QID ARMS Phase 1 - Screening Form Version 1 - Rev

2021 AGRICULTURAL RESOURCE MANAGEMENT SURVEY
OMB No. 0535-0218
Approval Expires: 11/30/2023
Project Code: 905
SurveyID: 1222 Phase 1
Version 1 - CT, DE, MD, MA, MT, NV, NH, NJ,
RI, SC, WV, WY

United States
Department of
Agriculture
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: nass@nass.usda.gov

Please make any needed corrections to name, including the correct operation name, and mailing address on the label.
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 15 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.

1. During 2021, will this operation (name on label),
·
·
·
·

grow any crops, including field crops, fruits, vegetables, nursery/greenhouse, or other specialty crops; or
cut any hay; or
have any livestock, poultry, or bees; or
sell any agricultural products; or
· receive government payments (CRP, WRP, etc.); or
· have more than 19 acres of idle cropland or more than 99 acres of pastureland?
EXCLUDE crops planted on land rented/leased to others.
☐ Yes - Continue on next page

☐ No - Complete items below, then go to Conclusion on back page

a. Has the operation named on the label been sold, rented, or turned over to someone else?
☐ Yes - Complete item b.

☐ No - Complete item c.

b. What is the name and address of the new operation?
Operation Name: ________________________________________
Operator Name: _________________________________________
Address: _______________________________________________
City: _________________________State: ____ Zip: ____________
Phone: (________)_______________________________________

c. Will the land be used for any agricultural purpose by you, the
individual listed on the label, or anyone else in the next year?
☐ Yes ☐ No ☐ Don't know
Please explain, then go to Conclusion on back page.
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

2
2021 Total Acres Operated
1. Including the farmstead, all cropland, woodland, pastureland, wasteland, and
government program land, how many total acres does this operation--

Acres
901

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

902
b. rent or lease from others, including for cash, shares or rent free? EXCLUDE land used on an
+
animal unit month (AUM) basis, or fee per head basis under a grazing permit.........................................
905

c. rent to others, including for cash, shares or rent free?.............................................................................
=
2. Total acres operated: [item 1a + 1b - 1c]...................................................................................................

900

3. Of the total [item 2] acres operated, how many acres are considered cropland? INCLUDE land in hay, 802
summer fallow, idle cropland, cropland used for pasture and cropland in government programs..................

2020 Value of Sales
1. Is the 2020 gross value of sales and government agricultural payments for this operation $1,000 or more?
1500 1

☐

Yes - Go to item 2

3

☐

No – Continue to item 1a

3
Value of Sales - Continued
a. Record all 2021 crops, land uses, and livestock or poultry now on the total acres operated.
Land Use

ACRES

Field Crops Intended For
Harvest

Other Crops

ACRES

ACRES

CRP/WRP .....................................

__________________ ........

Idle Cropland .................................

__________________ ........

Nursery & Greenhouse.......

Summer Fallow .............................

__________________ ........

___________________ ..........

_________________________ ...........

__________________ ........

___________________ ..........

Government Payments

WHOLE
DOLLARS

Fruits/Nuts

Cut Christmas Trees...........

Livestock

ACRES

NUMBER

CRP/WRP Payments ....................

__________________ ........

Cattle – Milk Cows...........

Other Gov’t Payments ...................

__________________ ........

Cattle – Other...................

Pasture/Rangeland

__________________ ........

Chickens..........................

Cropland Used Only For Pasture...

__________________ ........

Hogs.................................

Permanent Pasture .......................

__________________ ........

Woodland Pasture.........................

Vegetables/Melons

Aquaculture

__________________ ........

ACRES

NUMBER

Horses..............................
ACRES

Mules/Burros....................
Sheep & Goats...................

Acres of Ponds in Use ...................

__________________ ........

___________________ ..........

Foodsize/Stockers..........................

__________________ ........

___________________ ..........

Fingerlings/Broodfish.....................

Berries

Trout Eggs .....................................
Other Aquaculture .........................

Office Use

ACRES

__________________..........
__________________..........

Total Points
861

Pasture Points
869

__________________..........

2. Which of these categories represents the largest portion of the gross income from the operation in 2020?
Code

Farm Type Code

1- Grains, Oilseeds, Dry Beans, and Dry Peas (corn, flaxseed, grain silage and forage,
grains and oilseeds, popcorn, rice, small grains, sorghum, soybeans, sunflowers,
straw, etc.)............................................................................................................................1

☐

☐
2- Tobacco ................................................................................................................................................
2
☐
3- Cotton and Cottonseed .........................................................................................................................
3
4- Vegetables, Melons, Potatoes and Sweet Potatoes (beets, cabbage, cantaloupes,
pumpkins, sweet corn, tomatoes, watermelons, vegetable seeds, etc.)..............................4
☐
5- Fruit, Tree Nuts and Berries (almonds, apples, blueberries, cherries, grapes,
hazelnuts, kiwifruit, oranges, pears, pecans, strawberries, walnuts, etc.)...........................5
6- Nursery, Greenhouse, Floriculture and Sod (bedding plants, bulbs, cut flowers, flower
seeds, foliage plants, mushrooms, nursery potted plants, shrubbery, sod, etc.).................6

☐
☐

☐
7- Cut Christmas Trees and Short Rotation Woody Crops........................................................................
7

Farm Type Code

8- Other Crops and Hay, CRP and Pasture (grass seed, hay and grass silage, hops,
maple syrup, mint, peanuts, sugarcane, sugarbeets, CRP, etc.).........................................8

862

☐

☐
9- Hogs and Pigs ......................................................................................................................................
9
☐
10- Milk and Other Dairy Products from Cows ...........................................................................................
10
11- Cattle and Calves (beef and dairy cattle for breeding stock, fed cattle, beef and dairy
☐
cull animals, stockers and feeders, veal calves, etc.)..........................................................11
12- Sheep, Goats, and their Products (wool, mohair, milk and cheese)....................................12

☐

13- Horses, Ponies, and Mules (burros and donkeys)...............................................................13
14- Poultry and Eggs (broilers, chickens, turkeys, ducks, eggs, emus, geese, hatchlings,
ostriches, pigeons, pheasants, quail, poultry products, etc.)...............................................14

☐

15- Aquaculture (catfish, trout, ornamental and other fish, mollusks, crustaceans, etc.)...........15
16- Other Animals and Other Animal Products (honey bees, honey, rabbits, fur-bearing
animals, semen, manure, other animal specialties, etc.).....................................................16

☐

☐

☐

4
Operation Type
1. Are the day-to-day decisions for this operation made by one individual, a hired manager, or partners? (Check one)

☐
☐
☐

One individual - Go to Conclusion, below
A hired manager - Go to Conclusion, below
Partners - Complete items a and b, then go to Conclusion, below

Number

a. How many individuals, including the operator, are involved in the day-to-day decisions of this
operation?..............................................................................................................................................................
b. Please record partners' names and addresses, then go to Conclusion, below. Enter names and addresses of
partners, including partners who jointly operate land and share in decision making. Do not include landlords and
tenants as partners.
Partner name: _________________________________________ Partner name: _________________________________________
Address: _____________________________________________

Address: _____________________________________________

City: ______________________ State: ________ Zip: ________ City: ______________________ State: _______ Zip: _________
Phone: (_______)____________________________________________

Phone: (_______)____________________________________________

Partner name: _________________________________________ Partner name: _________________________________________
Address: _____________________________________________

Address: _____________________________________________

City: _____________________ State: ________ Zip: ________

City: ______________________ State: _______ Zip:_________

Phone: (_______)____________________________________________

Phone: (_______)____________________________________________

Conclusion
1. Do you (the operator named on the label) make any day-to-day decisions for another farm or ranch?
1

Yes - Please list the other operation(s): __________________________________________________________

3

No - Continue

Contact Information
Operation Email: (if different from above)

Operation Phone:

9937

9936

(

) - ________________________

Respondent Name:

Respondent Phone: (if different from above)

9912

9911

(

check if
cell phone

) - __________________

check if 9910
cell phone

Date:

MM

DD

YY

__ __

__ __

21

OFFICE USE
R. Unit

Ptr 1 Str

9921

9922
Response

1-Comp
2-R
3-Inac
4-Office Hold
5-R - Est
6-Inac - Est
7-Off Hold - Est

9901

Ptr 2 Str
9923

Ptr 3 Str
9927

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

9902

Ptr 4 Str
9928

OPS
923

Mode
1-PASI (Mail)
2-PATI (tel)
3-PAPI (Face-to-Face)
4-CATI
5-Web
6-E-mail
7-Fax
8-CAPI
19-Other

SSO 1
9907

Optional Use
9906

9908

Enum.
9903

9998

9916

POID
9989

__ __ __ __ __ __ __ __ __
Eval.
9900

ADJ
922

Change
9985