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Agricultural Coverage Evaluation Survey Screening Form - Version B
ICR 202609-0535-002 · OMB 0535-0213 · Object 173054100.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Agricultural Coverage Evaluation Survey Screening Form - Version B |
| Author | Davis, Ramonia - NASS |
| File Modified | 2026-08-28 |
| File Created | 2022-02-16 |
| Conversion State | complete |
Extracted Text
2027 AGRICULTURAL COVERAGE EVALUATION SURVEY AREA SCREENING FORM - VERSION B 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 AL, AR, DE, FL, GA, HI, IL, IN, IA, KY, LA, MD, MI, MN, MS, MO, NH, NJ, NY, NC, OH, PA, SC, TN, VA, WV, WI 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 2.] 2 5 6 8 9 10 11 On the total acres operated in 2027, have there been or will there be any crops grown, hay cut, livestock, poultry, honey bees or aquaculture raised this year? On the total acres operated in 2027, have you sold or will you sell agricultural products or receive government payments this year? On the total acres operated in 2027, are any crops now in storage or will there be any crops stored before June 1, 2028? Has this operation owned or raised any hogs or pigs in the past 12 months, or does it expect to own or raise any this year? □ 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 Phone: (_______) ________-____________________________ □ No □ No □ No □ No Name: □ 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 Phone: (_______) ________-____________________________ □ No □ No □ No □ No Name: □ 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 Phone: (_______) ________-____________________________ □ No □ No □ No □ No Name: □ 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 Phone: (_______) ________-____________________________ □ No □ No □ No □ No Name: □ 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 Phone: (_______) ________-____________________________ □ No □ No □ No □ No Name: □ 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 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 Name: _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ Phone: (_______) ________-____________________________ 3 13 14 15 16 Excluding home Excluding home use, have there use, have there been or been or will there will there be be any any nursery, vegetables, greenhouse, melons, fruit, nuts floriculture, sod, or berries grown cut Christmas on this operation trees or other this year? woody crops grown on this operation this year? In 2027, did this operation have any idle cropland or more than 99 acres of pasture? □ Yes – Go to □ Yes – Go to □ Yes – Go to □ Yes – Go to Questionnaire Questionnaire Questionnaire Questionnaire In 2027, were there any horses, ponies, or other equine, regardless of ownership, on the total acres operated? □ 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 17 □ 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 O F U F S I E C E □ 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 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 Questionnaire Questionnaire Questionnaire Questionnaire □ No □ No □ No □ No Does this tract have potential for agriculture before 2028? What best describes this nonagricultural tract? Enter code Enter code Enter acres and land use, then continue 818 783 LAND USE □ YES = 1 □ DK = 2 □ NO = 3 00 846 818 783 • __ __ LAND USE □ YES = 1 □ DK = 2 □ NO = 3 00 846 818 783 • LAND USE □ YES = 1 □ DK = 2 □ NO = 3 00 846 818 783 • LAND USE □ YES = 1 □ DK = 2 □ NO = 3 00 846 818 783 • □ YES = 1 □ DK = 2 □ NO = 3 846 818 • 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 __ __ □ DK – Go to 20a • __ __ □ DK – Go to How many acres are inside the colored segment lines? 846 __ __ □ DK – Go to 20 NON-AGRICULTURAL TRACTS __ __ □ DK – Go to 18 LAND USE □ YES = 1 □ DK = 2 □ NO = 3 783 4 [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. Total of items 3 + 4 .......................................................................................................................= 5326 (Item 5 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.] 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