3-2380 Tracking Sheet & Household Consent Form

OMB Control No. 1018-0124, Expires XX/XX/2019

AMBCC Harvest Survey

page ____ / ____

OMB FWS Form 3-2380 Expires 06/30/2016

Tracking Sheet & Household Consent Form
Copy here only the households selected to be surveyed.

Village: ________________________________ Harvest Year: ____________ Surveyor:______________________________
Household
ID

Harvest report

Household consent

(spring, summer,
and fall)

Household name

FWS Form 3-2380 10/09. This form supersedes form R7-102, which is obsolete.

Agreed

Refu- No Date completed Date completed
sed contact (mm/dd/yyyy)
(mm/dd/yyyy)
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Comments
(Why no contact? Moved?)