________________
Phone (________)____________________________
[Enumerator Note: If the operation on the face page was in business part of the 2023 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]

5

A

LAND OPERATED

A

Acres Operated
1. How many acres does this operation—

Acres
901

+
a. own?...........................................................................................................................................

.___

902
b. rent or lease from others or use rent free? EXCLUDE land used on an animal unit
+
month (AUM) basis......................................................................................................................

.___

905

–
c. rent to others?.............................................................................................................................
=
2. Then the total acres operated are: [item 1a + 1b – 1c]................................................................

.___

900

.___

a. Does this include the farmstead, all cropland, woodland, pastureland, wasteland, and
government program land?
Yes – [Continue]
No – [Make corrections, then continue.]
The remaining questions in this survey refer to these [item 2] acres.
802

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

.___

INCLUDE
· land in hay
· summer fallow
· cropland idle
· cropland used for pasture
· cropland in government programs
803
4. Of the total acres operated, how many acres are in fruit? INCLUDE bearing and non–
bearing acreage in trees, vineyards, and bushes.............................................................................

.___

6

B

FRUIT ACREAGE

B

1. What target fruit crops were on these [Section A, item 4] acres during
the 2023 crop year?

Table
001
Office Use
Lines in Table

EXCLUDE
· new plantings
· other plantings which are not yet bearing
1

2

3

Crop

Crop Code

Acres
11

01
11
02
11
03
11
04
11
05
11
06
11
07
11
08
11
09
11
10
11
11
11
12
11
13
11
14
11
15

Notes:

4

How many
bearing acres of
[crop] did this
operation have?

L
I
N
E

Line 99

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

5

Were any
Were any herbicides,
commercial
insecticides,
fertilizers applied fungicides, etc. applied
to this crop?
to this crop?
Yes = 1
Yes = 1
No = 3
No = 3
12

199

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

12

13

INCLUDE
· Target Crops Only
· All commercial bearing
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.
· Bearing acreage not harvested
due to weather, economic or
other reasons.
· Crops planted in the fall of
2022 if they were part of the
2023 crop.
EXCLUDE
· All crops grown in another
state.
· Non–commercial orchard and
vineyard acreage (home
garden).
· Non–target fruit.
· New plantings and other
plantings which are not yet
bearing.
· All target crops grown by
institutional, experimental,
research and university farms
(abnormal farms).
· Abandoned orchards and
vineyards.

7

C

FERTILIZER APPLICATIONS

C

Enumerator Note—
If column 4 of the table in Section B is Yes for any crops, continue with item 1.
If column 4 of the table in Section B is No for all crops, go to Section D.
1. I need to record complete information on all commercial fertilizers applied to the bearing
acres of target fruit grown during the 2023 crop year. INCLUDE all applications regardless
of how they were applied such as irrigation water, foliar applications, etc. Record amount
of an analysis of fertilizers applied or pounds of actual plant nutrients applied. Complete
the table below and any necessary supplemental fertilizer tables. EXCLUDE
micronutrients, lime, and gypsum.
Office Use
Lines in Table
1

2

L
I
N
E

Crop

Crop Code

3

4

5

6

7

N
I
T
R
O
G
E
N

P
H
O
S
P
H
A
T
E

P
O
T
A
S
H

S
U
L
F
U
R

How much was
applied per acre
per application?

N

P2O5

K2 O

S

01

31

32

33

34

36

02

31

32

33

34

36

03

31

32

33

34

36

04

31

32

33

34

36

05

31

32

33

34

36

06

31

32

33

34

36

07

31

32

33

34

36

08

31

32

33

34

36

09

31

32

33

34

36

10

31

32

33

34

36

11

31

32

33

34

36

12

31

32

33

34

36

13

31

32

33

34

36

14

31

32

33

34

36

15

31

32

33

34

36

16

31

23

33

34

36

17

31

32

33

34

36

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

200

Table
001

299

8

9

10

Unit Codes

How many acres
was this applied
to? [Include
bearing acres
only]

How many
times was it
applied?

Acres

Number

1 Pounds
12 Gallons
13 Quarts
15 Liquid Oz.
28 Dry Oz.
19 Actual
Nutrients

[Leave this column
blank if actual
nutrients were
reported.]

Office Use

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41

8

C

FERTILIZER APPLICATIONS
1

2

L
I
N
E

Crop

Crop Code

C

3

4

5

6

7

8

9

10

N
I
T
R
O
G
E
N

P
H
O
S
P
H
A
T
E

P
O
T
A
S
H

S
U
L
F
U
R

How much was
applied per acre
per application?

Unit Codes

How many acres
was this applied
to? [INCLUDE
bearing acres
only]

How many
times was it
applied?

N

P2O5

K2 O

1 Pounds
12 Gallons
13 Quarts
15 Liquid Oz.
28 Dry Oz.
19 Actual
Nutrients

[Leave this column
blank if actual
nutrients were
reported.]

S

Acres

18

31

32

33

34

36

19

31

32

33

34

36

20

31

32

33

34

36

21

31

32

33

34

36

22

31

32

33

34

36

23

31

32

33

34

36

24

31

32

33

34

36

25

31

32

33

34

36

26

31

32

33

34

36

27

31

32

33

34

36

28

31

32

33

34

36

29

31

32

33

34

36

30

31

32

33

34

36

31

31

32

33

34

36

32

31

32

33

34

36

33

31

23

33

34

36

34

31

32

33

34

36

35

31

32

33

34

36

36

31

32

33

34

36

37

31

32

33

34

36

38

31

32

33

34

36

39

31

32

33

34

36

40

31

32

33

34

36

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

37

40

Number

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41
41

9

D

PESTICIDE APPLICATIONS

D

Now I have some questions about pesticide and chemical applications to your bearing fruit acreage before
harvest. Please consider all applications made to trees, vineyards or bushes which occurred after last season's
harvest.

1. Since last year's (2022) harvest, did you use herbicides on any of your bearing fruit
☐ Yes
acreage?.........................................................................................................................................

☐ No

2. Since last year's (2022) harvest, did you use insecticides, nematicides, or miticide on any of
☐ Yes
your bearing fruit acreage?.............................................................................................................

☐ No

3. Since last year's (2022) harvest, did you use any fungicides on any of your bearing fruit
☐ Yes
acreage?.........................................................................................................................................

☐ No

4. Since last year's (2022) harvest, did you use any other chemicals such as chemical
thinners, growth regulators, microbial agents, pheromones, rodenticides, etc. on any of your
☐ Yes
bearing fruit acreage?.....................................................................................................................

☐ No

[Enumerator Action: If all items 1 – 4 are No, go to Section E, page 12, otherwise continue.]

10

D

PESTICIDE APPLICATIONS

D

[Enumerator Action: If pesticides were reported in Section B, column 5, continue. Otherwise, go to Section E.]
5. 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 2023 crop year to each of the target fruit crops you grew. Let's start
with the first application to your crop since the 2022 crop year harvest.
INCLUDE the table for all chemical applications to the target fruit crops. Use supplemental tables if
necessary.
INCLUDE herbicides, insecticides, nematicides, miticide fungicides, chemical thinners, growth regulators,
microbial agents, pheromones, rodenticides, and soil fumigants.
EXCLUDE seed treatments, foliar applications of nutrients, and applications made to fruit after harvest.
Office Use
Lines in Table
1

Chemical
Product Name

L
I
N
E

2

3
What products were
applied to the [crop]?

Crop

Crop Code

[Enter product code.]

399

Table
001

4
Was this product bought
in liquid or dry form?
[Enter L or D.]

5
Was this part of a
tank mix?
[If tank mix, enter
line number of first
product in mix.]

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15

[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.

11

D

PESTICIDE APPLICATIONS

D

Codes for Column 8
30 Grams
40 Kilograms
41 Liters
46 Spirals
47 Packets
50 Other
(Specify:___________)

1 Pounds
12 Gallons
13 Quarts
14 Pints
15 Ounces, Liquid
28 Ounces, Dry
6
L
I
N
E

OR

7

How much was applied
per acre per
application?

What was the total
amount applied per
application?

65
65
02
65
03
65
04
65
05
65
06
65
07
65
08
65
09
65
10
65
11
65
12
65
13
65
14
65
15

.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___

73
73
73
73
73
73
73
73
73
73
73
73
73
73
73

.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___

300

8

9

10

11

[Enter
unit code
from above.]

What percent of the rows
were covered with an
airblast application?

How many acres were
treated with this product?
[INCLUDE bearing acres
only.]

How many times
was this product
applied?

Bearing Acres

Number

Code
01

Office Use

100 All Rows
50 Every Other Row
-- Other

Percent

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

79
79
79
79
79
79
79
79
79
79
79
79
79
79
79

[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.

12

D

PESTICIDE APPLICATIONS

1

Chemical
Product Name

L
I
N
E

Crop

2

Crop Code

D

3

4

What products were
applied to the [crop]?

Was this product bought in
liquid or dry form?

[Enter product code.]

[Enter L or D.]

5
Was this part of a
tank mix?
[If tank mix, enter line
number of first
product in mix.]

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

61

63

16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

[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.

13

D

PESTICIDE APPLICATIONS

D

Codes for Column 8
1 Pounds
12 Gallons
13 Quarts
14 Pints
15 Ounces, Liquid
28 Ounces, Dry

L
I
N
E

6
OR
How much was applied
per acre per
application?

7
What was the total
amount applied per
application?

30 Grams
40 Kilograms
41 Liters
46 Spirals
47 Packets
50 Other (Specify:___________)
8
9
10
11
[Enter
What percent of the rows
How many acres were How many times was
unit code from were covered with an
treated with this product? this product applied?
above.]
airblast application?
[INCLUDE bearing acres
only.]
100 All Rows
Code

65
16
65
17
65
18
65
19
65
20
65
21
65
22
65
23
65
24
65
25
65
26
65
27
65
28
65
29
65
30
65
31
65
32
65
33

.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___

73
73
73
73
73
73
73
73
73
73
73
73
73
73
73
73
73
73

.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___
.___ ___

50 Every Other Row
-- Other

Bearing Acres

Percent

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

74

75

77

Number

.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___
.___

79
79
79
79
79
79
79
79
79
79
79
79
79
79
79
79
79
79

[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.

14

E

PEST MANAGEMENT PRACTICES

E

Now I have some questions about pest management practices you may have used on any of the total fruit acres
on this operation. INCLUDE bearing and non-bearing acreage of both target and non-target fruit 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]
Code

1. Was weather data used to assist in determining either the need or when to make
Yes=1
pesticide applications?............................................................................................................No=3
2. Were any biological pesticides such as Bt (Bacillus thuringiensis), insect growth
regulators, such as Courier, Intrepid, etc., Neem or other natural/biological based
Yes=1
products sprayed or applied to manage pests?.......................................................................
No=3
3. Were pesticides with different mechanisms of action rotated or tank mixed for the
Yes=1
primary purpose of keeping pests from becoming resistant to pesticides?.............................No=3

600

601

602

1 By deliberately going to the fruit acres specifically
for scouting activities. [Enter code 1 and go to
item 5.]

4. In 2023, how were your fruit acres
2 By conducting general observations while
primarily scouted for insects, weeds,
performing routine tasks. [Enter code 2 and go to
diseases, and/or beneficial organisms?......... item 7.]

Code
608
...........

3 The fruit acres were not scouted. [Enter code 3
and go to item 10.]

Code

5. Was an established scouting process used such as systemic sampling, recording
Yes=1
counts, insect traps, etc., on any fruit acres?..........................................................................No=3

609

6. Was scouting for pests done on these fruit acres due to—

Code
Yes=1

610

a. a pest advisory warning?.........................................................................................................
No=3
b. a pest development

Yes=1
model?....................................................................................................
No=3

611

[If column 1 is Yes, ask—]
Who did the majority of the scouting for column 1?

7. Were your fruit acres scouted for —
Yes = 1
No = 3

1
2
3
4

612

614

615

617

618

620

a. weeds?............................................................
b. insects or mites?.............................................
c. disease?..........................................................

Operator, partner or family member
An employee
Farm supply or chemical dealer
Independent crop consultant or commercial scout

15

E

PEST MANAGEMENT PRACTICES

E
Code

8. Were written or electronic records kept to track the activity or numbers of weeds,
Yes=1
insects or diseases?...............................................................................................................No=3

623

9. Was scouting data compared to published information on infestation thresholds to
Yes=1
determine when to take measures to manage pests?............................................................No=3

624

10. Was field mapping data used for making pest management

Yes=1
decisions?...............................No=3

625

11. Were the services of a diagnostic laboratory used for pest identification or soil or plant Yes=1
tissue pest analysis?..............................................................................................................No=3

626

12. Were crop residues, including drops, rotting fruit and/or debris, removed to manage
Yes=1
pests?.....................................................................................................................................No=3

627

13. Were ground covers, mulches, or other physical barriers maintained to manage pest
Yes=1
problems?...............................................................................................................................No=3

629

14. Were any beneficial organisms such as insects, nematodes, or fungi applied or
released to manage pests?

636

Yes=1
No=3

15. Were floral lures, attractant repellants, pheromone traps or other biological pest
Yes=1
controls used on any fruit acres?...........................................................................................No=3
16. Were any fruit acres cultivated for weed control during the growing

Yes=1
season?.......................No=3

637

640

17. Were field edges, lanes, ditches, roadways or fence lines chopped, mowed, plowed, or Yes=1
burned to manage pests on any fruit acres?..........................................................................No=3

642

18. Were equipment and implements cleaned after completing field work to reduce the
Yes=1
spread of pests?.....................................................................................................................No=3

643

19. Were any fruit acres irrigated for the 2023

Yes=1
crop?...................................................................No=3

644

[If item 19 = Yes, ask—]
a. Were water management practices, excluding chemigation, such as irrigation
scheduling, controlled drainage, or treatment of retention water used to manage
Yes=1
pests?.....................................................................................................................................
No=3

645

COMPLETION CODE for PEST
MANAGEMENT PRACTICES
1 Incomp/R

500

16

CONCLUSION
[Enumerator Note: Thank the respondent, then review this questionnaire.]
Office Use Only
Ending Time (Military)
Hours

OR

Total Hours

Minutes

0005

Hours

Minutes

0008

1. Ending time................................................................

Record Use

Code

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

Yes=1
No=3

064

Supplement Use
[Record the total number of supplements used to complete this interview.]
Number
068

Pesticide Supplements................................................................................................................
Contact Information
Operator Email:

Operator Phone:

9929

9917
Check to receive
results by email

9918

☐

(

Operation Email: (if different from above)

check if
cell phone

☐

) _____________________

Operation Phone: (if different from above)

9937

9920
Check to receive
results by email

9936

☐

(

check if
cell phone

Respondent Name:

Respondent Phone (if different from above)

9912

9911

_________________________________________
___

(

check if 9910
cell phone
) _____________________

☐

) _____________________

☐

MM

Date:

__ __

DD

YY

__ __ __ __

This completes the survey. The results will be available on the release date at nass.usda.gov/results
Thank you for your help.

OFFICE USE
R. Unit

Ptr 1 Str

9921

9922

9923

Response
1-Comp
2-R
3-Inac
4-Office Hold

Ptr 2 Str

Ptr 3 Str
9927

Respondent
9901

1-Op/Mgr
2-Spouse
3-Acct/Bkpr
4-Partner
9-Other

9902

Ptr 4 Str
9928

OPS
923

SSO 1
9907

Mode
2-PATI (tel)
3-PAPI (Face-toFace)

ADJ
922

9906

Enum.
9903

9998

Optional Use
9916

POID
9989
___ ___ ___ ___ ___ ___ ___ ___ ___
Eval.
9900

Change
9985


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