Your agricultural operation, large or small, is important to U.S. agriculture.  NASS conducts a census of all agricultural operations every five years as well as other agricultural surveys.  We need to know about all types of agricultural operations of all sizes.  Please fill in all the information below.  New names will be processed for future surveys and censuses.

The Information you provide is kept confidential by law, Title 7, U.S. Code and will not be disclosed to any other government or private entity.

Name

Address

City

State

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Zip

Phone Number

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Race:

(Mark one or more)

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or Other Pacific Islander

 White

Sex:

 Male

 Female

Comments:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid control number for this survey is OMB number is 0535-0140. The time required to complete this information is estimated to average 5 minutes. Approval Expires 2/28/2013