Document
Project 171 QID 051050
ICR 202606-0535-001 · OMB 0535-0003 · Object 169453100.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Project 171 QID 051050 |
| Author | WILSCH |
| Last Modified By | Writer |
| File Modified | 2023-05-23 |
| File Created | 2026-06-17 |
| Conversion State | complete |
Extracted Text
PRICES PAID - SCREENER OMB No. 0535-0003 Approval Expires: xx/xx/20xx Project Code: 171 QID: 050801 NATIONAL AGRICULTURAL STATISTICS SERVICE 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 E-mail: [email protected] Please make corrections to name, address and ZIP Code, if necessary. 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 control number is 0535-0003. 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. Please mail your report promptly in the enclosed postage paid envelope. Thank you for your cooperation. Fuel 1. Does this operation sell Fuel to farmers in the U.S.? Yes. What was the total value of fuel sales for last year? $ __________ No. Go to Item 2. Feed 2 Does this operation sell Feed to farmers in the U.S.? Yes What was the total value of feed sales for last year? $ ___________ No. Got to Item 3 Seed 3 Does this operation sell Seed to farmers in the U.S.? Yes What was the total value of seed sales for last year? $ ____________ No. Go to Item 4 OVER Fertilizer and Chemicals 4 Does this operation sell Fertilizers or Agricultural Chemicals to farmers in the U.S.? Yes. What was the total value of fertilizer and chemical sales for last year? $ ____________ No. Go to Item 5 Tractors and Farm Machinery 5 Does this operation sell NEW tractors or farm machinery to farmers in the U.S.? Yes. What was the total value of new tractors and farm machinery sales for last year $ _________ No. Go to Item 6 Type of Operation 6 Does this business operate at a single location or multiple locations? One location. Multiple locations. Multiple Locations. Please complete the following information if you operate at multiple locations. List all addresses where this operation does business. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Considering all the locations listed, how would you prefer to report? Contact each site individually. Headquarters reports for all locations on one report. Contact: ___________________________ Headquarters reports for all locations on separate reports. Contact: ___________________________ Reported by: _______________________ Date______________ Phone: (______) ______ - ___________