3-2328 Federal Subsistence Fishing Permit

OMB Control No. 1018-0075 Expires ##/##/2022

Permit No.

Federal Subsistence Fish Application
Federal Land Unit:

Federal Fish Management Area:

Applicant’s Name (First, Middle Initial, Last):

Date of Birth (mm/dd/yy):

Telephone Number:

Mailing Address:

Physical Address:

Community of Primary Residence:

Applicant’s Signature

Issuing Agent (Print):

X ____________________________________________________________________

Date Permit Issued (mm/dd/yy):

I certify that I am a rural resident as defined by 50 CFR 100.4 and 36 CFR 242.4. I have read and understand the conditions
on the permit and agree to comply with them and applicable regulations as found in 50 CFR 100 and 36 CFR 242.

Federal Subsistence Permit and Harvest Report

Report Due:

Permit Number:
Season:
Limit:

Did you fish?
Yes ___ No ___
Did you use a designated fisher? Yes ___

Permittee’s Name:
No ___

Print household members authorized to fish with this Permit (must be Federally qualified subsistence users)

Name (s) _________________________________________________________________________________________________
Gear Legend

Month/
Day

Specific Location

Species Legend

Gear
Code

Species
Code

Number
Harvested

Month/
Day

Specific Location

Gear
Code

Species
Code

Number
Harvested

FWS Form 3-2328 Rev. 05/2018

Conditions of the Permit:

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the Alaska National Interest Lands Conservation Act; 36 CFR 242 and 50 CFR 100.
Purpose: The applicant’s information will be used to contact the individual if there are any questions on the harvest reported in the effort to manage fish and wildlife resources for future seasons.
Routine Uses: The Federal Subsistence Board will use the provided information to make recommendations to the Secretaries of Interior and Agriculture for the appointment of members to the Federal
Subsistence Regional Advisory Councils. More information about routine uses can be found in the System of Records Notice, Permits System, FWS-21.
Disclosure: Providing the information is voluntary, but required to obtain or retain a benefit.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to make recommendations to the Secretaries of the Interior and Agriculture
for appointment of members to the Federal Subsistence Regional Advisory Councils. It is our policy not to use your name for any other purpose. Your response is voluntary, but is required to obtain or retain a
benefit. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid
OMB control number. OMB has approved this collection of information and assigned Control No. 1018-0075.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 10 minutes for the application and permit, and 5 minutes for the report, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Service Information Collection Clearance Officer, Division of Policy, Performance, and Management Programs, Fish and Wildlife Service, Mail
Stop BPHC, 5275 Leesburg Pike, Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.

U.S. Fish and Wildlife Service
Office of Subsistence Management
1011 E. Tudor R. M/S 121
Anchorage, AK 99503-6199

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

OFFICIAL BUSINESS
PENALITY FOR PRIVATE USE $300

BUSINESS REPLY MAIL
FIRST-CLASS MAIL PERMIT NO. 12874 ANCHORAGE, AK
POSTAGE WILL BE PAID US FISH AND WILDLIFE SERVICE

US FISH AND WILDLIFE SERVICE

Conditions of the Permit:

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the Alaska National Interest Lands Conservation Act; 36 CFR 242 and 50 CFR 100.
Purpose: The applicant’s information will be used to contact the individual if there are any questions on the harvest reported in the effort to manage fish and wildlife resources for future seasons.
Routine Uses: The Federal Subsistence Board will use the provided information to make recommendations to the Secretaries of Interior and Agriculture for the appointment of members to the Federal
Subsistence Regional Advisory Councils. More information about routine uses can be found in the System of Records Notice, Permits System, FWS-21.
Disclosure: Providing the information is voluntary, but required to obtain or retain a benefit.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to make recommendations to the Secretaries of the Interior and Agriculture
for appointment of members to the Federal Subsistence Regional Advisory Councils. It is our policy not to use your name for any other purpose. Your response is voluntary, but is required to obtain or retain a
benefit. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid
OMB control number. OMB has approved this collection of information and assigned Control No. 1018-0075.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 10 minutes for the application and permit, and 5 minutes for the report, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Service Information Collection Clearance Officer, Division of Policy, Performance, and Management Programs, Fish and Wildlife Service, Mail
Stop BPHC, 5275 Leesburg Pike, Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.

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