Download:
pdf |
pdfCOMPREHENSIVE WILD FOOD HARVEST SURVEY
SURVEY COMMUNITY
COMPREHENSIVE
SURVEY COMMUNITY, ALASKA
From January 1, 2015 to December 31, 2015
OMB# 1024-0262
Expiration date: 04/30/2015
This survey is used to estimate wild food harvests and to
describe rural community economies. We will publish a summary
report, and send it to all households in your community. We
share this 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 wild food resources.
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 skip
questions or stop at any time.
HOUSEHOLD ID:
COMMUNITY ID:
INTERVIEWER 1:
INTERVIEWER 2:
INTERVIEW DATE:
START TIME:
STOP TIME:
DATA CODED BY:
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. 54 U.S.C.100101 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 Wrangell-St. Elias National Park and Preserve. Response to this request is voluntary. Your name will not appear
anywhere on the completed survey and your responses will be 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:
Barbara Cellarius, Wrangell-St. Elias National Park and Preserve, Resources Division, Mile 106.8 Richardson Highway, P.O. Box 439, Copper Center, AK
99573, Barbara [email protected] (email).
COOPERATING ORGANIZATIONS
GATES OF THE ARCTIC
NATIONAL PARK AND PRESERVE
4175 GEIST RD.
FAIRBANKS, AK 99709
907-822-5234
ALASKA DEPARTMENT OF FISH AND GAME
HUGHES VILLAGE
DIVISION OF SUBSISTNCE
1300 COLLEGE RD.
FAIRBANKS, AK 99701
907-328-6116
P.O. BOX 45029
HUGHES, AK 99745
907-778-2311
Page 1
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HOUSEHOLD MEMBERS
HOUSEHOLD ID
First, I would like to ask about the people in your household, permanent members of your household who sleep at your house. This
includes students who return home every summer. I am NOT interested in people who lived with you temporarily, even if they stayed
several months.
Last year, that is, between January 1, 2015 and December 31, 2015 WHO were the head or heads of your household?
Is this person answering
questions on this
survey?
ID #
HEAD 1
(circle)
Y
How is this
person
related to
HEAD 1?
Is this
person
MALE or
FEMALE?
Is this
person an
ALASKA
NATIVE?
(relation)
(circle)
(circle)
M
Y
N
F
In what
Where were
How many years
YEAR was parents living when has this person
this person
this person was
lived in
Last grade of
born?
born?
Northway?
school completed?
(year)
(AK city or state)
(number)
(number in years)
N
1
NEXT enter spouse or partner. If a household has a SINGLE HEAD, leave HEAD 2 row BLANK and move to PERSON 3.
HEAD 2
Y
N
M
F
Y
N
2
BELOW, enter children (oldest to youngest), grandchildren, grandparents, or anyone else living full-time in this household.
PERSON
Y N
M
F
Y
N
03
3
PERSON
04
4
PERSON
05
5
PERSON
06
6
PERSON
07
7
PERSON
08
8
PERSON
09
9
PERSON
10
10
PERSON
11
11
PERSON
12
12
PERSON
13
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
Y
N
M
F
Y
N
13
PERMANENT HH MEMBERS: 01
#N/A
Page 2
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HOUSEHOLD PARTICIPATION
To continue our questions about people in your household, I would like to ask a few questions about participation in harvesting wild
foods…
Between January 1, 2015 and December 31, 2015
Did this person ….
PERSON
LARGE LAND
MAMMALS
FISH
ID#
FROM
SMALL LAND
MAMMALS/
FURBEARERS
BIRDS AND EGGS
PLANTS / BERRIES /
WOOD
PAGE 2
FISH FOR
PROCESS
HUNT /
TRAP
PROCESS
HUNT /
TRAP
PROCESS
HUNT /
GATHER
PROCESS
GATHER
PROCESS
ID #
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
(circle)
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
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
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
HEAD 1
1
HEAD 2
2
PERSON
03
3
PERSON
04
4
PERSON
05
5
PERSON
06
6
PERSON
07
7
PERSON
08
8
PERSON
09
9
PERSON
10
10
PERSON
11
11
PERSON
12
12
PERSON
13
13
PERMANENT HH MEMBERS: 01
#N/A
Page 3
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HOUSEHOLD PARTICIPATION
HOUSEHOLD ID
… Continued from previous page
Between January 1, 2015 and December 31, 2015
Did this person ….
PERSON
ID#
FROM
PAGE 2
BUILD FISH
WHEELS
BUILD FISH
TRAPS
BUILD DOG
SLEDS
ID #
(circle)
(circle)
(circle)
HEAD 1
SEW SKINS
&/OR CLOTH
(circle)
COOK WILD
FOODS
MAKE HANDICRAFTS
W/NATURAL
MATERIALS
BUILD A
SHELTER,
CABIN, LEANTO, etc.
(circle)
(circle)
(circle)
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
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
1
HEAD 2
2
PERSON
03
3
PERSON
04
4
PERSON
05
5
PERSON
06
6
PERSON
07
7
PERSON
08
8
PERSON
09
9
PERSON
10
10
PERSON
11
11
PERSON
12
12
PERSON
13
13
PERMANENT HH MEMBERS: 01
#N/A
Page 4
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
RETAINED COMMERCIAL HARVESTS
HOUSEHOLD ID
1. Do you or members of your household USUALLY participate in any commercial fishery?...........................................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household PARTICIPATE in any commercial fishery?..................................................
Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
Please estimate how many fish ALL MEMBERS OF YOUR HOUSEHOLD
removed from commercial harvests for personal use during the last year.
Include COMMERCIALLY HARVESTED fish that members of this household
gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If
helping others, report ONLY THIS HOUSEHOLD'S share.
did you or members of your household…
A … FISH commercially for ______?
B … KEEP any ____ from your commercial
catch for your own use2 or to share?
if keep
is "yes"
4
C Was the ____ that you kept INCIDENTAL
catch?
A
Read names below
in blanks above
CHINOOK (KING) SALMON
B
COMM
FISH?
C
KEEP?
INCI?
How many
were
removed for
your OWN
USE?5
How many
were
removed for
your
CREW?5
How many
were
removed to
give to
OTHERS?
Units3
number
number
number
specify
Y
N
Y
N
Y
N
IND.
Y
N
Y
N
Y
N
IND.
Y
N
Y
N
Y
N
IND.
Y
N
Y
N
Y
N
IND.
Y
N
Y
N
Y
N
IND.
Y
N
Y
N
Y
N
LB.
Y
N
Y
N
Y
N
GAL.
Y
N
Y
N
Y
N
GAL.
Y
N
Y
N
Y
N
IND.
Y
N
Y
N
Y
N
comments
113000001
SOCKEYE (RED) SALMON
115000001
COHO (SILVER) SALMON
112000001
CHUM (DOG) SALMON
111000001
PINK (HUMPIES) SALMON
114000001
HALIBUT
121800001
HERRING
120200001
HERRING ROE
120300001
CRAB
501099001
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes eating, feeding to dogs, sharing or trading with others, etc.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
4 "INCIDENTAL CATCH" means the fish kept was not being commercially fished. For example, a king salmon kept from a chum commerical fishery.
5 Double counting (captains' removals for crew members and crew members' removal for own uses) is fixed in analysis. Collect both.
COMMERCIAL FISHING: 03
#N/A
Page 5
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: SALMON
HOUSEHOLD ID
1. Do you or members of your household USUALLY participate in non-commercial fishing activities for salmon?.................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST salmon?...........................................................
Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
Please estimate how many salmon ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested
with ….
INCLUDE salmon that members of this household gave away, ate
fresh, fed to dogs, lost to spoilage, or got by helping others. If
fishing with or helping others, report ONLY THIS HOUSEHOLD'S
share of the harvest.DO NOT INCLUDE catch and release fish or
retained commercial harvests.
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
C …give _____ to another HH or community?
if harvest
is "yes"
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
SUMMER CHUM
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
DIP
NET
GILL NET
FISH
OR
WHEEL
SEINE
ROD &
REEL3
(number harvested by each gear type)
OTHER GEAR
(specify type) Units4
amount / type
specify
Y N
/
IND.
Y N
Y N
/
IND.
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
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
Y N
Y N
Y N
Y N
/
111010000
FALL CHUM
111020000
CHINOOK (KING) SALMON
113000000
COHO
112000000
PINK SALMON
114000000
SOCKEYE SALMON
115000000
UNKNOWN SALMON
119000000
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 "ROD AND REEL" includes fish caught in open water with a hook and and a line attached to a rod or a pole. Jigging through the ice is "ice fishing."
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
#REF!
#N/A
Page 6
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: SALMON
HOUSEHOLD ID
If this household did NOT USE or HARVEST salmon last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
MAPPING
Refer to data collection maps and mapping instructions to map salmon…
ASSESSMENTS: SALMON
110000000
To conclude our salmon section, I am going to ask a few general questions about salmon.
During the last year,1
… did your household use LESS, SAME, or MORE salmon than in recent years? ……………………………………………………….
IF LESS or MORE …
X L S M
X = do not use
WHY was your use different?
1
2
During the last year,1
…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?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF SALMON: 66, 67
#N/A
Page 7
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: OTHER FISH
HOUSEHOLD ID
1. Do you or members of your household USUALLY parcitipate in non-commercial fishing activities for other fish?...................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST other fish?...........................................................
Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,
1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
C …give _____ to another HH or community?
if
harvest
is "yes"
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
HUMPBACK WHITEFISH
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Please estimate how many other fish ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested
with ….
INCLUDE other fish that members of this household gave away, ate
fresh, fed to dogs, lost to spoilage, or got by helping others. If fishing
with or helping others, report ONLY THIS HOUSEHOLD'S share of
the harvest. DO NOT INCLUDE catch and release fish or retained
commercial harvests.
FISH
WHEEL
GILL NET
OR
ICE
SEINE FISHING
ROD &
3
REEL
(number harvested by each gear type)
OTHER GEAR
(specify type) Units4
amount / type
specify
Y N
/
IND.
Y N
Y N
/
IND.
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
Y N
/
IND.
126408000
LEAST CISCO
126406060
BROAD WHITEFISH
126404000
BERING CISCO
126406040
ROUND WHITEFISH
126412000
SHEEFISH
125600000
UNKNOWN WHITEFISH
126499000
PIKE
125500000
BURBOT
(LINGCOD)
124800000
ARCTIC GRAYLING
125200000
…Continue on next page
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 "ROD AND REEL" includes fish caught in open water with a hook and and a line attached to a rod or a pole. Jigging through the ice is " ice fishing."
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
#REF!
#N/A
Page 8
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: OTHER FISH
HOUSEHOLD ID
…continued from previous page
Y
N
IF the answer is YES, continue on this page …
During the last year,
1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
C …give _____ to another HH or community?
if
harvest
is "yes"
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
DOLLY VARDEN
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Please estimate how many other fish ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested
with ….
INCLUDE other fish that members of this household gave away, ate
fresh, fed to dogs, lost to spoilage, or got by helping others. If fishing
with or helping others, report ONLY THIS HOUSEHOLD'S share of
the harvest.DO NOT INCLUDE catch and release fish or retained
commercial harvests.
FISH
WHEEL
GILL NET
OR
ICE
SEINE FISHING
ROD &
3
REEL
(number harvested by each gear type)
OTHER GEAR
(specify type) Units4
amount / type
specify
Y N
/
IND.
Y N
Y N
/
IND.
Y N
Y N
Y N
/
IND.
Y N
Y N
Y N
Y N
/
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
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
/
125006000
LAKE TROUT
125010000
UNKNOWN TROUT
126299000
LONGNOSE SUCKER
126000000
Y N
Did anyone in the household harvest or receive any other nonsalmon fish, such as halibut, hooligan, or char?..........................................
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 "ROD AND REEL" includes fish caught in open water with a hook and and a line attached to a rod or a pole. Jigging through the ice is " ice fishing."
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
OTHER FISH: 06
#N/A
Page 9
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: OTHER FISH
HOUSEHOLD ID
If this household did NOT USE or HARVEST other fish last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
Refer to data collection maps and mapping instructions to map other fish…
MAPPING
ASSESSMENTS: OTHER FISH
120000000
To conclude our other fish section, I am going to ask a few general questions about other fish.
During the last year,1
… did your household use LESS, SAME, or MORE other fish than in recent years? ……………………………………………………….
IF LESS or MORE …
X L S M
X = do not use
WHY was your use different?
1
2
1
During the last year,
…did your household GET ENOUGH other fish?...............................................................................................................................
Y
N
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?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF OTHER FISH: 66, 67
#N/A
Page 10
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: MARINE INVERTEBRATES
HOUSEHOLD ID
1. Do you or members of your household USUALLY participate in non-commercial activities for marine invertebrates?.......
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST marine invertebrates?...........................................................Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
if
harvest
is "yes"
C …give _____ to another HH or community?
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
DUNGENESS CRAB
Please estimate how many marine invertebrates ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested with ….
INCLUDE marine invertebrates that members of this household gave away,
ate fresh, fed to dogs, lost to spoilage, or got by helping others. If harvesting
with or helping others, report ONLY THIS HOUSEHOLD'S share of the
harvest. DO NOT INCLUDE marine invertebrates caught commercially, or
were not retained.
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
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
AMOUNT
Units4
COMMENTS
(amt)
specify
(text)
501004000
KING CRAB
501008000
TANNER CRAB
501012000
RAZOR CLAMS
500612000
FRESHWATER CLAMS
500604000
BUTTER CLAMS
500602000
CLAMS
500699000
During the last year, did your household use any other kind of marine invertebrates?........................................................................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 "ROD AND REEL" includes fish caught in open water with a hook and and a line attached to a rod or a pole. Jigging through the ice is " ice fishing."
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
#REF!
#N/A
Page 11
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: MARINE INVERTEBRATES
HOUSEHOLD ID
If this household did NOT USE or HARVEST marine invertebrates last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
Refer to data collection maps and mapping instructions to map marine invertebrates…
MAPPING
ASSESSMENTS: MARINE INVERTEBRATES
500000000
To conclude our marine invertebrates section, I am going to ask a few general questions about marine invertebrates.
During the last year,1
… did your household use LESS, SAME, or MORE marine invertebrates than in recent years? ……………………………………………………….
X L S M
IF LESS or MORE …
X = do not use
WHY was your use different?
1
2
1
During the last year,
…did your household GET ENOUGH marine invertebrates?...............................................................................................................................Y
N
If NO…
What KIND of marine invertebrates did you need?
How would you describe the impact to your household of not
getting enough marine invertebrates last year?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF MARINE INVERTEBRATES: 66, 67
Page 12
#N/A
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: LARGE LAND MAMMALS
HOUSEHOLD ID
1. Do you or members of your household USUALLY hunt for large land mammals?
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST large land mammals?...........................................................Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
did you or members of your household…
MOOSE
HAR
M/F
UNKNOWN
TRY
DECEMBER
GIVE
NOVEMBER
REC
OCTOBER
USE
SEPTEMBER
E
AUGUST
D
JULY
C
JUNE
B
MAY
A
APRIL
Read names below
in blanks above
MARCH
2
D …try to harvest _____?
E …actually harvest any _____?
SEX
if
harvest
is "yes"
C …give _____ to another HH or community?
FEBRUARY
B …receive _____ from another HH or community
JANUARY
Please estimate how many large land mammals ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested in ….
INCLUDE large land mammals that members of this household gave away, ate
fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting with or
helping others, report ONLY THIS HOUSEHOLD'S share of the harvest.
2
A … use _______?
(specify amount harvested per month)
UNITS3
(specify)
M
IND
211800000
F
UNK
IND
IND
211800001
1
Y N
Y N
Y N
Y N
Y N
211800002
2
211800009
-9
CARIBOU
M
IND
211000000
F
UNK
IND
IND
211000001
1
Y N
Y N
Y N
Y N
Y N
211000002
2
211000009
-9
BLACK BEAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
210600000
BROWN BEAR
210800000
DALL SHEEP
212200000
MUSKOX
212000000
During the last year, did your household use any other kind of large land mammals?........................................................................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
LARGE LAND MAMMALS: 10
#N/A
Page 13
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: LARGE LAND MAMMALS
HOUSEHOLD ID
If this household did NOT USE or HARVEST large land mammals last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
Refer to data collection maps and mapping instructions to map large land mammals…
MAPPING
ASSESSMENTS: LARGE LAND MAMMALS
210000000
To conclude our large land mammals section, I am going to ask a few general questions about large land mammals.
During the last year,1
… 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
WHY was your use different?
1
2
1
During the last year,
…did your household GET ENOUGH large land mammals?...............................................................................................................................Y
N
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?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF LARGE LAND MAMMALS: 66, 67
Page 14
#N/A
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: SMALL LAND MAMMALS OR FURBEARERS
HOUSEHOLD ID
1. Do you or members of your household USUALLY hunt or trap for small land mammals or furbearers?...............................................
Y N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST small land mammals or furbearers?...........................................................
Y N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
BEAVER
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
NUMBER
USED FOR
FOOD OR
FOR FOOD
UNITS3
& FUR
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
JULY
A
MAY
Read names below
in blanks above
JUNE
2
D …try to harvest _____?
…actually
harvest any _____?
E
APRIL
if
harvest
is "yes"
C …give _____ to another HH or community?
MARCH
B …receive _____ from another HH or community
Please estimate how many small land mammals or furbearers ALL MEMBERS OF
YOUR HOUSEHOLD got during the last year. How many were harvested in ….
INCLUDE small land mammals or furbearers that members of this household gave
away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting or
trapping with or helping others, report ONLY THIS HOUSEHOLD'S share of the
harvest.
FEBRUARY
2
A … use _______?
JANUARY
did you or members of your household…
(specify amount harvested per month)
(amount)
specify
220200000
MUSKRAT
222400000
PORCUPINE
222600000
WOLF
223200000
WOLVERINE
223400000
COYOTE
220400000
FOX
(SPECIFY)
220800000
SNOWSHOE HARE
221004000
LYNX
221600000
MARTEN
222000000
…Continue on next page
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
SMALL LAND MAMMALS OR FURBEARERS: 14
#N/A
Page 15
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: SMALL LAND MAMMALS OR FURBEARERS
HOUSEHOLD ID
…continued from previous page
During the last year,1
LAND OTTER
UNKNOWN
DECEMBER
NOVEMBER
OCTOBER
SEPTEMBER
AUGUST
NUMBER
USED FOR
FOOD OR
FOR FOOD
& FUR
UNITS3
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
JULY
A
MAY
Read names below
in blanks above
JUNE
2
D …try to harvest _____?
…actually
harvest any _____?
E
APRIL
if
harvest
is "yes"
MARCH
B …receive _____ from another HH or community
…give _____ to another HH or community?
C
Please estimate how many small land mammals or furbearers ALL MEMBERS OF
YOUR HOUSEHOLD got during the last year. How many were harvested in ….
INCLUDE small land mammals or furbearers that members of this household gave
away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting or
trapping with or helping others, report ONLY THIS HOUSEHOLD'S share of the
harvest.
FEBRUARY
2
A … use _______?
JANUARY
did you or members of your household…
(specify amount harvested per month)
(amount)
specify
221200000
ERMINE
(WEASEL)
223000000
MINK
222200000
During the last year, did your household use any other kind of small land mammals or furbearers?...................................................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
SMALL LAND MAMMALS OR FURBEARERS: 14
#N/A
Page 16
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: SMALL LAND ANIMALS
HOUSEHOLD ID
If this household did NOT USE or HARVEST small land animals last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
MAPPING
Refer to data collection maps and mapping instructions to map small land mammals…
ASSESSMENTS: SMALL LAND MAMMALS/FURBEARERS
220000000
To conclude our small land mammals/furbearers section, I am going to ask a few general questions about small land mammals/furbearers.
During the last year,1
… did your household use LESS, SAME, or MORE small land mammals/furbearers than in recent years? ……………………………………………………….
X L S M
IF LESS or MORE …
X = do not use
WHY was your use different?
1
2
During the last year,1
…did your household GET ENOUGH small land mammals/furbearers?...............................................................................................................................
Y N
If NO…
What KIND of small land mammals/furbearers did you need?
How would you describe the impact to your household of not
getting enough small land mammals/furbearers last year?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF SMALL LAND ANIMALS: 66, 67
Page 17
#N/A
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: MARINE MAMMALS
HOUSEHOLD ID
1. Do you or members of your household USUALLY hunt for marine mammals?...............................................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST marine mammals?...........................................................
Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
Please estimate how many marine mammals ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested in ….
did you or members of your household…
2
A … use _______?
BEARDED SEAL
UNKNOWN
AUGUST
JUNE
APRIL
MARCH
FEBRUARY
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
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
Y N
Y N
Y N
Y N
M/F
JULY
B
MAY
A
SEX
Read names below
in blanks above
JANUARY
E …actually harvest any _____?
DECEMBER
…try2 to harvest _____?
NOVEMBER
D
if
harvest
is "yes"
OCTOBER
C …give _____ to another HH or community?
SEPTEMBER
INCLUDE marine mammals that members of this household gave away, ate
fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting with or
helping others, report ONLY THIS HOUSEHOLD'S share of the harvest.
B …receive _____ from another HH or community
(specify amount harvested per month)
UNITS3
(specify)
300802000
SPOTTED SEAL
300812000
STELLER SEA LION
301200000
FUR SEAL
300804000
WHALE (SPECIFY)
301699000
UNKNOWN SEAL
(OR SEAL OIL)
300899000
During the last year, did your household use any other kind of Marine mammals?.............................................................................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
MARINE MAMMALS: 12
#N/A
Page 18
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: MARINE MAMMALS
HOUSEHOLD ID
If this household did NOT USE or HARVEST marine mammals last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
Refer to data collection maps and mapping instructions to map marine mammals…
MAPPING
ASSESSMENTS: MARINE MAMMALS
300000000
To conclude our marine mammals section, I am going to ask a few general questions about marine mammals.
During the last year,1
… did your household use LESS, SAME, or MORE marine mammals than in recent years? ……………………………………………………….
X L S M
IF LESS or MORE …
X = do not use
WHY was your use different?
1
2
1
During the last year,
…did your household GET ENOUGH marine mammals?...............................................................................................................................
Y
N
If NO…
What KIND of marine mammals did you need?
How would you describe the impact to your household of not
getting enough marine mammals last year?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF MARINE MAMMALS: 66, 67
#N/A
Page 19
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: MIGRATORY WATERFOWL
HOUSEHOLD ID
1. Do you or members of your household USUALLY hunt for migratory waterfowl?...............................................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST migratory waterfowl?........................................................... Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
…give _____ to another HH or community?
C
if
harvest
is "yes"
2
D …try to harvest _____?
E …actually harvest any _____?
Please estimate how many migratory waterfowl ALL MEMBERS OF
YOUR HOUSEHOLD got during the last year. How many were
harvested in ….
INCLUDE migratory waterfowl that members of this household gave
away, ate fresh, fed to dogs, lost to spoilage, or got by helping others.
If hunting with or helping others, report ONLY THIS HOUSEHOLD'S
share of the harvest.
January
February
Read names below
in blanks above
CANADA GEESE
July
March
April
May
June
August
September
WINTER
SPRING
SUMMER
October
November
Season of
December harvest
FALL
unknown
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
(number killed in each season)
(number)
UNITS3
(specify)
410404990
WHITE-FRONTED GEESE
410410000
SNOW GEESE
410408000
SWAN
(SPECIFY)
410699000
LOON
(SPECIFY)
411216990
AMERICAN WIGEON
410236020
TEAL
410232990
MALLARD
410214000
NORTHERN PINTAIL
410220000
NORTHERN SHOVELER
410230000
…Continue on the next page
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
MIGRATORY WATERFOWL: 15
Page 20
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: MIGRATORY WATERFOWL
HOUSEHOLD ID
…continued from previous page
During the last year,1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
if
harvest
is "yes"
C …give _____ to another HH or community?
2
D …try to harvest _____?
E …actually harvest any _____?
Please estimate how many migratory waterfowl ALL MEMBERS OF
YOUR HOUSEHOLD got during the last year. How many were
harvested in ….
INCLUDE migratory waterfowl that members of this household gave
away, ate fresh, fed to dogs, lost to spoilage, or got by helping others.
If hunting with or helping others, report ONLY THIS HOUSEHOLD'S
share of the harvest.
January
February
Read names below
in blanks above
BLACK SCOTER
(BLACK DUCKS)
March
May
April
June
WINTER
SPRING
July
October
August
November
September December
Season of
harvest
unknown
UNITS3
(number)
(specify)
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
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
Y N
Y N
Y N
Y N
SUMMER
(number killed in each season)
FALL
410228020
WHITE-WINGED SCOTER
410228060
OTHER SCOTER
410228990
BUFFLEHEAD
410202000
UNKNOWN GOLDENEYE
(SPECIFY)
410210990
UNKNOWN EIDER
(SPECIFY)
410206990
LONG-TAILED DUCK
(OLDSQUAW)
410218000
During the last year, did your household use any other kind of migratory waterfowl?..........................................................................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
MIGRATORY WATERFOWL: 15
Page 21
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: OTHER BIRDS
HOUSEHOLD ID
1. Do you or members of your household USUALLY hunt for other birds?...............................................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST other birds?...........................................................
Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
if
harvest
is "yes"
C …give _____ to another HH or community?
2
D …try to harvest _____?
E …actually harvest any _____?
Please estimate how many other birds ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested in
….
INCLUDE other birds that members of this household gave away, ate
fresh, fed to dogs, lost to spoilage, or got by helping others. If hunting
with or helping others, report ONLY THIS HOUSEHOLD'S share of
the harvest.
January
February
Read names below
in blanks above
PTARMIGAN
March
April
November
December
May
June
July
August
September
Season of
October
harvest
SPRING SUMMER
FALL
unknown
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
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
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
WINTER
(number killed in each season)
(number)
UNITS3
(specify)
421804000
SPRUCE GROUSE
421802020
RUFFED GROUSE
421802060
SHARP-TAILED GROUSE
421802040
Y N
During the last year, did your household use any other kind of other birds?.......................................................................................................................................................
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
3 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
OTHER BIRDS: 15
Page 22
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: BIRD EGGS
HOUSEHOLD ID
1. Do you or members of your household USUALLY harvest bird eggs?...............................................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST bird eggs?...........................................................
Y
N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
if
harvest
is "yes"
C …give _____ to another HH or community?
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
GULL EGGS
(SPECIFY)
431212000
GEESE EGGS
(SPECIFY)
430400000
DUCK EGGS
(SPECIFY)
Please estimate how many bird eggs ALL MEMBERS OF YOUR
HOUSEHOLD got during the last year. How many were harvested with ….
INCLUDE bird eggs that members of this household gave away, ate fresh, fed
to dogs, lost to spoilage, or got by helping others. If harvesting with or helping
others, report ONLY THIS HOUSEHOLD'S share of the harvest.
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
IND.
Y N
Y N
Y N
Y N
Y N
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
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
AMOUNT
Units4
COMMENTS
(amt)
specify
(text)
430200000
During the last year, did your household use any other kind of bird eggs?..........................................................................................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
BIRD EGGS: 15
#N/A
Page 23
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: BIRDS AND EGGS
HOUSEHOLD ID
If this household did NOT USE or HARVEST birds and eggs last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
Refer to data collection maps and mapping instructions to map birds and eggs…
MAPPING
ASSESSMENTS: BIRDS AND EGGS
400000000
To conclude our birds and eggs section, I am going to ask a few general questions about birds and eggs.
During the last year,1
… did your household use LESS, SAME, or MORE birds and eggs than in recent years? ………………………………………………………. X L S M
IF LESS or MORE …
X = do not use
WHY was your use different?
1
2
1
During the last year,
…did your household GET ENOUGH birds and eggs?...............................................................................................................................
Y
N
If NO…
What KIND of birds and eggs did you need?
How would you describe the impact to your household of not
getting enough birds and eggs last year?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF BIRDS AND EGGS: 66, 67
#N/A
Page 24
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: PLANTS AND BERRIES (INCLUDING WOOD)
HOUSEHOLD ID
1. Do you or members of your household USUALLY harvest plants and berries (including wood)?...............................................
Y
N
2. During the last year (between January 1, 2015 and December 31, 2015),
did you, or members of your household USE or TRY TO HARVEST plants and berries (including wood)?...........................................................
Y N
IF the answer to QUESTION 2 is NO, to to the NEXT PAGE .
IF the answer is YES , continue on this page …
During the last year,1
Please estimate how many plants and berries (including wood) ALL
MEMBERS OF YOUR HOUSEHOLD got during the last year.
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
if
harvest
is "yes"
C …give _____ to another HH or community?
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
BLUEBERRY
INCLUDE plants and berries (including wood) that members of this household
gave away, ate fresh, fed to dogs, lost to spoilage, or got by helping others. If
harvesting with or helping others, report ONLY THIS HOUSEHOLD'S share of
the harvest.
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
AMOUNT
Units4
COMMENTS
(amt)
specify
(text)
601002000
LOW BUSH CRANBERRY
601004000
RASPBERRY
601020000
HIGH BUSH CRANBERRY
601006000
CROWBERRY (BLACKBERRY)
601007000
CLOUD BERRY
(SALMONBERRY)
601016000
LABRADOR TEA
602018000
ROOTS (FOR FOOD)
602009000
ROSE HIPS
NCHOO
602036000
MUSHROOMS
(SPECIFY)
602040000
…Continue on the next page
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
PLANTS AND BERRIES (INCLUDING WOOD): 17
#N/A
Page 25
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVESTS: PLANTS AND BERRIES (INCLUDING WOOD)
HOUSEHOLD ID
…continued from previous page
During the last year,1
did you or members of your household…
2
A … use _______?
B …receive _____ from another HH or community
C …give _____ to another HH or community?
if harve
is "yes"
2
D …try to harvest _____?
E …actually harvest any _____?
Read names below
in blanks above
MOUSEFOODS
Please estimate how many plants and berries (including wood) ALL
MEMBERS OF YOUR HOUSEHOLD got for subsistence uses during the last
year. How many were harvested with ….
INCLUDE plants and berries (including wood) that members of this household
gave away, are fresh, fed to dogs, lost to spoilage, or got by helping others. If
harvesting with or helping others, report ONLY THIS HOUSEHOLD'S share of
the harvest.
A
B
C
D
E
USE
REC
GIVE
TRY
HAR
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
GAL.
Y N
Y N
Y N
Y N
Y N
CORD.
Y N
Y N
Y N
Y N
Y N
CORD.
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
AMOUNT
Units4
COMMENTS
(amt)
specify
(text)
602060000
SPRUCE TIPS
602030000
OTHER WILD GREENS
602038000
WILD RHUBARB
602006000
CHAGA
(SALMONBERRY)
602046040
PUNK
602046010
WOOD (OTHER )
(SPECIFY USE)
604000000
FIREWOOD
604000002
During the last year, did your household use any other kind of PLANTS AND BERRIES (INCLUDING WOOD)?...............................................................................................
Y N
IF YES, enter the name in a blank row above, and answer the questions in that row.
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 "USE" includes harvesting, processing, eating, trading, feeding to dogs, etc. "TRY" includes looking, hunting, fishing, or any attempt to get.
4 UNITS will differ by species and situation. Units may be pounds (lbs), individuals (ind), portions of individuals (1/4), buckets, sacks, tubs, etc.
PLANTS AND BERRIES (INCLUDING WOOD): 17
#N/A
Page 26
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: PLANTS AND BERRIES
HOUSEHOLD ID
If this household did NOT USE or HARVEST plants and berries last year, go to the ASSESSMENT section below.
Otherwise, continue with mapping, and assessment sections…
MAPPING
Refer to data collection maps and mapping instructions to map plants, berries, and wood…
ASSESSMENTS: PLANTS AND BERRIES (INCLUDING WOOD)
600000000
To conclude our plants and berries (including wood) section, I am going to ask a few general questions about plants and berries (including
wood).
During the last year,1
… did your household use LESS, SAME, or MORE plants and berries (including wood) than in recent years? ……………………………………………………….
X L S M
IF LESS or MORE …
X = do not use
WHY was your use different?
1
2
During the last year,1
…did your household GET ENOUGH plants and berries (including wood)?...............................................................................................................................
Y N
If NO…
What KIND of plants and berries (including wood) did you need?
How would you describe the impact to your household of not
getting enough plants and berries (including wood) last year?
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
NETWORKS & ASSESSMENTS OF PLANTS AND BERRIES: 66, 67
Page 27
#N/A
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
HARVEST SUMMARY: ALL RESOURCES
HOUSEHOLD ID
ASSESSMENTS: ALL RESOURCES
0
To conclude our harvests section, I am going to ask a few general questions about wild resources.
During the last year,1
… did your household use LESS, SAME, or MORE wild resources than in recent years? ………………………………………………………. X L S M
IF LESS or MORE …
WHY was your use different?
X = do not use
1
2
1
During the 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? …………………
… no impact
… minor
… moderate
… major
… severe
(0)
(1)
(2)
(3)
(4)
HEALTH IMPACT ASSESSMENTS
(circle ONE response)
In a normal week, how often are wild foods
such as salmon, non-salmon fish, moose,
caribou, birds, etc. served in your household?
None,
don't use
(0)
Less than
once per 1 - 3 times 4 - 6 times Once per
week
per week per week
day
(1)
(2)
(3)
(4)
2 times
per day
(5)
3 Times per
day
(6)
If this household does NOT USE wild foods, go to the next page
Otherwise, continue below…
Please list the TOP FIVE MOST IMPORTANT WILD FOODS that are used in your household. Include wild foods that may not be available
now, but are important at other times of the year. Please list most important foods first.
(Not necessary to fill out every line)
Wild Food 1
Wild Food 2
Wild Food 3
Wild Food 4
Wild Food 5
TOP FIVE WILD
FOODS
If your household CANNOT GET WILD FOODS, what foods do members of your household eat instead? These can be general categories or more specific
items you purchase or grow. Please list most important alternative foods first. These can be general categories or more specific items you purchase, grow,
or are grown locally.
(DO NOT ENTER GROCERIES OR STORE BOUGHT FOODS! Please be more specific. Not necessary to fill out every line)
Other Food
OTHER FOODS
(1 TO 5)
2
OTHER FOODS
(6 TO 10)
2
Other Food
Other Food
Other Food
Other Food
1 ''LAST YEAR'' means between January 1, 2015 and December 31, 2015.
2 For "OTHER FOODS", we are not interested in condiments or staples, such as sugar, flour, coffee, or butter etc... We are interested in
foods used in place of traditional foods for meals or snacks. This includes foods substituted by personal preference or out of necessity
(traditional food not available).
ASSESSMENTS OF ALL RESOURCES: 66
#N/A
Page 28
ADDITIONAL ASSESSMENTS
HOUSEHOLD ID
Resource Health
Between January 1, 2015 and December 31, 2015... 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
Between January 1, 2015 and December 31, 2015... did members of your household use the following
when harvesting or attempting to harvest wild foods?
circle
boat
snowmachine
4-wheeler/ORV
airplane
highway vehicle
dogsled
horses
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Does your household own, borrow, lease, or charter this equipment?
Own
Borrow
Charter
Lease
Circle only responses that the respondent answered yes to above.
boat
snowmachine
4-wheeler/ORV
airplane
highway vehicle
dogsled
horses
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
chainsaw
ice auger
winch
generator
Other (specify)
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Comments:
Between January 1, 2015 and December 31, 2015... did members of your household use the
following or other motorized equipment when harvesting or attempting to harvest wild foods?
circle
N
N
N
N
N
Heating
What proportion of your household's heating comes from firewood?
0%
76-99%
1-25%
100%
26-50%
51-75%
circle
In the past 5 years has your harvest area for firewood changed?
Y
N
If yes, please explain why?
Approximately how much did you spend between January 1, 2015 and December 31, 2015 to heat your home?
$
Handicrafts
Between January 1, 2015 and December 31, 2015... did members of your household participate in the making of handicrafts
using locally harvested or collected natural materials?
Y
If yes, which of the following?
circle
birchbark
diamond willow
grass
spruce roots
other (specify)
_________________
Y
Y
Y
Y
N
N
N
N
Y N
collect / harvest
horns/antlers
bones
bear claws
animal hides
fish skin
baleen
ivory
N
circle
circle one or both
Y
Y
Y
Y
Y
Y
Y
collect / harvest
collect / harvest
collect / harvest
collect / harvest
collect / harvest
collect / harvest
collect / harvest
N
N
N
N
N
N
N
Did members of your household sell the handicrafts that were made from the locally harvested or collected natural materials?
Y
N
Comments/Explanations
ADDITIONAL ASSESSMENTS
#N/A
Page 29 of 35
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
FOOD SECURITY
HOUSEHOLD ID
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
community have enough to eat. I'd like you to think about all your household's food, both wild food and store-bought...
Which of these three statements best describes the food eaten in your household in the last 12 months…
(Circle one)
STATEMENT 1. We had enough of the kinds of food we wanted to eat…………………………
STATEMENT 2. We had enough food, but not always the KIND of food we wanted to eat……
STATEMENT 3. Sometimes, or often, we did NOT HAVE ENOUGH food to eat………………
FOOD ABBREV
HH1
1
2
3
If 2 or 3
Now I am going to read you several statements about different food situations.
Please tell me whether EACH statement was true for your household (HH) in the last 12 months.
HH2
STATEMENT 4. We WORRIED that our household would run out of food before we could get more.
In the last 12 months, was this ever true for your household?................................................................................
If YES…
N
Y
?
J F M A M J J A S O N D
…in which months did this happen?....................................................................................................................................
…did this happen because your household couldn't get WILD FOOD,
your HH couldn't get STORE-BOUGHT food, or your HH couldn't get BOTH KINDS of food?..........................
WILD STOR BOTH
HH4
STATEMENT 5. We could not get the kinds of 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 did not have
enough money to buy food.
In the last 12 months, was this ever true for your household?................................................................................
If YES…
N
Y
?
J F M A M J J A S O N D
…in which months did this happen?....................................................................................................................................
…did this happen because your household couldn't get WILD FOOD,
your HH couldn't get STORE-BOUGHT food, or your HH couldn't get BOTH KINDS of food?..............
WILD STOR BOTH
HH3
STATEMENT 6. The 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…
N
Y
?
J F M A M J J A S O N D
…in which months did this happen?....................................................................................................................................
Now, think just about your household's WILD FOOD…
STATEMENT 7. The WILD 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
If YES…
Y
?
J F M A M J J A S O N D
…in which months did this happen?....................................................................................................................................
Now, think just about your household's STORE-BOUGHT food…
STATEMENT 8. 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…
N
Y
?
J F M A M J J A S O N D
…in which months did this happen?....................................................................................................................................
If any ONE of the STATEMENTS 4, 5, OR 6 was "YES," continue with food security questions on next page. Otherwise, go to next section…
FOOD SECURITY: 201
#N/A
Page 30
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
FOOD SECURITY
HOUSEHOLD ID
If any ONE of the STATEMENTS 4, 5, or 6 on previous page was "YES," continue with food security questions below. Otherwise, go to next section…
In the past 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…
J F M A M J J A S O N D
…in which months did this happen?....................................................................................................................................
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?..............
AD2
N
Y
?
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
?
N
Y
?
In the last 12 months, were adults in the HH ever HUNGRY BUT DID NOT EAT
AD3
AD4
In the last 12 months, did adults in the HH ever NOT EAT FOR A WHOLE DAY
because there was not enough food?.............................................................
If YES…
…in which months did this happen?...................................................................................
FOOD SECURITY: 201
AD5
J F M A M J J A S O N D
#N/A
Page 31
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
EMPLOYMENT
HOUSEHOLD ID
The next few pages ask about jobs and income. We ask about these things because we are trying to understand all parts of the community economy. Many
people use wages from jobs to support hunting, fishing, and gathering activities.
Between January 1, 2015 and December 31, 2015 ...
…Did any members of your household earn money from a JOB or from SELF EMPLOYMENT?...................................
Y
N
Starting with the first head of your household, what job or jobs did he or she have last year?
For each member of this household born before 1999, list EACH JOB held last year. For household members who did not have a job, write: RETIRED,
UNEMPLOYED, STUDENT, HOMEMAKER, DISABLED, etc..
(ID #)
1ST JOB
1
6 910100000
6 910100000
SOC:
SIC:
6 910100000
SOC:
6 910100000
SIC:
5
6 910100000
6 910100000
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
7
6 910100000
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
8
6 910100000
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
9
6 910100000
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
10 6 910100000
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
/ YR
schedule:
SIC:
If a person FISHES COMMERCIALLY or is otherwise
SELF-EMPLOYED, list that as a separate job. For job
title, enter COMMERCIAL FISHER, CARVER,
SEWER, BAKER, etc. Work schedule usually will be
ON CALL. For gross income from self-employment,
enter revenue MINUS expenses.
/ YR
schedule:
SIC:
10TH JOB
/ YR
schedule:
SIC:
9TH JOB
/ YR
schedule:
SIC:
8TH JOB
/ YR
schedule:
SIC:
7TH JOB
/ YR
schedule:
SIC:
6TH JOB
6
SHIFT - PART TIME
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
/ YR
schedule:
SIC:
5TH JOB
/ YR
schedule:
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
/ YR
schedule:
J F M A M J J A S O N D FT PT SF OC SP $
SOC:
/ YR
schedule:
SIC:
4TH JOB
4
gross income 3
J F M A M J J A S O N D FT PT SF OC SP $
3RD JOB
3
(circle one)
In the past
year how
much did hee
or she earn in
this job?
J F M A M J J A S O N D FT PT SF OC SP $
2ND JOB
2
ON-CALL, VARIES
What kind of work For whom did he or
did he or she do in she work in this In the past year, what months did
he or she work in this job?
this job?
job?
1
(job title )
(employer)
(circle each month worked)
PART TIME
Person
code
from
page 2
FULL TIME
INCLUDE EACH PERSON 16 YEARS AND OLDER EVEN IF THEY DID NOT
HAVE A JOB
SHIFT - FULL TIME
WORK SCHEDULE2
If a person does not earn money from any kind
of work, enter RETIRED, UNEMPLOYED,
DISABLED, STUDENT, or HOMEMAKER or
other appropriate description as the job title.
Leave employer, months worked, schedule,
and gross income blank.
EMPLOYMENT: 23
WORK SCHEDULE
FT - Fulltime (35+ hr/wk)
PT - Parttime (<35 hr/wk)
SF - Shift (2wks on/2wks
off, etc.)
SP - Shift - part time
OC - Irregular, on call
-- -Unemployed
GROSS
INCOME is the
same as
TAXABLE
INCOME on a
W-2 form. Selfemployment,
enter revenue expense
#N/A
Page 32
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
OTHER INCOME
HOUSEHOLD ID
Between January 1, 2015 and December 31, 2015 ...
…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…
Did anyone in TOTAL amount all
your household members of your
receive income household received
from
from
____________ ____________ in
in 2014
2014
(circle one)
(dollars)
DIVIDENDS
ALASKA PERMANENT
FUND DIVIDEND
32
NATIVE CORPORATION
DIVIDENDS
13
Y
N
$
/ YR
Y
N
$
/ YR
Alaska PFD IN 2014
1 PFD = $2,072
2 PFDs = $4,144
3 PFDs = $6,216
4 PFDs = $8,288
5
6
7
8
9
10
11
PFDs = $10,360
PFDs = $12,432
PFDs = $14,504
PFDs = $16,576
PFDs = $18,648
PFDs = $20,720
PFDs = $22,792
Regional corporations
Dividend
Village Corporation(s)
Dividend
Between January 1, 2015 and December 31, 2015 ...
…Did any members of your household receive OTHER income such as SENIOR BENEFITS or UNEMPLOYMENT?............................
Y
N
IF NO, go to the next section on this page
IF YES, continue below…
PENSION &
RETIREMENT
5
DISABILITY
Received?
Total amount?
(dollars)
(circle one)
(dollars)
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
FUEL VOUCHERS
49
MEETING HONORARIA
(not per diem*)
50
OTHER (describe)
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
Y
N
$
/ YR
3
SUPPLIMENTAL SECURITY
INCOME (SSI)
10
Y
N
$
/ YR
for _________ weeks =
for _________ weeks =
ENERGY
ASSISTANCE
Y
N
$
/ YR
for _________ weeks =
for _________ weeks =
Y
N
$
/ YR
35
ENTITLEMENTS
TANF
(say "tanif", used to be AFDC)
2
CHILD
SUPPORT
15
FOSTER
CARE
41
Y
31
VETERANS ASSISTANCE
STATE BENEFITS
FAMILY & CHILD
12
WORKERS'
COMP
8
SOCIAL
SECURITY
7
Total amount?
(circle one)
FOOD STAMPS
(QUEST CARD)
11
ADULT
PUBLIC ASSISTANCE
9
ALASKA SENIOR
BENEFITS (LONGEVITY)
OTHER
EMPLOYMENT RELATED
UNEMPLOYMENT
Received?
OTHER (describe)
* per diem covers travel expenses, and is not counted as income.
Scratch paper for calculations
Senior Benefits of $125 per month for 12 months = $1,500 per elder
Senior Benefits of $175 per month for 12 months = $2,100 per elder
Senior Benefits of $250 per month for 12 months = $3,000 per elder
6
OTHER INCOME: 24
#N/A
Page 33
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
COMMENTS
HOUSEHOLD ID
DO YOU HAVE ANY QUESTIONS, COMMENTS OR CONCERNS?
INTERVIEW SUMMARY:
DON'T FORGET TO FILL IN THE STOP TIME _________________________________________
COMMENTS: 300
#N/A
Page 34
Survey Community Comprehensive - Comprehensive Wild Food Harvest Survey, 2015
THIS PAGE HAS BEEN LEFT BLANK INTENTIONALLY
Page 35
| File Type | application/pdf |
| Author | Koster, David S (DFG) |
| File Modified | 2016-06-15 |
| File Created | 2016-05-26 |