Agricultural Flood Damage Survey

Producer information

Producer name*

Farm name- If applicable

Phone number*

Email address- Optional

USDA Farm Number (FSN)- Optional

Community / area of farm*

Flood information

Date flooding began- Optional

Is water still on your fields?

Maximum water depth on your fields

About how many days were your fields under water?- Optional

Crop loss information

Fill in only the crops that apply to your operation. Leave the rest blank.

Soybeans

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Corn

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Cotton

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Rice

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Sugarcane

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Pasture/Hay

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Other

Acres planted

Acres flooded

Estimated % loss

Estimated $ loss

Additional agricultural damages

Check all that apply.

Estimated losses

Damage to equipment- Optional

Damage to buildings, grain bins, irrigation, or other infrastructure- Optional

Livestock losses- Optional

Estimated total crop loss$0

Estimated total other agricultural losses$0

Estimated total agricultural loss$0

Totals are calculated from the amounts above.

Additional comments- Optional

Photos of damage- Optional — up to 10Add photosFlooded fields, damaged equipment, buildings, or livestock. Up to 10 images.

I certify that the information provided is accurate to the best of my knowledge.

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