Employers - Point of Contact Questions

S:\NAWSDOC\CYCLE63\OMBCYCLE63\ENGOMBCY63
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ENGLISH
Cycle 63, SPRING 2008
OMB NO. 1205-0453

6
COUNTY

EXPIRATION DATE: XX/XX/XX

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FARM WORKER ID
[FOR OFFICE USE ONLY]

[REV.10/07/08]

NATIONAL AGRICULTURAL WORKERS SURVEY - 2009 (“NAWS”)
CS2

DATE:

/

/
[FOR OFFICE USE ONLY]

CROP CODE
CS5

CROP:

CS6 TASK:

TASK CODE

LANGUAGE DURING INTERVIEW: __________________

GN:

ID:
IF GN REFERRED TO CONTRACTOR, GROWER OR OTHER,
WRITE INFORMATION)
NAME :
_______________________________________
ADDRESS:
_______________________________________
TELEPHONE:
(_________)___________-________________

GN REFERRED TO:

9 “CONTRACTOR”?:
9 OTHER GROWER?
9 OTHER?:_______

WORKER IS ACTUALLY EMPLOYED BY?:
TYPE OF WORK?: 91 FIELD WORK

9 1 GROWER

92 NURSERY

9 2 CONTRACTOR

93 PACKING HOUSE

97 OTHER:________

FARM WORKER’S
NAME:
LOCAL ADDRESS:
TELEPHONE:
INTERVIEWER’S
NAME:
CP5 TIME BEGAN:

CS9 INTERVIEWER’S ID:

:

9 AM
9 PM

CP6 TIME ENDED:

:

9 AM
9 PM

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control
number. Public reporting burden for this collection of information, which is voluntary, is estimated to average 1 hour
(or 60 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. Send
comments regarding this burden estimate to the Office of Policy, Development and Evaluation, ETA, Department of
Labor, Room N5641, 200 Constitution Avenue, N.W., Washington, D.C. 20210.

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