FH-PS(T) FHWAR Pre-Screener Questionnaire (Accompanies Panel 1 &

FH-PS(T) Attachment 11 OMB # and Expiration Date

2016 National Survey of Fishing, Hunting, and Wildlife-Associate Recreation

Pre-Screener Questionnaire

INSTRUCTIONS: You can help the U.S. Fish and Wildlife Service and state conservation agencies better manage our Nation’s natural resources and help us keep our costs down by completing this form and returning it within the next 2 weeks using the enclosed postage-paid envelope. This information will be kept strictly confidential and will be used only to contact you for this study.

Control Number:

011132001

Step 1

First Name:

Last Name:

Step 2 Address: We have your address listed as: 555 Main Street Anytown, XX 11111-xxxx 1 Address is correct (Skip to Step 4) 2 Address changes are needed (complete Step 3)

Step 3 If any part of the address in Step 2 is incorrect, please enter the correct information below.

Street Address

City

State

Zip/Postal Code

Step 4 Telephone Number: Telephone interviews are less costly than personal visits. Please provide a current telephone number below.

Evening telephone number

Daytime telephone number

(

)

_

(

)

_

Please check the correct box for evening telephone number. Home Cell Other

Please check the correct box for daytime telephone number. Home Cell Other

To help classify participating households, please respond to the following six questions by checking the correct box:

1. Have you or anyone in your household closely observed, fed, or photographed wildlife recreationally or maintained natural areas around your home for the benefit of wildlife in the past 5 years?

• Yes

• No

2. Do you or anyone in your household plan to closely observe, feed, or photograph wildlife recreationally or maintain natural areas around your home for the benefit of wildlife within the next 12 months?

• Yes

• No

3. Have you or anyone in your household hunted game or other wildlife recreationally in the past 5 years?

• Yes

• No

4. Do you or anyone in your household plan to hunt game or other wildlife recreationally within the next 12 months?

• Yes

• No

5. Have you or anyone in your household fished recreationally, including shell fishing, in the past 5 years?

• Yes

• No

6. Do you or anyone in your household plan to fish recreationally, including shell fishing, within the next 12 months?

• Yes

• No

Thank you for your participation in this important study!

For Office Use Only
Date	VC		1	2		3	4	5	6
Time
Int. Code		Specify: