3-2381-1 Western Alaska Harvest Report

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

1

Yukon-Kuskokwim Delta, Household Harvest Report
Community:

Household ID:

Harvest Year:

In the last 12 months, how many permanent household members tried to harvest? birds
eggs
(write number of people in each box)

Spring:

Did the household harvest birds or eggs from 2 April to 30 June? (check one)

Yes

No

Please write number of birds and eggs harvested by all members of this household.
American widgeon

Teal

Mallard

Northern pintail

Gadwall

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Northern shoveler
Birds: ______

Black scoter
Birds: ______

Surf scoter
Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Bufflehead
Birds: ______

Goldeneye
Birds: ______

Canvasback
Birds: ______

Scaup
Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Common eider
Birds: ______

King eider
Birds: ______

Eggs: ______

Eggs: ______

Harlequin duck
Birds: ______

Eggs: ______
Black brant
Birds: ______

Eggs: ______

Long-tailed duck
Birds: ______

Eggs: ______

Spectacled eider
Birds: ______

Eggs: ______

Steller’s eider
Birds: ______

Eggs: ______

Eggs: ______

Merganser
Birds: ______

Unknown duck
Birds: ______

Eggs: ______

Eggs: ______

Cackling/Canada goose Greater white-fronted
goose
Birds: ______
Birds: ______

FWS Form 3-2381-1, OMB Control Number 1018-0124. Expires ##/##/20##.

White-winged scoter
Birds: ______

Eggs: ______

Emperor goose

Snow goose

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Turn to page 2 to continue reporting spring harvest. 

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

Yukon-Kuskokwim Delta, Household Harvest Report,

2

Spring (2 April–30 June)

Community:

Household ID:

Please write number of birds and eggs harvested by all members of this household.
Swan

Sandhill crane

Grouse

Ptarmigan

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Pacific loon
Birds: ______

Pacific loon
nonbreeding

Yellow-billed loon

Loon 4

Red-throated loon

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Birds: ______

Eggs: ______
Grebe

Cormorant

Murre

Guillemot

Puffin

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Mew gull
Birds: ______

Eggs: ______
Godwit/Tevatevaaq
Birds: ______

Eggs: ______
Phalarope/Imaqcaar/
Augtuar
Birds: ______

Black-legged kittiwake Bonaparte’s/Sabine’s
gull
Birds: ______
Birds: ______

Eggs: ______
Whimbrel/Pipipiaq/
Ikikikiaq
Birds: ______

Eggs: ______

Eggs: ______
Kukukuaq
Birds: ______

Eggs: ______

Small sandpiper/
Iisuraar

Other or unknown bird:

Birds: ______

_________________

Large gull

Tern

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Black-bellied/Golden
plover/Tuyik

Turnstone/Cillmak/
Qiuracetaaq

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Comments:

Birds: ________
Eggs: ______

Eggs: ______

Eggs: ________
Turn to page 3 to report summer harvest. 

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

3

Yukon-Kuskokwim Delta, Household Harvest Report

Summer:

Did the household harvest birds or eggs from 1 July to 31 August? (check one)

Community:

Household ID:

Yes

No

Harvest Year:

Please write number of birds and eggs harvested by all members of this household.
American widgeon

Teal

Mallard

Northern pintail

Gadwall

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Northern shoveler

Black scoter

Surf scoter

White-winged scoter

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Bufflehead

Goldeneye

Canvasback

Scaup

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Common eider

King eider

Spectacled eider

Steller’s eider

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Harlequin duck

Long-tailed duck

Merganser

Unknown duck

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Black brant
Birds: ______

Eggs: ______

Cackling/Canada goose Greater white-fronted
goose
Birds: ______
Birds: ______

Eggs: ______

FWS Form 3-2381-1, OMB Control Number 1018-0124. Expires ##/##/20##.

Eggs: ______

Emperor goose

Snow goose

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Turn to page 4 to continue reporting summer harvest. 

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

Yukon-Kuskokwim Delta, Household Harvest Report,

4

Summer (1 Jul–31 Aug)

Community:

Household ID:

Please write number of birds and eggs harvested by all members of this household.
Swan

Sandhill crane

Grouse

Ptarmigan

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Pacific loon
Birds: ______

Pacific loon
nonbreeding

Yellow-billed loon

Loon 4

Red-throated loon

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Birds: ______

Eggs: ______

Grebe

Cormorant

Murre

Guillemot

Puffin

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Mew gull
Birds: ______

Eggs: ______
Godwit/Tevatevaaq
Birds: ______

Eggs: ______
Phalarope/Imaqcaar/
Augtuar
Birds: ______

Black-legged kittiwake Bonaparte’s/Sabine’s
gull
Birds: ______
Birds: ______

Eggs: ______
Whimbrel/Pipipiaq/
Ikikikiaq
Birds: ______

Eggs: ______
Small sandpiper/
Iisuraar
Birds: ______

Eggs: ______
Kukukuaq
Birds: ______

Eggs: ______
Other or unknown bird:

Large gull

Tern

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Black-bellied/Golden
plover/Tuyik

Turnstone/Cillmak/
Qiuracetaaq

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Comments:

_________________
Birds: ________

Eggs: ______

Eggs: ______

Eggs: ________
Turn to page 5 to report fall harvest. 

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

5

Yukon-Kuskokwim Delta, Household Harvest Report

Fall: Did the household harvest birds or eggs from 1 September to 31 October? (check one)
Community:

Household ID:

Yes

No

Harvest Year:

Please write number of birds and eggs harvested by all members of this household.
American widgeon
Birds: ______

Northern shoveler
Birds: ______

Bufflehead
Birds: ______

Common eider
Birds: ______

Harlequin duck
Birds: ______

Black brant
Birds: ______

Teal

Mallard

Birds: ______

Black scoter
Birds: ______

Goldeneye
Birds: ______

King eider
Birds: ______

Long-tailed duck
Birds: ______

Northern pintail

Birds: ______

FWS Form 3-2381-1, OMB Control Number 1018-0124. Expires ##/##/20##.

Birds: ______

Birds: ______

Surf scoter

White-winged scoter

Birds: ______

Canvasback

Birds: ______

Scaup

Birds: ______

Spectacled eider
Birds: ______

Merganser

Birds: ______

Steller’s eider
Birds: ______

Unknown duck

Birds: ______

Cackling/Canada goose Greater white-fronted
goose
Birds: ______
Birds: ______

Gadwall

Emperor goose
Birds: ______

Birds: ______

Snow goose
Birds: ______

Turn to page 6 to continue reporting fall harvest. 

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

6

Yukon-Kuskokwim Delta, Household Harvest Report,
Community:

Fall (1 Sep–31 Oct)

Household ID:

Please write number of birds and eggs harvested by all members of this household.
Swan
Birds: ______

Pacific loon
Birds: ______

Sandhill crane

Grouse

Birds: ______

Pacific loon
nonbreeding

Ptarmigan

Birds: ______

Yellow-billed loon
Birds: ______

Birds: ______

Loon 4
Birds: ______

Red-throated loon
Birds: ______

Birds: ______

Grebe
Birds: ______

Mew gull
Birds: ______

Godwit/Tevatevaaq
Birds: ______

Phalarope/Imaqcaar/
Augtuar
Birds: ______

Cormorant
Birds: ______

Murre
Birds: ______

Guillemot
Birds: ______

Black-legged kittiwake Bonaparte’s/Sabine’s
gull
Birds: ______
Birds: ______

Large gull

Whimbrel/Pipipiaq/
Ikikikiaq

Black-bellied/Golden
plover/Tuyik

Birds: ______

Small sandpiper/
Iisuraar
Birds: ______

Kukukuaq
Birds: ______

Other or unknown bird:

Birds: ______

Birds: ______

Puffin
Birds: ______

Tern
Birds: ______

Turnstone/Cillmak/
Qiuracetaaq
Birds: ______

Comments:

_________________
Birds: ________

Quyana  Thank you for completing the survey!

FWS Form 3-2381-1, OMB Control Number 1018-0124, Expires ##/##/20##

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.