QID Crop or Livestock Loss Survey

Project XXX QID XXXXXX				OMB No. 0535-0213 Approval Expires 12/31/2010
	Crop or Livestock Loss Survey 2010					NATIONAL AGRICULTURAL STATISTICS SERVICE
DRAFT			U.S. Department of Agriculture Room 5030, South Building 1400 Independence Ave., S.W. Washington, DC 20250-2000 Phone: 1-800-727-9540 Fax: 202-690-2090 Email: nass@nass.usda.gov Due to recent weather conditions or disease in your area, NASS has decided to conduct a special survey to measure the extent of damage to the crops and/or livestock in your area. Your reply to the questions on this form will be very helpful in making updates to earlier estimates. Information requested in this survey is used to prepare estimates of selected agricultural commodities. Under Title 7 of the U.S. Code and CIPSEA (Public Law 107-347), facts about your operation are kept confidential and used only for statistical purposes in combination with similar reports from other producers. Response is voluntary. Thank you for your cooperation.
Please make corrections to name, address and Zip Code, if necessary.

REPORT FOR THE TOTAL ACRES YOU OPERATE

CROP DISASTER

Due to recent weather conditions (flooding, drought, freezes, hurricanes, etc.) how many of your ______________ (corn, soybean, wheat, small grains, etc.) acres were damaged or destroyed?........................................................................................................

200

How many of the acres above were or will be replanted this year for harvest this year? .............

201

What crop(s) were used to replant these acres? ____________. Crop code……….	202 Acres
What other crop(s) were used to replant these acres? ____________. Crop code…..	203 Acres

How many of the acres mentioned in question 1 were not replanted this year for harvesting this year? …………………….........................................................................................................

204

Considering the acres identified in question 1, how much was the production for this area reduced from what you are normally expecting from these acres? …....................................

205 Bu./Acre

OR

206

Total Bu.

OR

207

% of Total Bu.

LIVESTOCK DISASTER

6. Were any livestock, poultry or fish lost due to recent weather conditions,

disease outbreaks (brucellosis, Avian flu, etc.), or accidents on or near your operation?

Yes No

_

7. List the type(s) of animals lost. ________________ _______________ ________________.

			202
How many head or live animals were lost or had to be destroyed due to the circumstances listed above?................................................................................................................................		200

HARVEST DELAY

9. Due to the recent weather events,

1. How many of your ______________ (corn, soybean, wheat, small grains, etc.) acres

have not been harvested thus far? …………………………………………………………..

2. What is the expected yield for your un-harvested ______________ (corn, soybean, wheat, small grains, etc.) acres? …………………………………………………………...

OR

What is the expected total production for your un-harvested ______________

(corn, soybean, wheat, small grains, etc.) acres? …………………………………………...

10. Around <DATE> you reported ______________ (corn, soybean, wheat, small grains, etc.)

acres to be harvested. How many of these acres have now been harvested? ..................

11. What was the average yield for these ______________ (corn, soybean, wheat, small

grains, etc.) acres? ………………………………………………………………………………..

OR

What the total production for these ______________ (corn, soybean, wheat, small

grains, etc.) acres? ………………………………………………………………………………..

Your comments are greatly appreciated. Please comment on disease and weather effects on your operation over the last few months.

Reported by:

Phone:

Date:

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 0535-0213. The time required to complete this information collection is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information.