3-2381-3 Interior Alaska Harvest Report

1

Interior Alaska, 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

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: ______

Harlequin duck

Long-tailed duck

Merganser

Unknown duck

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Cackling/Canada goose

Greater white-fronted goose

Snow goose

Swan

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

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

Turn to page 2 to continue reporting spring harvest. 

2

Interior Alaska, Household Harvest Report,

Spring (2 April–30 June)

Community:

Household ID:

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

Grouse

Ptarmigan

Grebe

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Pacific loon
Birds: ______

Pacific loon
nonbreeding

Loon 4

Red-throated loon

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Birds: ______

Eggs: ______

Mew gull

Bonaparte’s gull

Large gull

Tern

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Godwit

Whimbrel

Kukukuaq

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Phalarope
Birds: ______

Other or unknown bird:

Black-bellied/Golden
plover
Birds: ______

Eggs: ______

Small sandpiper
Birds: ______

Eggs: ______

Comments:

_________________
Birds: ________

Eggs: ______

Eggs: ________

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

Turn to page 3 to report summer harvest. 

3

Interior Alaska, 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: ______

Harlequin duck

Long-tailed duck

Merganser

Unknown duck

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Cackling/Canada goose

Greater white-fronted goose Snow goose

Swan

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

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

Turn to page 4 to continue reporting summer harvest. 

4

Interior Alaska, Household Harvest Report,

Summer (1 Jul–31 Aug)

Community:

Household ID:

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

Grouse

Ptarmigan

Grebe

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Pacific loon
Birds: ______

Pacific loon
nonbreeding

Loon 4

Red-throated loon

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Birds: ______

Eggs: ______

Mew gull

Bonaparte’s gull

Large gull

Tern

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Godwit

Whimbrel

Kukukuaq

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Phalarope
Birds: ______

Other or unknown bird:

Black-bellied/Golden
plover
Birds: ______

Eggs: ______

Small sandpiper
Birds: ______

Eggs: ______

Comments:

_________________
Birds: ________

Eggs: ______

Eggs: ________

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

Turn to page 5 to report fall harvest. 

5

Interior Alaska, 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: ______

Harlequin duck
Birds: ______

Cackling/Canada goose
Birds: ______

Teal

Mallard

Birds: ______

Birds: ______

Black scoter
Birds: ______

Goldeneye
Birds: ______

Long-tailed duck
Birds: ______

Greater white-fronted goose
Birds: ______

Northern pintail

Birds: ______

Birds: ______

Surf scoter

White-winged scoter

Birds: ______

Canvasback

Birds: ______

Scaup

Birds: ______

Merganser

Birds: ______

Unknown duck

Birds: ______

Snow goose

Birds: ______

Swan

Birds: ______

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

Gadwall

Birds: ______

Turn to page 6 to continue reporting fall harvest. 

6

Interior Alaska, Household Harvest Report,

Fall (1 Sep–31 Oct)

Community:

Household ID:

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

Pacific loon
Birds: ______

Mew gull
Birds: ______

Godwit
Birds: ______

Phalarope
Birds: ______

Grouse

Ptarmigan

Birds: ______

Birds: ______

Pacific loon
nonbreeding

Birds: ______

Large gull

Birds: ______

Other or unknown bird:

Red-throated loon

Birds: ______

Bonaparte’s gull

Birds: ______

Birds: ______

Loon 4

Birds: ______

Whimbrel

Grebe

Tern
Birds: ______

Birds: ______

Kukukuaq
Birds: ______

Black-bellied/Golden
plover
Birds: ______

Small sandpiper
Birds: ______

Comments:

_________________
Birds: ________

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

 Thank you for completing the survey!

FWS Form 3-2381-3, 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.