Form 3-2359 Big Game Harvest Report

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

Big Game Harvest Report

OMB Control Number
1018-0140
Expires

Name of Refuge: ______________________________
Hunt area (unit, zone, description): ____________________________________________________________
Hunter name:

___________________________________________________________________________

City, State, ZIP: ___________________________________________________________
Date of hunt: ________________________

Time: From:______ am/pm to: __________ am/pm

Total Hours hunted:__________
Number in party (please circle):

1

2

3

Species

Deer

Note: Not all species are hunted on this refuge.
Check refuge regulations for details.

4

5

Number harvested

other: ________________
Male/Female

Size*

Feral Hog
Turkey
Other (specify):
*points, approximate weight, beard length or other appropriate measure.

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 BPHC, 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 3-2359
(xx/15)