Agricultural Coverage Evaluation Survey Screening Form - Version A

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2027 AGRICULTURAL COVERAGE EVALUATION SURVEY AREA SCREENING FORM - VERSION A
OMB No. 0535-0213
Approval Expires: 5/31/20##
Project Code: 655
Survey ID: 3942

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]
Website: agcounts.usda.gov
AZ, CA, CO, ID, MT, NV, ND, OR, SD, UT,
WA, WY

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 Agricultural Coverage Evaluation 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 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.
The area of land shown on this photo (map) has been selected for this survey.
[Refer respondent to photo or map. Provide segment boundaries, houses and other identifying landmarks to help the respondent become
familiar with the segment.]
1. In 2027, did you live or operate land inside these colored segment 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 colored segment lines?
[Verify or draw tract boundaries in blue, then continue with page 3.]

3. Was any land inside these colored segment lines administered or controlled by a public agency, industrial corporation, or grazing
association for use on a fee per head or animal unit month (AUM) basis?

□ Yes - [Correct boundaries and assign a separate tract code to the PIGA land, then go to page 2.]
□ No - [Go to page 2.]

5

6

T
R L
A E
C T Line 1 – Full Name (First, Middle, Last)
T T Line 2 – Mailing Address
Line 3 – City, State, ZIP Code
E
Line 4 – Telephone Number
R

7

8

9

_____________________________________________________

Address:
_____________________________________________________

Has this
On the total
operation
acres
owned or
operated in
raised any hogs
2027, are any
or pigs
crops now
in the past
in storage
12 months, or
or will there
does it expect
be any crops
to own or raise
stored
any this
before
year?
June 1, 2028?

□ Yes –
Enter acres in
col.21
and conclude
interview.

_____________________________________________________

Phone: (_______) ________-___________________________ □ No
Name:
_____________________________________________________

Address:
_____________________________________________________

□ Yes –
Enter acres in
col.21
and conclude
interview.

_____________________________________________________

Phone: (_______) ________-___________________________ □ No
Name:
_____________________________________________________

Address:
_____________________________________________________

□ Yes –
Enter acres in
col.21
and conclude
interview.

_____________________________________________________

Phone: (_______) ________-___________________________ □ No
Name:
_____________________________________________________

Address:
_____________________________________________________

□ Yes –
Enter acres in
col.21
and conclude
interview.

_____________________________________________________

Phone: (_______) ________-___________________________ □ No
Name:
_____________________________________________________

Address:
_____________________________________________________

□ Yes –
Enter acres in
col.21
and conclude
interview.

_____________________________________________________

Phone: (_______) ________-___________________________ □ No
Name:
_____________________________________________________

Address:
_____________________________________________________

11

On the total
On the total
acres
acres operated
operated in
Is this tract
in 2027, have
2027, have
Public,
there been or will you sold or will
Industrial, or
you sell
there be
any crops grown,
Grazing
agricultural
hay cut,
Association
products or
land used on livestock, poultry,
receive
honey bees or
an AUM
government
aquaculture
basis?
payments
raised
this
this year?

year?

Name:

10

□ Yes –
Enter acres in
col.21
and conclude
interview.

_____________________________________________________

Phone: (_______) ________-___________________________ □ 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

□ 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

□ 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

□ DK – Go to

□ DK – Go to

□ DK – Go to

□ DK – Go to

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

12

13

14

15

Excluding
Excluding
Has this
In 2027,
home use,
home use,
operation
were there
have there
have there
owned or
any horses,
been or
been or will
custom fed
ponies, or
will there be
there be any
any sheep or other equine,
any nursery,
vegetables,
goats since
regardless of
greenhouse,
melons, fruit,
January 1, or ownership, on
floriculture,
nuts or berries
does it expect
the total
sod, cut
grown on this
to own or
acres
Christmas trees
operation
custom feed
operated?
or other woody
this year?
any this year?
crops grown on

16
In 2027, did
this operation
have any idle
cropland or
more than 99
acres of
pasture?

this operation
this year?

17

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

□ No

O
F
U
F
S
I
E
C
E

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

□ No

Questionnaire

Questionnaire

Questionnaire

__ __

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

□ No

Questionnaire

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

□ No

Questionnaire

Questionnaire

Questionnaire

__ __

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

□ No

Questionnaire

Questionnaire

Questionnaire

846

Questionnaire

Questionnaire

Questionnaire

Questionnaire

□ No

□ No

□ No

□ No

□ No

783

849

LAND USE

□ YES = 1
□ DK = 2
□ NO = 3

00

•
846

818

783

849

•
LAND USE

□ YES = 1
□ DK = 2
□ NO = 3

00

•
846

818

783

849

•

□ YES = 1
□ DK = 2
□ NO = 3
•
846

818

783

849

•

00

A - 01
B - 02
C - 03
D - 04
E - 05
F - 06
G - 07
H - 08
I - 09
J - 10
K - 11
L - 12
M - 13
N - 14
O - 15
P - 16
Q - 17
R - 18
S - 19
T - 20
U - 21
V - 22
W - 23
X - 24
Y - 25
Z - 26
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...

LAND USE

00

__ __
Questionnaire

818
•

Questionnaire

□ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to

849

•

□ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to
Questionnaire

783

□ YES = 1
□ DK = 2
□ NO = 3

00

__ __
Questionnaire

818

LAND USE

Questionnaire

□ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to

849

•

□ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to
Questionnaire

783

□ YES = 1
□ DK = 2
□ NO = 3
846

__ __
Questionnaire

818

LAND USE

Questionnaire

□ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to

Enter code

•

□ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to
Questionnaire

Enter acres

Questionnaire

□ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to

Questionnaire

Enter code

00

__ __

Questionnaire

Enter acres and
land use, then
continue

•

□ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to
Questionnaire

PIGA
Acres of
Public,
Industrial,
or
Grazing
Association
land used
on AUM
basis.

Questionnaire

□ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to

21

What best
describes this
nonagricultural
tract?

846

□ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to
Questionnaire

20a

How many
Does this tract
acres are inside have potential
for agriculture
the colored
before
segment
2028?
lines?

Questionnaire

□ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to □ DK – Go to

20

NON-AGRICULTURAL TRACTS

□ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to
Questionnaire

18

LAND USE

□ YES = 1
□ DK = 2
□ NO = 3
•

[Complete these items 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 ACES Version questionnaires completed...................................................................
4. Number of tracts with acreage listed in Column 18, page 3........................................................+
5. Number of tracts with acreage listed in Column 21, page 3........................................................+
6. Total of items 3 + 4 + 5..................................................................................................................=

5326

(Item 6 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.]

PIGA Tract Acres

Codes to be used in Column 20a are:
(1) Residential

________________________________________________________ (2) Woods
________________________________________________________ (3) Idle Open Land (Not Idle Cropland.)
________________________________________________________ (4) Pasture (Not Hayed or Grazed.)
________________________________________________________ (5) Water
________________________________________________________ (6) Reported Non-Ag by Respondent
________________________________________________________ (7) Vacant Houses
________________________________________________________ (8) Obvious Non-Ag
________________________________________________________ (9) Grassland (Not Hayed or Grazed.)
________________________________________________________ (10) Hunting Preserve or Private Land Managed for Wildlife
________________________________________________________ (11) Government Land
________________________________________________________ (12) Other

ENUMERATOR:________________________________
DATE:________________________________________

Reported Acres
(RA)

OFFICE USE
Digitized
Acres

RA / DA