3-2360 Fishing Report

U.S. Fish and Wildlife Service
1ational Wildlife Refuge System

Fishing Report

OMB Control Number
1018-0140
Expires

Name of Refuge: ______________________________

Fishing area (unit, zone, description): _______________________________________

Angler name: ___________________________________________

City, State, ZIP: ________________________________________________________

Date of fishing: ________________________

Time: From:______ am/pm

To: __________ am/pm

Total Hours fished:__________

Number in party:

2

3

4

5

Other: _____________

Crawfish

Crab

Other

Other
(Specify)

Shrimp

Redfish

Sea
Bass

Other
(Specify)

Salmon

Saltwater fish

Striped
Trout

Walleye

Trout

Bass

Perch

Sunfish

Crappie

Carp

Catfish

Freshwater Fish

1

Other
(Specify)

Number caught
Number released

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 3-2360
( xx/15)