QID Sheep and Goat Report - Jan. 1, 2021 - Revised Version

SHEEP AND GOAT REPORT – JANUARY 1, 2020
Questions in a red font are new to this questionnaire. Questions in green font are pulled forward from previous approval.			OMB No. 0535-0213 Approval Expires: 6/30/2020 Project Code: 155 SmetaKey: 1849
				United States Department of Agriculture
				NATIONAL AGRICULTURAL STATISTICS SERVICE

						USDA/NASS National Operations Division 9700 Page Avenue, Suite 400 St. Louis, MO 63132-1547 Phone: 1-888-424-7828 Fax: 1-855-415-3687 e-mail: nass@nass.usda.gov

Please make corrections to name, address, and ZIP Code, if necessary.

The information you provide will be used for statistical purposes only. Your responses 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 provisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal laws. 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 0535-0213. The time required to complete this information collection is estimated to average 30 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.

State	POID	Tract	Subtr.
__ __	__ __ __ __ __ __ __ __ __	__ __	__ __

1. [Verify name and mailing address of this operation. Make any corrections necessary (including the correct operation name) on the label and continue.]	[Check if name label verified]

2. Did this operation own or custom feed any sheep or lambs, regardless of location: (Include Barbados and all hair breed sheep.) on January 1, 2020? at any time during 2019? or will there be any at any time during 2020?
Yes [Go to Item 3.]	No [Go to Item 2a.]
a. Did this operation own any goats or kids, regardless of location: - on January 1, 2020? - at any time during 2019? - or will there be any at any time during 2020?
Yes [Go to Item 3.]	No [Go to Item 2b.]
b. Were you (the individual named on the label) operating a farm or ranch on January 1, 2020?
Yes [Go to Section 4.]	No [Go to Section 3.]

			OFFICE USE
3. Are the day-to-day decisions for this operation made by one individual, a hired manager, or partners? [Check one]			R. UNIT
			9921
One individual – [Go to page 3, Section 1, item 1.] A hired manager – [Go to page 3, Section 1, item 1.] Partners – How many partners make the day-to-day decisions?			SUB.
			9941
	Number		JUNE 1
[Enter number of partners, including operator, and then continue.]. . . . . .. . . . . . . . . .			9930

4. Please identify the other person(s) in this partnership, then go to page 3, Section 1, item 1. (Verify partners’ names and make necessary corrections if names have already been entered.)
Name: __________________________________________				Name: __________________________________________
Address: ________________________________________				Address: ________________________________________
City: ____________________ State: ______ ZIP: _______				City: ____________________ State: ______ ZIP: _______
Phone: (______ ) - ______________________				Phone: (_______) - ____________________
Did this partner also operate land individually on June 1, 2019?				Did this partner also operate land individually on June 1, 2019?
Yes No				Yes No
Name: __________________________________________				Name: __________________________________________
Address: ________________________________________				Address: ________________________________________
City: ____________________ State: ______ ZIP: _______				City: ____________________ State: ______ ZIP: _______
Phone: (______) - _____________________				Phone: (_______) - ____________________
Did this partner also operate land individually on June 1, 2019?				Did this partner also operate land individually on June 1, 2019?
Yes No				Yes No

For Office Use Only		For Office Use Only		For Office Use Only		For Office Use Only
Stratum		Stratum		Stratum		Stratum
9922		9923		9927		9928
Ind. Op.		Ind. Op.		Ind. Op.		Ind. Op.
9924		9924		9924		9924

Section 1 - Sheep and Lambs

1. On January 1, 2020 were any sheep or lambs, regardless of ownership, on this operation? (Include Barbados and all hair breed sheep. Sheep and lambs on grazing land leased on a fee per head or animal unit month (AUM) basis should be included by the sheep owner, excluded by the land owner.)
	Yes – [Go to Item 2.] No – [Go to Item 1a.]
	Will there be any sheep or lambs, regardless of ownership, on this operation at any time during 2020? 1 Yes 3 No ­2 Don’t Know Were any sheep or lambs, regardless of ownership, on this operation at any time during 2019? Yes – [Go to Item 5.] No – [Go to Item 2.]

Sheep and Lambs for Breeding
2. Of the sheep and lambs for breeding, regardless of ownership, on this operation on January 1, how many were:
a. Ewes 1 year old and older?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	281
b. Rams 1 year old and older?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	282
c. Replacement lambs less than 1 year old (including unweaned lambs kept for breeding)?. . . . . .	+	285

Sheep and Lambs for Market
3. Of the sheep and lambs for market, regardless of ownership, on this operation on January 1, how many were:
a. Market lambs less than 1 year old and:
(i) Under 65 pounds (including unweaned market lambs)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	836
(ii) 65 to 84 pounds?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	837
(iii) 85 to 105 pounds?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	838
(iv) Over 105 pounds?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	839
b. Market sheep 1 year old and older (not used for breeding)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	287

Total Sheep and Lambs
4. [Add Items 2a through 4b and verify total.]
Then the total sheep and lambs on hand January 1 was:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	=	280

Section 1 - Sheep and Lambs - Continued

Lamb Crop for 2019 (Include lambs born on grazing land leased on a fee per head or animal unit month (AUM) basis).
5. How many lambs were born alive on this operation during 2019? (Exclude lambs born dead.) . . . . . . . .	288

Wool Production in 2019 (Report sheep and lambs only once if shorn both Spring and Fall.)
6. How many sheep and lambs (breeding & market) were shorn in 2019?. . . . . . . . . . . . . . . . . . . . .			Head	215
a. How many total pounds of wool were shorn from these sheep and lambs in 2019? (Including tags). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .			Pounds	216
	Or – Average weight per fleece	217	. __

Wool Price in 2019
7. What was the average price received per pound for wool sold in 2019? (Including marketing charges for commissions, coring, and grading.) . . . . . . . . . . .	Dollars and cents	296	. __ __

Inventory Values for Sheep & Lambs on Hand on January 1, 2020
8. What is the average value per head (replacement value) of the: (Report to nearest dollar)
a. Breeding ewes 1 year old and older? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	680
b. Breeding rams 1 year old and older?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	681
c. Breeding replacement lambs less than 1 year old?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	679
d. Market lambs less than 1 year old?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	845
e. Market sheep 1 year old and older?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		$	846

Slaughter for Consumption (regardless of ownership)

		Lambs	Sheep
9. During 2019, how many lambs and sheep were custom slaughtered at commercial establishments for consumption by this operation?. . . . . . . . . . . . . .		1206	1205
10. During 2019, how many lambs and sheep were slaughtered on this operation for consumption by this operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		1201	1202
Include mobile slaughtering. Exclude custom slaughter at commercial establishments.

	1 – Incomplete, has sheep or lambs 2 – Incomplete, presence of sheep or lambs unknown	291
	3 – Valid Zero

Section 1 – Sheep and Lambs - Continued

Sheep and Lamb Deaths and Losses.

(Include sheep and lambs from this operation that died or were lost on grazing land leased on a fee per head or animal unit month (AUM) basis).

		Lambs, less than 1 year	Sheep, 1 year or older
11. Report the number of sheep or lambs that died or were lost from all causes for the following	=	­028	059
[If the total in Item 11 is zero, go to Item 17; otherwise, continue to Item 12.]
[Ask for deaths by each category, and record answers in the tables below.] How many lambs died or were lost from (cause)? How many sheep died or were lost from (cause)?
12. Predator Causes:		Lambs, less than 1 year	Sheep, 1 year or older
a. Bears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	953	042
b. Bobcats or Lynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	952	041
c. Coyotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	950	038
d. Dogs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	689	037
e. Eagles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	951	040
f. Foxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	688	036
g. Feral pigs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	949	064
h. Mountain Lions, Cougars, or Pumas . . . . . . . . . . . . . . . . . . .	+	954	043
i. Ravens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	957	044
j. Vultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	961	045
k. Wolves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	687	039
l. Other Predators [specify] ______________________ . . . .	+	955	049
m. Unknown predators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	960	060
13. Non – Predator Causes:
n. Enterotoxemia (‘overeating disease’). . . . . . . . . . . . . . . . . . .	+	025	051
o. Internal parasites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	968	067
p. Other digestive problem (bloat, scours, acidosis, etc.) . . . .	+	962	046
q. Respiratory problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	964	047
r. Metabolic problem (milk fever, etc.). . . . . . . . . . . . . . . . . . . . .	+	965	048
s. Other disease (mastitis, foot rot, etc.) [specify most common] ________________________. .	+	963	063
t. Weather related causes (chilling, drowning, lightening, fire, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	956	050
u. Starvation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	967	061
v. Lambing problems (dystocia, stillborn, etc). . . . . . . . . . . . . . . .	+	966	053
w. Neonatal disease (navel infection, septicemia) . . . . . . . . .	+	XXX
x. Old age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+		055
y. Being on their back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+		054
z. Poisoning (nitrate poisoning, noxious feeds, noxious weeds, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	958	052
aa. Theft (stolen). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	+	024	056
ab. Other non - predator causes (lameness, etc.) [specify] __________________ . . . . . . .	+	027	057
ac. Unknown non - predator causes. .. . . . . . . . . . . . . . . . . . . . .	+	032	058
14. Causes undetermined
ad. Found dead (undetermined cause)	+	026	062
ae. Missing, unknown status	+	XXX	XXX
[If Items 12a-12m all equal “No” then go to Item 16. If at least one is equal to “Yes”, continue to Item 15.]
15. Where any of the predator-related losses above confirmed by first-hand sightings?		Yes	No
[If Items 13a-13ac all equal “No” then go to Item 17. If at least one is equal to “Yes”, continue to Item 16.]
16. Were any of the non-predator-related losses above confirmed by laboratory testing or necropsy?		Yes	No

		Lambs	Sheep
17. How many lambs and sheep were injured but not killed by predators during 2019?	=	­970	971

18. Did you use any of the following nonlethal predator control methods to prevent wildlife-caused losses on your sheep operation in 2019?				­
Guard dogs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		121		Yes		No
Llamas for guarding sheep and lambs . . . . . . . . . . . . . . .		122		Yes		No
Donkeys for guarding sheep and lambs . . . . . . . . . . . . . .		123		Yes		No
Fencing (predator exclusion fencing, including electric). .		124		Yes		No
Lamb shed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		125		Yes		No
Herding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		126		Yes		No
Night penning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		127		Yes		No
Fright tactics (noise-making or triggered devices that flash lights, motorized or wind-powered flapping scarecrows, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		128		Yes		No
Removing carrion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		129		Yes		No
Culling older sheep to prevent death loss. . . . . . . . . . . . .		130		Yes		No
Changing bedding grounds . . . . . . . . . . . . . . . . . . . . . . .		131		Yes		No
More frequent checks in high predation areas/seasons. .		132		Yes		No
Altered breeding season so lambs are not born when predators such as coyotes are feeding their young . . . . .		192		Yes		No
Other nonlethal [specify] ________________________		133		Yes		No
[If Items 18a-18n all equal “No” then go to Item 20. If at least one is equal to “Yes”, continue to Item 19.]
19. Did you spend any money on nonlethal predator-control measures for sheep and lambs during 2019?. . . . . . . . . . . . .		135		Yes – [Continue]		No – [Go to Item 20]
				Dollars
How much was spent on sheep and lambs for nonlethal predator-control measures by this operation during 2019? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				136
20. Did you use any lethal predator control measures for sheep and lambs during 2019? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		XXX		Yes – [Continue]		No – [Go to Item 21]
a. Did you spend any money on lethal predator control measures for sheep and lambs during 2019? . . . . .. . . . .		137		Yes – [Continue]		No – [Go to Item 21]
				Dollars
How much was spent on sheep and lambs for nonlethal predator-control measures by this operation during 2019? . . . . . . . . . . . . . . . . . . . .				138
21. Did you have the assistance of a State or Federal government trapper in controlling predators of sheep and lambs during 2019? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		139		Yes		No
22. Did you use an official ID, such as an eartag with the US shield or a Scrapie tag, for any sheep or lambs on your operation during 2019? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		xxx		Yes		No
23. Did any sheep or lambs leave the operation during 2019 (not including deaths)? . . . . . . . . . . . . . . . . . . . . . . . . . . .		xxx		Yes – [Continue]		No – [Go to Item 24]
How many lambs, not going to slaughter or for feeding for slaughter, left the operation during 2019 (not including deaths)?. . . . . . . . . . . . . . . . . . . . . . . .				XXX
What percent of these lambs had an official ID, such as an eartag with a US shield or Scrapie tag, on them when they left the operation during 2019?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				XXX
How many mature sheep left the operation during 2019 (not including deaths)?. . . . . . . . . . . . . . . . . . .				XXX
What percent of the mature sheep had an official ID, such as an eartag with a US shield or Scrapie tag, on them when they left the operation during 2019? . . . . . . . . . . . . . . . . . . . .				XXX
24. Did you quit raising sheep during 2019?		XXX		Yes – [Continue]		No – [Go to Section 3]
	a. Which of the following was the main reason you quit raising sheep in 2019? [Check one only]
	Predator loss Internal parasites Other non-predator cause of morbidity or mortality [specify] _____________ Marketing of kids or products Personal or family situation (e.g., retirement, lack of successor) Labor or production costs (e.g., cost of feed, labor) Government regulations [specify] ________________ Other reason [specify] ________________________

	1 – Incomplete, has sheep or lambs losses 2 – Incomplete, sheep or lambs losses unknown	115
	3 – Valid Zero

Section 2 - Goats and Kids

1. On January 1, 2020 did this operation own any goats or kids at any location?
Yes – [Go to Item 2.]		No – [Go to Item 1a.]
a. Will this operation own goats or kids, regardless of location, during 2020?
	1 Yes = 1 2 Don’t Know = 2 3 No = 3		1171
b. Did this operation own any goats or kids, regardless of location, at any time during 2019?
	Yes – [Go to Item 5.]	No – [Go to Section 4.]

2. Goats & Kids for Breeding – Of the goats and kids for breeding owned by this operation on January 1, how many were:
(** Report based on utilization regardless of breed **)		Angora		Milk	Meat & Other
a. Does 1 year old and older?. . . . . . . . . . . . . . . . . . . . . . . . .	+	1172		1180	1186
b. Bucks 1 year old and older?. . . . . . . . . . . . . . . . . . . . . . . .	+	1175		1181	1187
c. Replacement kids less than 1 year old?. . . . . . . . . . . . . . .	+	1176		1182	1188
3. Goats & Kids for Market – Of the goats and kids for market owned by this operation on January 1, how many were:
a. Market kids less than 1 year old?. . . . . . . . . . . . . . . . . . . .	+	1177		1183	1189
b. Market goats 1 year old and older (not used for breeding)?	+	1178		1184	1190
Total Goats & Kids	=	1179		1185	1191
4. [Add Items 2a through 3b and verify.] Then the total goats and kids owned by this operation on January 1 was:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kid Crop for 2019	Angora	Milk	Meat & Other
5. How many kids were born on this operation during 2019? (Exclude kids born dead.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1101	1104	1107

6. Deaths and Losses During 2019	Angora	Milk	Meat & Other
a. How many kids died or were lost from all causes before being weaned during 2019: (Exclude kids born dead.). . . . . . . . . . . . . . . .	1110	1113	1115
b. How many kids died or were lost from all causes after being weaned during 2019?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1111	1114	1116
c. How many goats, 1 year or older, died or were lost from all causes during 2019?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1103	1106	1109
d. [Add Items 6a through 6c ] Then the 2019 total amount of goat and kid deaths or losses was . . .	1117	1118	1119

Inventory Values for Goats and Kids on Hand on January 1, 2020
7. What is the average value per head of the following: (Report to nearest dollar)
		Angora	Milk			Meat & Other
a. Breeding does 1 year old and older?. . . . . . . . . . . . . . . . .	$/Head	1120		1125	1130
b. Breeding bucks 1 year old and older?. . . . . . . . . . . . . . . . .	$/Head	1121		1126	1131
c. Breeding replacement kids less than 1 year old?. . . . . . . .	$/Head	1122		1127	1132
d. Market kids less than 1 year old?. . . . . . . . . . . . . . . . . . . .	$/Head	1123		1128	1133
e. Market goats 1 year old and older?. . . . . . . . . . . . . . . . . . .	$/Head	1124		1129	1134

Section 2 - Goats and Kids - continued

Slaughter for Consumption by this Operation (regardless of ownership)

		Kids	Goats
8. During 2019, how many kids and goats were custom slaughtered at commercial establishments for consumption by this operation?. . . . . . . . . . . . . . . . . . . . .		1208	1207
9. During 2019, how many kids and goats were slaughtered on this operation for consumption by this operation?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		1203	1204

Include mobile slaughtering. Exclude custom slaughter at commercial establishments.

Mohair Production in 2019 (Report goats and kids only once if clipped both Spring and Fall.)
10. How many Angora goats and kids were clipped in 2019?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				Head	278
a. How many pounds of mohair were clipped from these Angora goats and kids in 2019? (Include tags.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .			Pounds		279
	Or – Average weight per fleece	205	. __

Mohair Price in 2019
11. What was the average price received per pound for mohair sold in 2019? (Include marketing charges for commissions, coring, and grading.). . . . . . . . . . .	Dollars and cents	297	. __ __

	Office Use
	1 – Incomplete, has goats or kids 2 – Incomplete, presence of goats or kids unknown	1112
	3 – Valid Zero

Section 3 – Change in Operator

● [Complete this section only if all questions in Item 2 on the front page are answered “No”.]
1. Has the operation named on the label been sold, rented, or turned over to someone else?
Yes - [Continue] No - [Go to Item 1a.]	1a. Will the land be used for any agricultural purpose by you (the operator), or anyone else in the next year? (Including growing crops or raising livestock.) Yes Don't Know No [Regardless of answer to above, write a note to explain the situation, then go to Section 4.] __________________________________ __________________________________ __________________________________
2. Was the operator (name on label) operating a farm or ranch on June 1, 2019?
Yes - [Continue] No - [Continue]
3. Please provide the following information for the operation that has taken over the land:
a. What is the name and address of the new operation? Operation Name: _____________________________ Operator Name: ______________________________ Address: ____________________________________ City: ___________________ State: _______ Zip: ___ Phone: _________________________

b. Was the [Item 3a] new operation in business before June 1, 2019?

Yes - [Go to Section 4.] No - [Continue]

c. Is the [Item 3a] new operation managed?

Yes - [Go to Section 4.] No - [Continue]

d. Were any individuals associated with the [Item 3a] operation operating land individually before June 1, 2019?

Yes - [Go to Section 4.] No - [Go to Section 4.]

Section 4 – Conclusion

1. Do you (the operator named on the label) make any day-to-day decisions for another farm or ranch? Yes – [Continue.] No – [Go to Item 2.]
a. What is the name of the other operation(s)? . . . . . . .	Operation Name: ________________________________
b. Was this additional operation in business before June 1, 2019? Yes – [Continue.] No – [Continue.]	Address: ______________________________________
	City: __________________	State: __	ZIP: ______
	Phone: (______) __________________

2. SURVEY RESULTS:  To receive the complete results of this survey on the release date, go to: www.nass.usda.gov/Surveys/Guide_to_NASS_Surveys/. Would you rather have a brief summary mailed to you at a later date?
Yes – [Enter code 1.] No – [Enter code 3.]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	9990

Respondent Name:	9911	9910 MM DD YY
	Phone: ( )	Date: __ __ __ __ __ __
This completes the survey. Thank you for your help.

Response

Respondent

Mode

Enum.

Eval.

Change

Office Use for POID

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

9901

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

9902

1-PASI (Mail) 2-PATI (Tel) 3-PAPI (Face-to-Face) 4-CATI 6-e-mail 7-Fax 19-Other

9903

9998

9900

9985

9989 __ __ __ - __ __ __ - __ __ __

Optional Use

9907

9908

9906

9916

S/E Name