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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
/
/
/
/
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
| File Type | application/pdf |
| File Title | Household Permission Slip |
| Author | lcnaves |
| File Modified | 2019-03-18 |
| File Created | 2019-02-19 |