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pdfCOMPREHENSIVE SUBSISTENCE SURVEY
GATES OF THE ARCTIC, ALASKA
Between January and December 2011
OMB Control Number: 1024 – NEW
Expiration Date: XX/XX/XXXX
HOUSEHOLD ID:
This survey is used to estimate subsistence harvests and to describe community
subsistence economies. We will publish a summary report, and send it to all
households in your community. We will share the community information with the
Alaska Department of Fish and Game, the U.S. Fish and Wildlife Service and the
National Park Service. We work with the Federal Regional Advisory Councils and
with local Fish and Game Advisory Committees to better manage subsistence, and
to implement federal and state subsistence priorities.
422
COMMUNITY ID:
RESPONDENT ID:
INTERVIEWER:
INTERVIEW DATE:
START TIME: STOP
TIME:
DATA CODED BY:
We will NOT identify your household. We will NOT use this information for
enforcement. Participation in this survey is voluntary. Even if you agree to be
surveyed, you may stop at any time.
DATA ENTERED BY:
SUPERVISOR:
PAPERWORK REDUCTION ACT STATEMENT: A federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information,
unless a currently valid OMB control number is displayed. 16 U.S.C. 1a‐7 authorizes collection of this information. This information will be used by the National Park
Service, the Federal Subsistence Management Program, and the Alaska Department of Fish and Game, Division of Subsistence to understand more about the
communities eligible to engage in subsistence in Gates of the Arctic National Park and Preserve. Response to this request is voluntary. Your name will not appear
anywhere on the completed survey and your responses will remain completely anonymous. The public reporting burden for completing individual interviews is
estimated to take 60 minutes. Please direct comments regarding any aspect of this collection to: Marcy Okada, Gates of the Arctic National Park and Preserve,
Subsistence and Ethnography Program, 4175 Geist Road, Fairbanks, Alaska 99709, [email protected] (e‐mail).
COOPERATING ORGANIZATIONS
GATES OF THE ARCTIC
NATIONAL PARK AND PRESERVE
DIVISION OF SUBSISTENCE
ALASKA DEPT OF FISH & GAME
4175 GEIST ROAD
FAIRBANKS, AK 99709
333 RASPBERRY ROAD
ANCHORAGE, AK 99518
907‐455‐0639
907‐267‐2353
Page 1 of 26
HOUSEHOLD MEMBERS
HOUSEHOLD ID
Between JANUARY and DECEMBER, 2011…
…who lived in your household?
ALASKA
NATIVE?
IN WHAT
YEAR WAS
THIS
PERSON
BORN?
WHERE WERE
PARENTS LIVING
WHEN THIS PERSON
WAS BORN?
HOW IS THIS
PERSON RELATED
TO HOUSEHOLD
HEAD 1?
HOW MANY
YEARS HAS
THIS PERSON
LIVED IN
GAAR?
WHAT IS THE
HIGHEST LEVEL
OF EDUCATION
ATTAINED?
(year)
(AK city or state)
(relation)
(number)
(number)
IS THIS PERSON
ANSWERING
QUESTIONS ON
THIS
MALE OR
FEMALE?
SURVEY?
ID#
(circle)
(circle)
(circle)
HEAD 1
Y N
M F
Y N
YRS
YRS
YRS
YRS
01
Enter spouse or partner next. If household has a SINGLE HEAD, leave HEAD 2 blank.
HEAD 2
Y N
M F
Y N
02
Enter children (oldest to youngest), grandchildren, grandparents, brothers, sisters, or anyone else living full‐time in this household.
03
Y N
M F
Y N
YRS
YRS
04
Y N
M F
Y N
YRS
YRS
05
Y N
M F
Y N
YRS
YRS
06
Y N
M F
Y N
YRS
YRS
07
Y N
M F
Y N
YRS
YRS
08
Y N
M F
Y N
YRS
YRS
09
Y N
M F
Y N
YRS
YRS
10
Y N
M F
Y N
YRS
YRS
11
Y N
M F
Y N
YRS
YRS
12
Y N
M F
Y N
YRS
YRS
13
Y N
M F
Y N
YRS
YRS
14
Y N
M F
Y N
YRS
YRS
15
Y N
M F
Y N
YRS
YRS
PERMANENT HH MEMBERS: 01
GATES OF THE ARCTIC: 422
Page 2 of 26
HOUSEHOLD ID
HOUSEHOLD MEMBER PARTICIPATION
Between JANUARY and DECEMBER, 2011…
…did this person...
Fish
PERSON
Large Land Mammals
Small Land Mammals
Furbearers
Birds & Eggs
Plants/Berries/Wood
ID# FROM
Process
Fish For
Process
Hunt
Process
Hunt/Trap
Process
Hunt/Gather
Process
Gather
Page 2
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
Head 1
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Head 2
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
03
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
04
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
05
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
06
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
07
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
08
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
09
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
10
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
11
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
12
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
13
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
14
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
15
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
PERMANENT HH MEMBERS: 01
GATES OF THE ARCTIC: 422
Page 3 of 26
HOUSEHOLD ID
HOUSEHOLD MEMBER PARTICIPATION
Between JANUARY and DECEMBER, 2011…
…did this person...
PERSON
Build Fish Wheels
Build Fish Traps
Build Dog Sleds
Sew Skins/Cloth
Cook Wild Foods
ID# FROM
Page 2
(circle)
(circle)
(circle)
(circle)
(circle)
Head 1
Y
N
Y
N
Y
N
Y
N
Y
N
Head 2
Y
N
Y
N
Y
N
Y
N
Y
N
03
Y
N
Y
N
Y
N
Y
N
Y
N
04
Y
N
Y
N
Y
N
Y
N
Y
N
05
Y
N
Y
N
Y
N
Y
N
Y
N
06
Y
N
Y
N
Y
N
Y
N
Y
N
07
Y
N
Y
N
Y
N
Y
N
Y
N
08
Y
N
Y
N
Y
N
Y
N
Y
N
09
Y
N
Y
N
Y
N
Y
N
Y
N
10
Y
N
Y
N
Y
N
Y
N
Y
N
11
Y
N
Y
N
Y
N
Y
N
Y
N
12
Y
N
Y
N
Y
N
Y
N
Y
N
13
Y
N
Y
N
Y
N
Y
N
Y
N
14
Y
N
Y
N
Y
N
Y
N
Y
N
15
Y
N
Y
N
Y
N
Y
N
Y
N
PERMANENT HH MEMBERS: 01
GATES OF THE ARCTIC: 244
Page 4 of 26
HOUSEHOLD ID
HARVESTS: COMMERCIAL SALMON FISHING
Do members of your household USUALLY participate in COMMERCIAL SALMON FISHING ?................................... Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household participate in commercial salmon fishing?......................................................... Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate the number of salmon ALL MEMBERS OF YOUR HOUSEHOLD REMOVED FROM COMMERCIAL HARVEST FOR PERSONAL USE OR SHARING in
2011. INCLUDE the fish you gave away, ate fresh, fed to dogs, lost to spoilage, caught as incidental catch while fishing for another species, or got by helping
others. If harvested with others, report ONLY YOUR SHARE of the catch.
IN 2011
DID MEMBERS OF
YOUR HH…
COMMERCIAL
FISH FOR
?
(circle)
CHINOOK (KING) SALMON
IN 2011, HOW MANY
DID YOU REMOVE
CATCH AS
IN 2011, HOW MANY
FROM THE CATCH &
INCIDENTAL
CATCH
?
WERE
REMOVED FOR YOUR
OWN USE?
GIVE AWAY TO CREW
OR OTHERS? CREW
OTHERS
(circle)
(number)
ID NUMBER FROM PAGE 2
(number)
Y
N
Y
N
IND
IND
IND
Y
N
Y
N
IND
IND
IND
Y
N
Y
N
IND
IND
IND
Y
N
Y
N
IND
IND
IND
Y
N
Y
N
IND
IND
IND
Y
N
Y
N
IND
IND
IND
PERMIT
HOLDER
CREW
(number)
(number)
113000000
SOCKEYE (RED) SALMON
115000000
COHO (SILVER) SALMON
112000000
CHUM (DOG) SALMON
111000000
PINK (HUMPIES) SALMON
114000000
UNKNOWN SALMON
119000000
COMMERCIAL SALMON FISHING: 03
GATES OF THE ARCTIC: 422
Page 5 of 26
HOUSEHOLD ID
HARVESTS: COMMERCIAL NON‐SALMON FISHING
Do members of your household USUALLY participate in COMMERCIAL NON‐SALMON FISHING ?....................................... Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household participate in commercial non‐salmon fishing?.............................................................. Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate the number of commercially harvested non‐salmon fish ALL MEMBERS OF YOUR HOUSEHOLD REMOVED FROM COMMERCIAL HARVEST FOR
PERSONAL USE OR SHARING in 2011. INCLUDE the fish you gave away, ate fresh, fed to dogs, lost to spoilage, caught as incidental catch while fishing for another
species, or got by helping others. If harvested with others, report ONLY YOUR SHARE of the catch.
IN 2011
DID MEMBERS OF
YOUR HH…
COMMERCIAL
FISH FOR
?
(circle)
HALIBUT
Y
IN 2011, HOW MANY
DID YOU REMOVE
CATCH AS
IN 2011, HOW MANY
FROM THE CATCH &
INCIDENTAL
CATCH
?
WERE
REMOVED FOR
GIVE AWAY TO CREW
OR OTHERS? CREW
OTHERS
(circle)
(number)
YOUR OWN USE?
ID NUMBER FROM
(number)
N
Y N
LBS
LBS
LBS
Y N
Y N
GAL
GAL
GAL
Y N
Y N
GAL
GAL
GAL
Y N
Y N
GAL
GAL
GAL
Y N
Y N
IND
IND
IND
Y N
Y N
IND
IND
IND
Y N
Y N
IND
IND
IND
Y N
Y N
IND
IND
IND
Y N
Y N
GAL
GAL
GAL
Y N
Y N
IND
IND
IND
IND
IND
IND
IND
IND
IND
PAGE 2
PERMIT
HOLDER
CREW
(number)
(number)
121800000
HERRING
120200000
HERRING SPAWN ON KELP
120306000
HERRING SAC ROE
120304000
PACIFIC COD (GRAY)
121004000
PACIFIC TOM COD
121008000
SCULPIN
123000000
STARRY FLOUNDER
121406000
SMELT
120400000
ROCKFISH
122600000
LAMPREY
Y N
Y N
Y N
Y N
122000000
LINGCOD
121606000
COMMERCIAL NON‐SALMON FISHING: 03
GATES OF THE ARCTIC: 422
Page 6 of 26
HOUSEHOLD ID
HARVESTS: COMMERCIAL MARINE INVERTEBRATE HARVEST
Do members of your household USUALLY participate in COMMERCIAL MARINE INVERTEBRATE HARVEST ?.................................................. Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household participate in commercial marine invertebrate harvest?........................................................................... Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate the commercially harvested marine invertebrates ALL MEMBERS OF YOUR HOUSEHOLD REMOVED FROM COMMERCIAL HARVEST in 2011. INCLUDE the
marine invertebrates you gave away, ate fresh, fed to dogs, lost to spoilage, caught as incidental catch while fishing for another species, or got by helping others. If
harvested with others, report ONLY YOUR SHARE of the catch.
IN 2011
DID MEMBERS OF
YOUR HH…
COMMERCIAL
FISH FOR
?
(circle)
TANNER CRAB
IN 2011, HOW MANY
DID YOU REMOVE
CATCH AS
IN 2011, HOW MANY
FROM THE CATCH &
INCIDENTAL
CATCH
?
WERE
REMOVED FOR
GIVE AWAY TO CREW
OR OTHERS? CREW
OTHERS
(circle)
(number)
YOUR OWN USE?
ID NUMBER FROM
(number)
Y
N
Y
N
LBS
LBS
LBS
Y
N
Y
N
LBS
LBS
LBS
Y
N
Y
N
GAL
GAL
GAL
Y
N
Y
N
GAL
GAL
GAL
Y
N
Y
N
IND
IND
IND
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PAGE 2
PERMIT
HOLDER
CREW
(number)
(number)
501012000
DUNGENESS CRAB
501004000
SHRIMP
503400000
SQUID
503800000
OCTOPUS
502200000
COMMERCIAL MARINE INVERTEBRATE HARVEST: 03
GATES OF THE ARCTIC: 422
Page 7 of 26
HARVESTS: SALMON
ID
HOUSEHOLD ID
(NON‐COMMERCIAL)
Do members of your household USUALLY harvest SALMON ?............................................................................................................Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST salmon?................................................................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many salmon ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED in 2011, including with a rod and reel. INCLUDE salmon you gave
away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If fishing with others, report ONLY YOUR SHARE of the catch. Do not include fish
caught and released.
IN 2011
IN 2011, HOW MANY
DID YOUR HOUSEHOLD…
DID MEMBERS OF
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
YOUR HH…
…CATCH
…CATCH
…CATCH
…CATCH
WITH A
FISH
WHEEL?
WITH A
WITH
ROD AND
REEL?
WITH
OTHER
GEAR?
(circle)
CHINOOK (KING) SALMON
DIPNET?
(number taken by each gear type)
UNITS
(ind, lbs)
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
113000000
SOCKEYE (RED) SALMON
115000000
COHO (SILVER) SALMON
112000000
CHUM (DOG) SALMON
111000000
PINK (HUMPIES) SALMON
114000000
LANDLOCKED SALMON
Kokanee
116000000
UNKNOWN SALMON
119000000
These columns should include all the harvests:
salmon HARVESTED by members of this
household in 2011.
ASSESSMENTS: SALMON
Between JANUARY and DECEMBER, 2011…
To conclude our salmon section, I am going to ask a few general questions about salmon
Last year…
…did your household use LESS, SAME, or MORE salmon than in recent years?................................................................ X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?............................................................
2
Last year…
…did your household GET ENOUGH salmon?............................................................................................................................ Y
N
If NO…
What KIND of salmon did you need?..................................................
How would you describe the impact to your household
of not getting enough salmon last year?.....................................
...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough salmon?.................................. Y
IF YES…
What did your household do differently?........................
SALMON :04
N
1
2
GATES OF THE ARCTIC: 422
Page 8 of 26
HARVESTS: OTHER FISH
HOUSEHOLD ID
(NON‐COMMERCIAL)
Do members of your household USUALLY harvest OTHER FISH ?................................................................................................Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST other fish?.....................................................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many other fish ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED in 2011, including with a rod and reel. INCLUDE other fish you
gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If fishing with others, report ONLY YOUR SHARE of the catch. Do not
include fish caught and released
IN 2011, HOW MANY
DID YOUR HOUSEHOLD…
IN 2011
DID MEMBERS OF
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
YOUR HH…
…CATCH
…CATCH
WITH
ROD AND
REEL?
WITH
OTHER
GEAR?
(number taken by each gear type)
(circle)
RAINBOW TROUT
…CATCH
WITH GILL
NET OR
SEINE?
UNITS
(ind, lbs)
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
126204000
LAKE TROUT
125010000
CUTTHROAT TROUT
126202000
TROUT
Unknown
126200000
DOLLY VARDEN
125006000
GRAYLING
125200000
PIKE
125400000
BURBOT
Ling Cod
124800000
ROUND WHITEFISH
126412000
HUMPBACK WHITEFISH
126408000
BROAD WHITEFISH
126404000
LEAST CISCO
126406060
UNKNOWN WHITEFISH
126400000
SUCKER
126000000
Continue on next page
OTHER FISH: 06
IND
Y N
These columns should include all the harvests:
other fish HARVESTED by members of this
household in 2011.
GATES OF THE ARCTIC: 422
Page 9 of 26
HARVESTS: OTHER FISH
HOUSEHOLD ID
(NON‐COMMERCIAL)
…continued
Please estimate how many other fish ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED in 2011 , including with a rod and reel. INCLUDE other fish you
gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If fishing with others, report ONLY YOUR SHARE of the catch. Do not include
fish caught and released.
IN 2011, HOW MANY
DID YOUR HOUSEHOLD…
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
IN 2011
DID MEMBERS OF
YOUR HH…
…CATCH
…CATCH
…CATCH
WITH GILL
NET OR
SEINE?
WITH
ROD AND
REEL?
WITH
OTHER
GEAR?
(circle)
HALIBUT
(number taken by each gear type)
UNITS
(ind, lbs)
Y N
Y N
Y N
Y N
LBS
Y N
Y N
Y N
Y N
GAL
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
GAL
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
121800000
HERRING
120200000
PACIFIC COD (GRAY)
121004000
PACIFIC TOM COD
121008000
STARRY FLOUNDER
121406000
SMELT
120400000
ROCKFISH
122600000
LAMPREY
122000000
LINGCOD
121606000
These columns should include all the harvests:
other fish HARVESTED by members of this
household in 2011.
OTHER FISH
Between JANUARY and DECEMBER, 2011…
To conclude our other fish section, I am going to ask a few general questions about other fish.
Last year…
…did your household use LESS, SAME, or MORE other fish than in recent years?............................................................. X L S M
If LESS or MORE…
X = do not use
WHY was your use different?............................................................
Last year…
…did your household GET ENOUGH other fish?......................................................................................................................... Y
If NO…
What KIND of other fish did you need?...............................................
How would you describe the impact to your household
of not getting enough other fish last year?..................................
...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough other fish?...............................
IF YES…
What did your household do differently?.........................
OTHER FISH: 06
N
Y
N
1
2
GATES OF THE ARCTIC 422
Page 10 of 26
HOUSEHOLD ID
HARVESTS: MARINE INVERTEBRATES/SHELLFISH
Do members of your household USUALLY harvest MARINE INVERTEBRATES/SHELLFISH ?..............................................................Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST marine invertebrates/shellfish ?..........................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many marine invertebrates/shellfish ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED in 2011. INCLUDE marine
invertebrates/shellfish you gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If fishing with others, report ONLY YOUR SHARE of
the catch.
IN 2011
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
DID MEMBERS OF
YOUR HH…
IN 2011, HOW MANY
DID YOUR HOUSEHOLD HARVEST?
(circle)
DUNGENESS CRAB
UNITS
(ind, lbs,gal)
(number taken)
Y N
Y N
Y N
Y N
LBS
Y N
Y N
Y N
Y N
LBS
Y N
Y N
Y N
Y N
LBS
Y N
Y N
Y N
Y N
GAL
Y N
Y N
Y N
Y N
GAL
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
501004000
KING CRAB
501008000
TANNER CRAB
501012000
RAZOR CLAMS
500612000
FRESHWATER CLAMS
500604000
These columns should include all the harvests:
marine invertebrates/shellfish HARVESTED by
members of this household in 2011.
MARINE INVERTEBRATES/SHELLFISH
Between JANUARY and DECEMBER, 2011…
To conclude our marine invertebrates/shellfish section, I am going to ask a few general questions about marine invertebrates/shellfish.
Last year…
…did your household use LESS, SAME, or MORE marine invertebrates/shellfish than in recent years?............................ X L S M
If LESS or MORE…
X = do not use
WHY was your use different?............................................................
Last year…
…did your household GET ENOUGH marine invertebrates/shellfish?........................................................................................ Y
If NO…
What KIND of marine invertebrates/shellfish did you need?..............
How would you describe the impact to your household
of not getting enough marine invertebrates/shellfish last year?.
...minor?
(1)
...major?
(2)
N
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough marine invertebrates/shellfish Y
IF YES…
What did your household do differently?.........................
MARINE INVERTEBRATES/SHELLFISH: 08
GATES OF THE ARCTIC: 422
Page 11 of 26
HOUSEHOLD ID
HARVESTS: LARGE LAND MAMMALS
Do members of your household USUALLY hunt for LARGE LAND MAMMALS?......................................................................................................Y.
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST large land mammals?...............................................................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many large land mammals ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED in 2011. INCLUDE large land mammals you gave
away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting with others, report ONLY YOUR SHARE of the catch.
IN 2011
IN 2011, HOW MANY
DID
MEMBERS OF YOUR HOUSEHOLD HARVEST?
DID MEMBERS OF
TRY
GIVE
YOUR HH…
(circle)
MOOSE
UNITS
(enter number by sex and month of take)
(ind)
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
IND
211800000
211800001
211800002
211800009
CARIBOU
IND
211000000
211000001
211000002
211000009
BLACK BEAR
210600000
BROWN BEAR
210800000
DALL SHEEP
212200000
GOAT
211600000
DEER
211200000
BISON
210400000
LARGE LAND MAMMALS
Between JANUARY and DECEMBER, 2011…
To conclude our large land mammals section, I am going to ask a few general questions about large land mammals.
Last year…
…did your household use LESS, SAME, or MORE large land mammals than in recent years?...................................... X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?............................................................
2
Last year…
…did your household GET ENOUGH large land mammals?.................................................................................................. Y
If NO…
What KIND of large land mammals did you need?.................................
How would you describe the impact to your household of not
getting enough large land mammals last year?....................
...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough large land mammals?....... Y
IF YES…
What did your household do differently?.........................
LARGE LAND MAMMALS: 10
N
N
1
2
GATES OF THE ARCTIC: 422
Page 12 of 26
HOUSEHOLD ID
HARVESTS: MARINE MAMMALS
Do members of your household USUALLY hunt for MARINE MAMMALS for subsistence?................................................................. Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST marine mammals?................................................................................. Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many marine mammals ALL MEMBERS OF YOUR HOUSEHOLD HARVEST EACH MONTH for subsistence use this year. INCLUDE
marine mammals you gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting with others, report ONLY YOUR SHARE of
the catch.
HARBOR SEAL
(circle)
(enter number by sex and month of take)
301200000
301200001
301200002
301200009
SEA OTTER
301000000
FUR SEAL
UNITS
(ind)
(circle)
L S M ?
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
IND
L S M ?
Y N
Y N
Y N
Y N
IND
L S M ?
Y N
Y N
Y N
Y N
IND
L S M ?
Y N
Y N
Y N
Y N
IND
L S M ?
Y N
Y N
Y N
Y N
IND
L S M ?
IND
300806000
300806001
300806002
300806009
STELLER SEA LION
WERE LESS, SAME,
OR MORE
AVAILABLE IN 2011,
THAN IN RECENT
YEARS?
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
AUGUST
SEPTEMBER
JULY
JUNE
MAY
APRIL
MARCH
FEBRUARY
JANUARY
SEX
IN 2011, HOW MANY
DID MEMBERS OF
YOUR HOUSEHOLD HARVEST?
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
IN 2011
DID MEMBERS OF
YOUR HH…
L S M ?
IND
300804000
300804001
300804002
300804009
WHALE (SPECIFY)
301600000
WALRUS
301400000
" ? " means
"I don't know"
MARINE MAMMALS
Between JANUARY and DECEMBER, 2011…
To conclude our section, I am going to ask a few general questions about .
Last year…
…did your household use LESS, SAME, or MORE than in recent years?...........................................................................
If LESS or MORE… WHY was your use
different?...............................................
X L S M
X = do not use
Last year…
…did your household GET ENOUGH ?..................................................................................................................................
If NO…
What KIND of did you need?...............................................
How would you describe the impact to your household of not
getting enough marine mammals last year?........ ...minor?
(1)
N
...major?
(2)
Did your household do anything DIFFERENTLY because you did NOT get enough ?................
IF YES…
What did your household do differently?...
MARINE MAMMALS: 12
Y
Y
N
GATES OF THE ARCTIC: 422
Page 13 of 26
HOUSEHOLD ID
HARVESTS: SMALL LAND MAMMALS OR FURBEARERS
Do members of your household USUALLY hunt or trap for SMALL LAND MAMMALS OR FURBEARERS for subsistence?.............................Y.
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST small land mammals or furbearers?................................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many small land mammals or furbearers ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED EACH MONTH in 2011. INCLUDE
small land mammals or furbearers you gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting or trapping with
others, report ONLY YOUR SHARE of the catch.
(circle)
BEAVER
(enter number by month of take)
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
JULY
JUNE
MAY
APRIL
MARCH
FEBRUARY
JANUARY
SEX
IN 2011, HOW MANY _________DID MEMBERS OF YOUR
HOUSEHOLD HARVEST EACH MONTH?
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
IN 2011
DID MEMBERS OF
YOUR HH…
UNITS
(ind)
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
220200000
PORCUPINE
222600000
SNOWSHOE HARE
221004000
RED FOX
220804000
CROSS FOX
220804020
WOLF
223200000
WOLVERINE
223400000
LAND OTTER
221200000
MUSKRAT
222400000
WEASEL
223000000
LYNX
221600000
Continue on next page
SMALL LAND MAMMALS: 14
GATES OF THE ARCTIC: 422
Page 14 of 26
HOUSEHOLD ID
HARVESTS: SMALL LAND MAMMALS OR FURBEARERS
....continued
Please estimate how many small land mammals or furbearers ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED EACH MONTH in 2011. INCLUDE small land
mammals or furbearers you gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting or trapping with others, report ONLY YOUR
SHARE of the catch.
MARTEN
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
JULY
MAY
JUNE
APRIL
MARCH
JANUARY
SEX
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
(circle)
FEBRUARY
IN 2011, HOW MANY
DID MEMBERS
OF YOUR HOUSEHOLD HARVEST EACH MONTH?
IN 2011
DID MEMBERS OF
YOUR HH…
(enter number by month of take)
UNITS
(ind)
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
Y N
Y N
Y N
Y N
IND
222000000
COYOTE
220400000
MINK
222200000
MARMOT
221800000
GROUND SQUIRREL
222800000
TREE SQUIRREL
222804000
SMALL LAND MAMMALS OR FURBEARERS
Between JANUARY and DECEMBER, 2011…
To conclude our small land mammals or furbearers section, I am going to ask a few general questions about small land mammals or furbearers.
Last year…
…did your household use LESS, SAME, or MORE small land mammals or furbearers than in recent years?.............................. X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?............................................................
2
Last year…
…did your household GET ENOUGH small land mammals or furbearers?........................................................................................ Y
If NO…
What KIND of small land mammals or furbearers did you need?......................
How would you describe the impact to your household
of not getting enough small land mammals or furbearers last year?.......... ...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough small land mammals or furbearers?......... Y
IF YES…
What did your household do differently?.........................
SMALL LAND MAMMALS: 14
N
N
1
2
GATES OF THE ARCTIC: 422
Page 15 of 26
HOUSEHOLD ID
HARVESTS: MIGRATORY WATERFOWL
Do members of your household USUALLY hunt for MIGRATORY WATERFOWL?...................................................................................................Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST migratory waterfowl?..............................................................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many migratory waterfowl ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED DURING EACH SEASON in 2011. INCLUDE migratory
waterfowl you gave away, ate fresh, lost to spoilage, or got by helping others. If hunting with others, report ONLY YOUR SHARE of the catch.
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
JULY
JUNE
MAY
APRIL
MARCH
FEBRUARY
JANUARY
IN 2011, HOW MANY
DID MEMBERS OF
YOUR HOUSEHOLD HARVEST DURING EACH SEASON?
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
IN 2011
DID MEMBERS OF
YOUR HH…
(circle)
CANADA GEESE (CACKLERS)
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
410404040
CANADA GEESE (BIG LESSER)
410404080
CANADA GEESE (UNKNOWN)
410404000
WHITE‐FRONTED GEESE
Specklebelly
410410000
SPECTACLED EIDER
410206060
BRANT (SEA GEESE)
410402000
EMPEROR GEESE
410406000
SNOW GEESE
410408000
GEESE (UNKNOWN)
410400000
TUNDRA SWAN (WHISTLING)
410604000
SANDHILL CRANE
410802000
MALLARD
410214000
NORTHERN PINTAIL
410220000
Continue on next page.
MIGRATORY WATERFOWL: 15
GATES OF THE ARCTIC: 422
Page 16 of 26
HOUSEHOLD ID
HARVESTS: MIGRATORY WATERFOWL
...continued
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
JULY
JUNE
MAY
APRIL
MARCH
JANUARY
GIVE AWAY?
RECEIVE?
TRY TO HARVEST?
USE?
FEBRUARY
IN 2011, HOW MANY ______________DID MEMBERS OF YOUR
HOUSEHOLD HARVEST DURING EACH SEASON?
IN 2011
DID MEMBERS OF
YOUR HH…
(circle)
GOLDENEYE
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
410210000
GREEN WINGED TEAL
410232060
CANVASBACK
410204000
BLACK SCOTER (BLACK DUCK)
410228020
DUCKS (UNKNOWN)
410200000
MIGRATORY WATERFOWL
Between JANUARY and DECEMBER, 2011…
To conclude our migratory waterfowl section, I am going to ask a few general questions about migratory waterfowl.
Last year…
…did your household use LESS, SAME, or MORE migratory waterfowl than in recent years?........................................ X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?............................................................
2
Last year…
…did your household GET ENOUGH migratory waterfowl?...................................................................................................
If NO…
What KIND of migratory waterfowl did you need?...........................
How would you describe the impact to your household
of not getting enough migratory waterfowl last year?..............
...minor?
(1)
...major?
(2)
Y
N
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough migratory waterfowl?..........
Y
IF YES…
What did your household do differently?.......................
MIGRATORY WATERFOWL: 15
GATES OF THE ARCTIC: 422
Page 17 of 26
HOUSEHOLD ID
HARVESTS: OTHER BIRDS
Do members of your household USUALLY hunt for OTHER BIRDS?..........................................................................................................................Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST other birds?................................................................................................................Y
N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many other birds ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED DURING EACH SEASON in 2011. INCLUDE other birds you
gave away, ate fresh, lost to spoilage, or got by helping others. If hunting with others, report ONLY YOUR SHARE of the catch.
IN 2011, HOW MANY _____________DID MEMBERS OF YOUR
IN 2011
DID MEMBERS OF
HOUSEHOLD HARVEST DURING EACH SEASON?
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
JULY
JUNE
MAY
APRIL
MARCH
FEBRUARY
JANUARY
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
YOUR HH…
(circle)
PTARMIGAN
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
421804000
SPRUCE GROUSE
421802020
OTHER BIRDS
Between JANUARY and DECEMBER, 2011…
To conclude our other birds section, I am going to ask a few general questions about other birds.
Last year…
…did your household use LESS, SAME, or MORE other birds than in recent years?........................................................ X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?............................................................
2
Last year…
…did your household GET ENOUGH other birds?.................................................................................................................... Y
N
If NO…
What KIND of other birds did you need?...........................................
How would you describe the impact to your household
of not getting enough other birds last year?..............................
...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough other birds?......................... Y
IF YES…
What did your household do differently?.......................
OTHER BIRDS: 15
N
1
2
GATES OF THE ARCTIC: 422
Page 18 of 26
HOUSEHOLD ID
HARVESTS: BIRD EGGS
Do members of your household USUALLY look for BIRD EGGS?...........................................................................................................................Y N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO GATHER bird eggs?.................................................................................................................Y N
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many bird eggs ALL MEMBERS OF YOUR HOUSEHOLD GATHERED DURING EACH SEASON in 2011. INCLUDE bird eggs you gave
away, ate fresh, lost to spoilage, or got by helping others. If looking with others, report ONLY YOUR SHARE of the eggs.
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
JULY
JUNE
MAY
APRIL
MARCH
JANUARY
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
FEBRUARY
IN 2011, HOW MANY
DID MEMBERS OF
YOUR HOUSEHOLD GATHER DURING EACH SEASON?
IN 2011
DID MEMBERS OF
YOUR HH…
(circle)
GULL EGGS
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
431212000
GEESE EGGS
430400000
DUCK EGGS
430200000
EGGS (UNKNOWN)
430000000
EGGS
Between JANUARY and DECEMBER, 2011…
To conclude our eggs section, I am going to ask a few general questions about resource name.
Last year…
…did your household use LESS, SAME, or MORE eggs than in recent years?................................................................. X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?............................................................
2
Last year…
…did your household GET ENOUGH eggs?............................................................................................................................ Y
N
If NO…
What KIND of eggs did you need?..................................................
How would you describe the impact to your household
of not getting enough eggs last year?........................................
...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough eggs?................................... Y
IF YES…
What did your household do differently?.......................
BIRD EGGS: 15
N
1
GATES OF THE ARCTIC: 422
Page 19 of 26
HOUSEHOLD ID
HARVESTS: PLANTS AND BERRIES INCLUDING WOOD
Do members of your household USUALLY harvest PLANTS AND BERRIES INCLUDING WOOD?.................................................................................
Y
N
Y
N
Between JANUARY and DECEMBER, 2011…
…Did members of your household USE or TRY TO HARVEST plants and berries including wood?..............................................................................
IF NO, go to the next harvest page.
If YES, continue on this page…
Please estimate how many plants and berries including wood ALL MEMBERS OF YOUR HOUSEHOLD HARVESTED in 2011. INCLUDE plants and berries including wood
you gave away, ate fresh, lost to spoilage, or got by helping others. If harvesting with others, report ONLY YOUR SHARE of the harvest.
IN 2011
DID MEMBERS OF
IN 2011, HOW MANY
GIVE AWAY?
RECEIVE?
TRY TO
HARVEST?
USE?
YOUR HH…
(circle)
BLUEBERRY
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
DID MEMBERS OF
YOUR HOUSEHOLD
HARVEST?
UNITS/NOTES
(number)
(each, gallons, buckets, etc.)
601002000
LOW BUSH CRANBERRY
601004000
HIGH BUSH CRANBERRY
601006000
RASPBERRY
601020000
OTHER BERRIES
(List)
601000000
HUDSON BAY TEA
Labrador Tea
602018000
MUSHROOMS
602040000
OTHER PLANTS
(List)
602000002
WOOD
Firewood
604000000
WOOD
(Specify Use)
604000002
PLANTS AND BERRIES
Between JANUARY and DECEMBER, 2011…
To conclude our plants and berries section, I am going to ask a few general questions about plants and berries.
Last year…
X L S M
…did your household use LESS, SAME, or MORE plants and berries than in recent years?....................................................
If LESS or MORE…
X = do not use
WHY was your use different?............................................................
Last year…
…did your household GET ENOUGH plants and berries?................................................................................................................ Y
If NO…
What KIND of plants and berries did you need?.................................................
How would you describe the impact to your household
of not getting enough plants and berries last year?..................................... ...minor?
(1)
...major?
(2)
N
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough plants and berries?..................... Y
IF YES…
What did your household do differently?.........................
PLANTS AND BERRIES: 17
GATES OF THE ARCTIC: 422
Page 20 of 26
HOUSEHOLD ID
ASSESSMENTS
WILD RESOURCES
Between JANUARY and DECEMBER, 2011…
To conclude our wild resources section, based on everything we’ve talked about, wild resources will include any of the resources we’ve talked about
so far. Now, I am going to ask a few questions about wild resources in general. Last year…
…did your household use LESS, SAME, or MORE wild resources than in recent years?....................................................... X L S M
If LESS or MORE…
X = do not use
1
WHY was your use different?..........................................................
2
Last year…
…did your household GET ENOUGH wild resources?................................................................................................................... Y
N
If NO…
What KIND of wild resources did you need?...................................
How would you describe the impact to your household
of not getting enough wild resources last year?....................
...minor?
(1)
...major?
(2)
severe?
(3)
Did your household do anything DIFFERENTLY because you did NOT get enough wild resources?.........................
IF YES…
Y
N
1
2
What did your household do differently?....................
HEALTH IMPACT ASSESSMENTS
Now I am going to ask you some questions about the foods your family normally eats. The purpose of these questions is to identify the
most commonly eaten subsistence foods and the foods you most commonly eat if you are not eating subsistence foods. We do not care if
you harvest the foods, receive them from others or purchase them at the store, just what you most commonly eat.
In a normal week, how many times a day on average are subsistence foods such as salmon, non‐salmon fish, moose, caribou, birds, etc.
served in your household?
None ‐ don't use
less than 1 time per day
1 time per day
2 times per day
3 times per day
more than 3 times a day
Please list the top five subsistence foods you eat in your household on a regular basis. Think about those foods that may not be
important now but are important at other times of the year as well.
If you cannot get subsistence foods, what do you eat instead?
ASSESSMENTS
GATES OF THE ARCTIC: 422
Page 21 of 26
HOUSEHOLD ID
FOOD SECURITY
The questions on this page have been asked all over the United States to find out if Americans have enough to eat. We would like to know if
people in your village have enough to eat. I am going to read you five statements about different food situations. Please tell me whether EACH
statement was true for your household (HH) in the last 12 months.
Think about all your household's food, both subsistence and store‐
bought…
STATEMENT 1. We WORRIED that our household would not have ENOUGH FOOD.
In the last 12 months, was this OFTEN true, SOMETIMES true, or NEVER true for your household?....................... [ 1 ] Often True
HH2
[ 2 ] Sometimes True
[ 3 ] Never True
STATEMENT 2. The food we had JUST DID NOT LAST, and we could not get more.
In the last 12 months, was this OFTEN true, SOMETIMES true, or NEVER true for your household?....................... [ 1 ] Often True
HH3
[ 2 ] Sometimes True
[ 3 ] Never True
STATEMENT 3. We could not get the foods we wanted to eat because of a LACK OF RESOURCES. By "lack of resources," we mean your
household did NOT have what you needed to hunt, fish, gather, or buy food. In the last 12 months, was this OFTEN true, SOMETIMES true, or
NEVER true for your household?.......................
[ 1 ] Often True
HH4
[ 2 ] Sometimes True
[ 3 ] Never True
Now, think just about your household's SUBSISTENCE food…
STATEMENT 4. The SUBSISTENCE food we had just did not last, and we could not get more. In the last 12 months, was this ever true for your
household?................................................................................
N
Y
If YES, in which months did this happen?.................................................................................................................. J
?
F MAM J J A S ON D
Now, think just about your household's STORE‐BOUGHT food…
STATEMENT 5. The STORE‐BOUGHT food we had just did not last, and we could not get more.
In the last 12 months, was this ever true for your household?.................................................................................
If YES, in which months did this happen?..................................................................................................................
N
J
Y
?
FMAM J J A S ON D
If Statement 1, Statement 2, AND Statement 3 were NEVER TRUE, go to the next page.
If Statement 1, Statement 2, OR Statement 3 was SOMETIMES TRUE or OFTEN TRUE, continue on this page…
In the last 12 months, did you or other adults in your household ever CUT THE SIZE OF YOUR MEALS OR SKIP
MEALS because the HH could not get the food that was needed?...........................................................................
AD1
N
Y
?
If YES, how often did this happen?................................................................................................................... [ 1 ] Almost every month
[ 2 ] Some months…
[ 3 ] Only 1 or 2 months
In the last 12 months, did you or other adults in your household ever EAT LESS THAN YOU FELT YOU SHOULD
because the HH could not get the food that was needed?.......................................................................................
N
Y
?
AD2
In the last 12 months, were adults in the HH ever HUNGRY BUT DID NOT EAT because there was not
enough food?............................................................................................................................................................
N
Y
?
In the last 12 months, did adults in the HH LOSE WEIGHT because there was not enough food?...........................
N
Y
?
In the last 12 months, did you or other adults in your household ever NOT EAT FOR A WHOLE DAY
because there was not enough food?.......................................................................................................................
N
Y
?
AD3
AD4
AD5
If YES, how often did this happen?................................................................................................................... [ 1 ] Almost every month
[ 2 ] Some months…
[ 3 ] Only 1 or 2 months
FOOD SECURITY: 201
GATES OF THE ARCTIC: 422
Page 22 of 26
ADDITIONAL ASSESSMENTS
HOUSEHOLD ID
Resource Health
During 2011, were there any resources that your household avoided harvesting due to poor resource health? If YES, which resources did you
avoid and why?
Transportation and Motorized Equipment
During 2011, did members of your household use the following when harvesting or attempting to harvest wild foods
Boat
Snowmachine
4‐wheeler/ORV
Airplane
Dogsled
circle
Y N
Y N
Y
N
Y
N
Y
N
Does your household own, borrow, lease, or charter this equipment?
Boat
Snowmachine
4‐wheeler/ORV
Airplane
Dogsled
Own
Borrow
Lease
Charter
Circle only responses that the respondent answered yes to above.
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Comments:
During 2011, did members of your household use the following portable motors or motorized equipment when harvesting or attempting to
harvest wild foods?
circle
Y N
Chainsaw
Y N
Ice auger
Y N
Winch
Y N
Generator
Y N
Other
Heating
What proportion of your household's heating comes from firewood?
circle
In the past 5 years has your harvest area for firewood changed?
0%
1‐25%
26‐50%
51‐75%
76‐99%
100%
circle
Y N
If yes, please explain why?
How much do you spend annually to heat your home?
$
Handicrafts
During 2011, did members of your household participate in the making of handicrafts using the following materials?
Birchbark
Horns
Antlers
Other natural material (specify)
ADDITIONAL ASSESSMENTS
circle
Y
N
Y
N
Y
N
Y N
GATES OF THE ARCTIC: 422
Page 23 of 26
JOBS
HOUSEHOLD ID
FOR EACH PERSON IN THE HOUSEHOLD, 16 YEARS OLD AND OLDER
Between JANUARY and DECEMBER, 2011…
…Did any members of your household earn money from a JOB or from SELF EMPLOYMENT?........................................................................................................... Y
N
For each member of this household born before 1996, please list EACH JOB held between JANUARY and DECEMBER, 2011.
For household members who did not have a job, write: "RETIRED," "UNEMPLOYED," "STUDENT," "HOMEMAKER," etc.
There should be at least ONE ROW for each member of this household born BEFORE 1996.
WORK SCHEDULE…
We ask about jobs and income because we are trying to understand all
parts of the community economy. Many people use wages from jobs to
support subsistence activities. If one person has more than one job, list
each job on a separate line. (One person may have several lines.)
REMEMBER COMMERCIAL
IN 2011, WHAT
DID HE/SHE
MONTHS DID HE OR
THIS
HE/SHE DO
WORK IN
JOB?
IN THIS JOB?
person
job title
THIS JOB?
employer, SIC
JOB
LOCATION?
community
1ST JOB
1 6 910100000
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
J F MA M J J A S O N D
SOC
FT PT SF OC SP $
/ YR
FT PT SF OC SP $
/ YR
FT PT SF OC SP $
/ YR
FT PT SF OC SP $
/ YR
FT PT SF OC SP $
/ YR
FT PT SF OC SP $
/ YR
FT PT SF OC SP $
/ YR
SCHEDULE
J F MA M J J A S O N D
SOC
If a person is SELF-EMPLOYED (selling carvings,
crafts, bread, etc), list that as a separate job. Enter
"sewer," "carver," "baker," etc. as JOB TITLE. Work
schedule usually will be "ON CALL." For gross
income from self employment ("profit"), enter
revenue MINUS expenses.
/ YR
SCHEDULE
12TH JOB
12 6 910100000
FT PT SF OC SP $
SCHEDULE
11TH JOB
11 6 910100000
/ YR
SCHEDULE
10TH JOB
10 6 910100000
FT PT SF OC SP $
SCHEDULE
9TH JOB
9 6 910100000
/ YR
SCHEDULE
8TH JOB
8 6 910100000
FT PT SF OC SP $
SCHEDULE
7TH JOB
7 6 910100000
/ YR
SCHEDULE
6TH JOB
6 6 910100000
THIS JOB?
gross income
SCHEDULE
5TH JOB
5 6 910100000
FT PT SF OC SP $
MUCH DID
HE/SHE EARN IN
SCHEDULE
4TH JOB
4 6 910100000
circle one
IN 2011, HOW
SCHEDULE
3RD JOB
3 6 910100000
JOB?
circle each month worked
J F MA M J J A S O N D
2ND JOB
2 6 910100000
SHE WORK IN THIS
ON‐CALL, VARIES
FOR WHOM
WORK DID
SHIFT ‐ FULL TIME
WHAT KIND OF
HAD
PART TIME
WHO
FULL TIME
APPLICABLE.
SHIFT ‐ PART TIME
FISHING & TRAPPING IF
FT PT SF OC SP $
/ YR
SCHEDULE
If a person is UNEMPLOYED, specify retired, unemployed,
disabled, student, or homemaker as the JOB TITLE.
TRAPPING for barter or sale IS a job.
COMMERCIAL FISHING is recorded as "ON-CALL, VARIES" for
work schedule.
EMPLOYMENT: 23
WORK SCHEDULE
1 - Fulltime (35+
hours/week)
2 - Parttime (<35
hours/week)
3 - Shift (2 wks on/2
off, etc.)
4 - Irregular, on call
GROSS
INCOME
is the same as
TAXABLE
INCOME
on a W -2 form.
GATES OF THE ARCTIC: 422
Page 24 of 26
OTHER INCOME
HOUSEHOLD ID
THIS PAGE IS ONLY FOR INCOME THAT IS NOT EARNED FROM WORKING
Between JANUARY and DECEMBER, 2011…
…Did any members of your household receive a dividend from the Permanent Fund or a Native Corporation?..................................................
Y
N
IF NO, go to the next section on this page.
If YES, continue below…
ALASKA PFD IN
DOYON LIMITED DIVIDENDS IN
DID ANYONE
TOTAL
IN YOUR HH
AMOUNT ALL
RECEIVE
MEMBERS OF
1 PFD =
INCOME
YOUR HH
2 PFDs =
100 shrs=
150 shrs=
200 shrs=
RECEIVED
3 PFDs =
IN 2011?
IN 2011?
4 PFDs =
(circle one)
(dollars)
5 PFDs =
FROM
ALASKA PERMANENT
Y
FUND DIVIDEND
N
$
1 share=
6 PFDs =
/YR
7 PFDs =
8 PFDs =
32
NATIVE CORPORATION
Y
DIVIDENDS
N
$
9 PFDs =
/YR
10 PFDs =
13
11 PFDs =
Between JANUARY and DECEMBER, 2011…
…Did any members of your household receive OTHER income such as SENIOR BENEFITS or UNEMPLOYMENT?.................................................
Y
N
IF NO, go to the next page.
If YES, continue below…
UNEMPLOYMENT
RECEIVED
TOTAL AMOUNT
IN 2011?
IN 2011?
(circle one)
(dollars)
scratch paper for calculations
Y
N
$
/YR
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
/YR
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
/YR
$
$
per week
per month
for
for
weeks =
months =
$
$
per week
per month
for
for
weeks =
months =
JOB
12
WORKERS'
COMPENSATION
8
FOOD STAMPS
(QUEST CARD)
11
ADULT
PUBLIC ASSISTANCE
Y
N
$
/YR
Y
N
$
/YR
3
ALASKA SENIOR
BENEFITS (LONGEVITY)
Depends
6
ELDER
PENSION &
RETIREMENT
$
/YR
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
/YR
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
/YR
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
/YR
$
$
per week
per month
for
for
weeks =
months =
Y
N
$
/YR
Y
N
$
/YR
/YR
10
CHILD
FOSTER
CARE
41
CHILD
SUPPORT
15
ENERGY
ASSISTANCE
$250 per month for 12 months = $3,000 per elder
N
7
SUPPLEMENTAL
SECURITY
$175 per month for 12 months = $2,100 per elder
Income
Y
5
SOCIAL
SECURITY
$125 per month for 12 months = $1,500 per elder
on
9
OTHER (describe)
OTHER INCOME: 24
GATES OF THE ARCTIC: 422
25
HOUSEHOLDID-
DO YOU HAVE ANY QUESTIONS, COMMENTS, OR CONCERNS?
INTERVIEW SUMMARY
BE SURE TO FILL IN THE STOP TIME ON THE FIRST PAGE!!!!
COMMENTS 30
GATES OF THE ARCTIC 422
26
| File Type | application/pdf |
| File Title | GAAR Communities OMB Mock 11 8 11.xlsx |
| Author | dlholen |
| File Modified | 2011-12-13 |
| File Created | 2011-12-13 |