3-2361 Migratory Bird Hunt Report

U.S. Fish and Wildlife Service
National Wildlife Refuge System

Migratory Bird Hunt Report

Name of Refuge: ______________________________

OMB Control Number
1018-0140
Expires 

Hunt area (unit, zone, description): ___________________________________________

Hunter name: _______________________________________ City, State, ZIP: ___________________________________________________________

Other (specify)

Other (specify)

Other: _______________

Dove (specify)

5

Woodcock

Snipe

4

Rail

3

Swan (specify)

Snow/Ross’s
Goose

1

Canada Goose

Coot

Other duck
(specify)

Canvasback

Scaup

Redhead

2

Northern Pintail

Number in party:

Gadwall

Total Hours hunted:__________
American Wigeon

To: __________ am/pm

Mallard

Time: From:______ am/pm

Teal (specify)

Date of hunt: ________________________

Number
harvested
Number
knocked down
but not
retrieved

Comments:

Notice
In accordance with the Privacy Act (5 U.S. C. 552a) and the Paperwork Reduction Act (44 U.S. C. 3501), please note the following information:
1. We estimate the public reporting burden on the applicant for information collection to be 15 minutes. This burden estimate includes time for reviewing instructions, gathering and maintaining data and
completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service,
Mail Stop 23'0, U.S. Department of the Interior, 1849 C Street, NW, Washington D.C. 20240.
2. Routine use disclosures may be made: (a) to the U.S. Department of Justice when related to litigation or anticipated litigation; (b) of information indicating a violation or potential violation of a statute,
rule, order, or license to appropriate Federal, State, local, or foreign agencies responsible for investigating or prosecuting the violation or for enforcing or implementing the statute, rule, regulations, order,
or license; (c) from the record of the individual in response to an inquiry from a Congressional office made at the request of the individual (42 FR 19083; April 11, 1977); and (d) to provide addresses
obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a debtor to collect or compromise a Federal Claim against the debtor, or to consumer reporting agencies to
prepare a commercial credit report for use by the Department (48 FR 54716; December 6, 1983).
3. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. This information collection has
been approved by OMB and assigned control number 1018-0140.
FWS Form 3-2361
(12/11)