3-2380 Tracking Sheet & Household Consent Form

page ____ / ____

AMBCC Harvest Survey
FWS Form 3-2380 (10/2018)
OMB Control No. 1018-0124
Expires ##/##/###

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

Community: __________________________________ Harvest Year: ____________ Surveyor:______________________________
Household
ID

Household consent
Household name

Attempt

Date
(mm/dd/yy)

Agreed

Refu- No
sed contact

Harvest report
completed
Date (mm/dd/yy)

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Please note: Why refused? Why no contact?
out of town, vacant dwelling, non-residential, non-yearlong
resident, moved to community less than 12 months ago

page ____ / ____

AMBCC Harvest Survey

FWS Form 3-2380 (10/2018) OMB Control No. 1018-0124 Expires ##/##/####

Household
ID

Household consent
Household name

Attempt

Date
(mm/dd/yy)

Agreed

Refu- No
sed contact

Harvest report
completed
Date (mm/dd/yy)

1st

/

/

/

/

2nd

/

/

/

/

3rd

/

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1st

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2nd

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3rd

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3rd

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1st

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2nd

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3rd

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/

Please note: Why refused? Why no contact?
out of town, vacant dwelling, non-residential, non-yearlong
resident, moved to community less than 12 months ago