NAHMS-241 Urban Chicken Prevalence Record

National Animal Health
Monitoring System
2150 Centre Ave Bldg B
Fort Collins, CO 80526

Animal and
Plant Health
Inspection
Service
Veterinary
Services

Form Approved
OMB Number 0579-xxxx
Expires

URBAN CHICKEN
PREVALENCE RECORD

1. Please indicate your level of agreement with each of the following statements:
Strongly
Agree

Agree

Slightly
Agree

Slightly
Disagree

Disagree

Strongly
Disagree

a. I would be in favor
of a law in my community
that allows ownership of
chickens in urban areas.

1

2

3

4

5

6

b. I would not mind if my
neighbor owned chickens.

1

2

3

4

5

6

1

2

3

4

5

6

1

2

3

4

5

6

c.

Eggs from pet chickens
are better for you than
eggs purchased at a
grocery store.

d. Chickens in urban areas
are a health hazard for
humans.

2. Do you own any chickens? ..................................................................................

†1 Yes

†3 No

If YES, do you purchase chicken feed at a local feed/tack/pet store? ................

†1 Yes

†3 No

If NO, do you plan to own any chickens in the next 5 years? .............................

†1 Yes

†3 No

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
resond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0579-XXXX. The time required to complete this information collection is estimated to average 0.045
hours per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collected.

NAHMS-241

JUN 2010