Form FSA 441 FSA 441 Request for Aerial Photography

United States Department of Agriculture

This form is available electronically. Form Approved - OMB No. 0560-0176

FSA-441 Farm Service Agency (proposal 2) Aerial Photography Field Office REQUEST FOR AERIAL IMAGERY & RELATED PRODUCTS See Page 2 for Privacy Act and Paperwork Reduction Act Statements

1. NAME

INSTRUCTIONS ORDERING - Products are made to order. Don't know what to order? See Page 2 for additional information. Faxing your order? Include your Credit Card number. Confirmation copies are not necessary, but if you do - mark it ''CONFIRMATION ONLY.'' Otherwise we'll handle it as a new order. PAYMENT- Prepayment is required. We accept Credit Cards. Make your check or money order payable to USDA FSA. Purchase orders are accepted from tax-supported agencies. Please do not send cash or blank checks. SHIPMENT- We ship the most economical method. No COD's, shipping costs are included in the price of the product.

     

2. ADDRESS (STREET ADDRESS)

     

3. ADDRESS (PO BOX)

     

4. CITY, STATE, ZIP+4

     

5. CONTACT NAME

     

6. TELEPHONE NUMBER

7. FAX NUMBER

     

     

8. E-MAIL ADDRESS

     

9. IF KNOWN:

A. CUSTOMER CODE

B. AGENCY CODE

FOR U.S. GOVERNMENT AGENCY USE ONLY

     

     

ORDERING UNIT CODE

FUNDS CHARGEABLE

C. PURCHASE ORDER (PO) NUMBER

     

     

     

I CERTIFY THAT THESE ITEMS ARE NECESSARY FOR USE IN THE PUBLIC SERVICE

10. CREDIT CARD NUMBER

11. EXP. DATE (MM/YY)

SIGNATURE

[Please call with information]

     

12. TOTAL REPRODUCTIONS

13. AMOUNT REMITTED / PO AMOUNT

TITLE

DATE

     

$      

     

     

IMAGERY DATA SECTION (See Page 2 for Ordering Information)

14. STATE OR REGION

15. SPECIAL INSTRUCTIONS

     

     

16. COUNTY (OR FOREST AREA)

     

17. IMAGERY IDENTIFICATION

DIGITAL REPRODUCTIONS

QUAN.

PROGRAM

RES.

QUARTER QUAD NAMES/NO.

18. AREA OR LOCATION DESCRIPTIONS

FILM SIZE AND TYPE REPRODUCTIONS A

EACH B

YEAR C

SYMBOL D

ROLL NO. E

EXPOSURE(S) (RANGE(S)) F

     

     

    

     

     

     

Include information in boxes below or Item 15 above.

     

     

    

     

     

     

Latitude / Longitude - point and radius or four corner points

     

     

    

     

     

     

     

     

     

    

     

     

     

     

     

    

     

     

     

Legal Description - Township, Range, Section(s)

     

     

    

     

     

     

     

     

     

    

     

     

     

Map - Detailed topographic, county, or city map outlining your area of interest as accurately as possible. - attach to form or email to address below. Electronic shapefiles with projection. - attach to email address below.

     

     

    

     

     

     

     

     

    

     

     

     

     

     

    

     

     

     

     

     

    

     

     

     

Address Order for Product or Request for Information to:

CUSTOMER SERVICE USDA FSA AERIAL PHOTOGRAPHY FIELD OFFICE 125 SOUTH STATE STREET SUITE 6416 SALT LAKE CITY UT 84138-1102

TELEPHONE: FAX: E-MAIL: WEBSITE:

801-844-2922 855-415-2014 mailto:apfo.sales@slc.usda.gov http://www.apfo.usda.gov

ORDERING INFORMATION

FSA-441 (Page 2) (proposal 2)

		A	Your customer information - please include your street address (Item 2) and telephone number (Item 6). If you are a tax-supported organization and want to be billed, place your purchase order number here (Item 9C).
		B	Total reproductions (Item 12) - in this area indicate the total number of reproductions by product (i.e. 1-24x24, 2-38x38).
			Amount remitted/PO amount (Item 13) - by check, money order or Credit Card (Item 10).
		C	Special instructions (Item 15) - provide any special instructions you require of us to process your order. Include area or location description here.
			Digital reproductions, film size and type reproductions (Item 17A) - refer to Prices for Aerial Imagery & Related Products (FSA-441A).
			Program or symbol (Item 17D)- you may know it as project code (ID), FIPS codes, etc.
			Resolution (Res.) or film roll number (Item 17E) - resolution of digital imagery or a unique number related to a specific project.
			Quarter Quad Name / No. or Exposure(s) (range(s)) (Item 17F) - indicate quarter quad name or number or the film exposure number or range of exposures here. Refer to FSA-441A (Page 2).
		D	Instructions - these are brief instructions related to your order. See ''HOW TO ORDER AERIAL IMAGERY'' below. Also, see FSA-441A.
		E	U.S. Government Agency Use Only - this may substitute for your purchase order. For FSA orders, your signature is required.
		F	Preferred types of area or location descriptions (Item 18).
* HOW TO ORDER AERIAL IMAGERY Fill out items 14 through 18 on the FSA-441, Request for Aerial Imagery & Related Products form. If you do not have the aerial photo identification numbers, furnish one or more of the following forms of information and we will make print selections for you: Latitude and Longitude coordinates (point and radius or four corner points.) Legal description of your area of interest in township, range, and section number. A topographic, county, or city map outlining your area of interest as accurately as possible. Electronic shapefiles with projection. Products are made after an order and payment is received. You may order over the telephone using a major credit card if you have complete aerial photo (symbol, roll, exposure) or quarter quad identification. * APFO PRODUCTS AND SERVICES Depending on the original film scale or digital resolution, photographs are available in selected scales ranging from 1 inch = 5,000 feet to 1 inch = 200 feet. Print sizes: 10"x10" to 38"x38" enlargements. Digital scans from film (10"x10") are available in TIF format. Digital Compressed County Mosaics (CCM) and Quarter Quads (QQ). See FSA-441A (Prices for Aerial Imagery & Related Products) for specific size and scale availability. For special needs not covered elsewhere on this form, contact us directly. Additional fees may apply. * OTHER PHOTOGRAPHY Photography secured for the Forest Service (FS) and National Resource Conservation Service (NRCS) can be purchased from us by the same procedures outlined for FSA photography. The negative scales vary from 1:6,000 to 1:80,000, depending on the project area. Most FS photography has been flown in natural color, some in black and white and color infrared. Most NRCS photography has been flown in black and white, some in natural color and color infrared.
NOTE:	The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended).  The authority for requesting the information identified on this form is the Agricultural Adjustment Act of 1938 (7 U.S.C. 1387).  The information will be used to process an order for aerial photography.  The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated).  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in an inability on the part of the Aerial Photography Field Office to process the order for aerial photography. Paperwork Reduction Act Statement: 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 control number for this information collection is 0560-0176. The time required to complete this information collection is estimated to average 40 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. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.  RETURN THIS COMPLETED FORM TO THE USDA FSA AERIAL PHOTOGRAPHY FIELD OFFICE AT THE ADDRESS LISTED ON PAGE 1.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.