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AMBCC Harvest Survey
Tracking Sheet & Household Consent Form
Copy here only the households selected to be surveyed.
Community: __________________________________ Harvest Year: ____________ Surveyor:______________________________
Household
ID
Household name
Household consent
Attempt
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Refu- No
Agreed
sed contact
Harvest report
completed
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FWS Form 3-2380, OMB Control No. 1018-0124, Expires ##/##/20##.
Please note: 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
Household
ID
Household name
Household consent
Attempt
Date
(mm/dd/yy)
Refu- No
Agreed
sed contact
Harvest report
completed
Date (mm/dd/yy)
1st
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2nd
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3rd
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FWS Form 3-2380, OMB Control No. 1018-0124, Expires ##/##/20##.
Please note: Why no contact?
out of town, vacant dwelling, non-residential, non-yearlong
resident, moved to community less than 12 months ago
Paperwork Reduction Act Statement: In accordance with the Paperwork Reduction Act (44 U.S.C. 3501 et seq.), please note the following information. This survey is authorized by the Migratory Bird
Treaty Act (16 U.S.C. 703 et seq.) and the Migratory Bird Treaty Act Protocol Amendment (1995) and its letter of submittal from the Department of State to the White House, which specifies the need for
harvest monitoring. Your participation in the survey is voluntary. We will use the information your household provides to estimate subsistence migratory bird harvest in subsistence eligible areas of
Alaska. Household harvest reports are anonymous and no names are used on harvest report forms. We may not conduct or sponsor and you are not required to respond to a survey unless it displays
a current OMB control number. OMB has approved this information collection and assigned Control No. 1018-0124.
Estimated Burden Statement: We estimate public reporting for this collection of information to average 5 minutes, including time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments to the Service Information Collection Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, Mailstop: PRB (JAO/3W), Falls Church, VA
22041-3803, or via email at [email protected]. Please do not send your completed survey to this address.
FWS Form 3-2380, OMB Control No. 1018-0124, Expires ##/##/20##.
| File Type | application/pdf |
| File Title | Household Permission Slip |
| Author | lcnaves |
| File Modified | 2023-10-03 |
| File Created | 2023-09-10 |