Farmer Questionnaire - TVA Form 9476 - with burden statement

Farmer Questionnaire

OMB No. 3316-- 0016
Exp. Date: 09/30/2006

Vicinity of Nuclear Power Plant
Tennessee Valley Authority
Interviewer

1.

Date

Name

Telephone Number

Address

2.

a.

Do you use irrigation? - Yes - No

b. What is your present source for irrigation?
- River

- Stream

- Well

- Farm pond

- Public water system

- Other (specify)
3.

What is your present source of drinking water?
- Stream
- Well
- Farm pond

- Public water system

- Other (specify)
4.

a. Do you have a home garden? - Yes - No
b. Do you produce green leafy vegetables such as collards, turnip greens, and lettuce for home consumption?
- Yes - No
If yes, how many months of the year do you harvest these crops?

5.

a. Is cows’ milk produced on this farm? - Yes - No
b. If yes, number of cows producing:
Grade A Type milk
Grade B Type milk
Unprocessed milk for home use
Unprocessed milk for sale to consumers
c.

If cows’ milk is sold unprocessed, complete the following table for the buyers of the unprocessed milk:
Consumer Information Concerning Use of Unprocessed Cows’ Milk
% of Total
Cows’ Milk
Oz./Day
Consumed
Milk
that is
Name of Consumer
Date of Birth
Consumed Unprocessed

TVA 9476 (9-- 2003)

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Average
Time Milk is
Kept Before
it is
Consumed

6.

a.

Is goats’ milk produced for human consumption on this farm?

b. Is unprocessed goats’ milk sold to consumers?
c.

- Yes - No

- Yes - No

If goats’ milk is sold unprocessed, complete the following table for the buyers of the unprocessed milk:
Consumer Information Concerning Use of Unprocessed Goats’ Milk
% of Total
Goats’ Milk
Oz./Day
Consumed
Milk
that is
Consumed Unprocessed
Name of Consumer
Date of Birth

7.
Month

Percent Substitutional Feeding For Dairy and Goat Herds
Goat
Dairy
Goat
Herds
Month
Herds
Herds
Month

Dairy
Herds

Average
Time Milk is
Kept Before
it is
Consumed

Dairy
Herds

Goat
Herds

January

%

%

May

%

%

September

%

%

February

%

%

June

%

%

October

%

%

March

%

%

July

%

%

November

%

%

April

%

%

August

%

%

December

%

%

TVA 9476 (9-- 2003)

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Paperwork Reduction Act Statement
Required Burden Estimate Statement
Public reporting burden for this collection of information 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. An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to Agency Clearance Officer, Tennessee Valley Authority, 1101
Market Street (EB 5B), Chattanooga, Tennessee 37402; and to the Office of Management and Budget,
Paperwork Reduction Project (3316-- 0016), Washington, DC 20503.

Privacy Act of 1974
The Tennessee Valley Authority is conducting this survey under the authority of the Tennessee Valley Authority
Act of 1933 and the National Environmental Policy Act to collect information concerning farming operations in the
areas surrounding proposed and operating nuclear-- fueled generating plants.
Your cooperation in this program will be of great benefit since the requested information will enable TVA to
assess the possible effects that such a plant might have on the production of crops and livestock in this area.
However, your cooperation with this program is voluntary and you may decline to participate the survey without
affecting your relationship with TVA. The information you provide will not be used in making any decisions about
you individually. Information you provide may be used in and verified through a computer match.
Information which you furnish and which is personally identifiable to you will be considered confidential and will
not be disclosed unless TVA is required to do so by law. Otherwise, information furnished by you will be used to
prepare environmental statements and evaluations and may be disclosed during licensing procedures concerning
a proposed plant, in litigation, or to other Federal agencies with authority to review TVA’s activities. Your
cooperation is appreciated and if there are any questions concerning this survey, please feel free to contact
William L. Raines, Manager of Western Area Radiological Laboratory, Tennessee Valley Authority, WAR 1A, P.O.
Box 1010, Muscle Shoals, Alabama 35662-- 1010.
This statement is provided to you in accordance with section 3(e)(3) of Privacy Act of 1974 (Pub. L. 93-- 579).

TVA 9476 (9-- 2003)

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