Form 3-2056J Waterfowl Hunting Record

United States Department of the Interior
FISH AND WILDLIFE SERVICE
Division of Migratory Bird Management
10815 Loblolly Pine Drive, Laurel, MD 20708-4028
1-800-419-2965 (phone) 301-497-5981 (fax)
8/20/2012

11720001
11720001
JOHN Q PUBLIC
15942 DEER RIDGE DRIVE
MORRISON, CO 80465

Dear JOHN PUBLIC,
You have been selected to participate in this year's National Migratory Bird Harvest Survey. We only select a
small percentage of the nation's hunters for this annual survey, so your response is important EVEN IF YOU DO
NOT HUNT MIGRATORY BIRDS THIS SEASON.
We are asking you to tell us about your waterfowl hunting during the 2012 hunting season. Please use the
attached diary to record the details of your hunt each time you go waterfowl hunting in Colorado. Please read the
instructions on the diary form, fill it out completely. After the season is over or when you are done hunting in
Colorado, send the completed form back to us in the enclosed postage-paid envelope. If you receive this survey
too late for you to remember all of the details of your hunts, please fill out the lower portion of the form labeled
"SEASON TOTALS."
Your response is very important, whether you bag any birds or not. If you don’t hunt waterfowl at all this season,
please mark the “Did not hunt” box at the upper right portion of the form and return it to us. If you do hunt
waterfowl, please ONLY REPORT YOUR OWN PERSONAL HUNTING activity and harvest. We also ask
that you please keep track throughout the season of birds that you knocked down, but could not retrieve. Record
this total number on the lower portion of the form labeled "SEASON TOTALS."
To protect your privacy, we will not associate your name with your hunting records after the survey is completed.
If you have any questions or need more information about this survey, please write us at the above address, call us
toll-free at 1-800-419-2965 from 7:30am-4:00pm EST, or go to http://hip.fws.gov. You can request additional
forms through this website: http://migbirdapps.fws.gov/hipweb. Thank you in advance for your time and your
participation in this year's National Migratory Bird Harvest Survey.
Sincerely,

James B. Bortner, Chief
Division of Migratory Bird Management
In accordance with the Privacy Act (5 U.S.C.522a) and the Paperwork Reduction Act (44 U.S.C. 3501), please note the following information. This study is authorized by the Migratory Bird Treaty Act (16
U.S.C. 703 et seq.) The information that you provide will be used for estimating migratory bird hunter activity and harvest in the United States. It is our policy not to use your name for any other purpose. All
names and identifying information will be removed when we compile the results, and only summary information will be reported. The information is maintained in accordance with the Privacy Act. Your
response is voluntary. We estimate that it will take you about 5 minutes to read the instructions and keep a record of your hunting depending upon the number of times you hunt. An agency may not conduct or
sponsor, and a person is not required to respond to an information collection unless it displays a currently valid OMB control number. The information collection has been approved by OMB and assigned OMB
Control Number 1018-0023. Comments on this form should be mailed to the Information Collection Clearance Officer, Mail Stop 2042-PDM, U.S. Fish and Wildlife Service, Washington D.C. 20240.
Form 3-2056J
Rev. 04/11

OMB CONTROL NO. 1018-0023
Approval expires 4/30/2014

Waterfowl Hunting Record

1. IF YOU DID NOT HUNT DUCKS, GEESE, OR BRANT THIS SEASON, please check the box to the right and mail this form.
2. Please record your personal hunting activity for each day you hunted ducks, geese, or brant in the State specified in the
included letter. Record the number of birds you personally bagged; DO NOT include birds shot by other people. Please
include ALL of your hunts for the birds listed; if you did not bag any birds during a hunt, record zero (0) for the birds you
hunted that day.
3. IF YOU HUNTED DUCKS, GEESE, OR BRANT BUT DO NOT HAVE DETAILED RECORDS, check the box to the right
and go to question number 6 to record your Season Totals.
2 2
4. Please include additional comments on a SEPARATE SHEET of paper.

Please print all characters in BLACK ink using CAPITAL LETTERS ONLY as shown below.
Date of Hunt
Month
Day

State
of Hunt

County of Hunt

1

,

2

,

3

,

4

,

5

,

6

,

7

,

8

,

9

,

10

,

11

,

12

,

13

,

14

,

Number of Birds Killed
and Retrieved

Sea
Ducks Ducks

Geese

5. IF YOU RUN OUT OF SPACE ON THIS FORM, you can request an additional survey form by logging on to
https://migbirdapps.fws.gov/hipweb or calling
1-800-419-2965 from 7:30 am to 4:00 pm EST.
6. SEASON TOTALS:
We will ask you for the serial number located at
Birds
Birds
the bottom of this form.
Days
Killed and
Downed
Hunted

Retrieved

but Lost

Ducks

Please report banded birds by logging onto
www.reportband.gov or calling 1-800-327-BAND

Sea Ducks
Geese
Brant
code 39 barcode

hunter number

state name

print job identifier

Brant