Survey

HH ID:__________

INFORMED CONSENT

FOR THE Survey and Interview

Southern Alaska Sharing Network and Subsistence Study

CONSENT TO PARTICIPATE IN RESEARCH: I am asking you, as the head of this household, to please take part in a research survey. The survey, being conducted for the U.S. Department of the Interior, Bureau of Ocean Energy Management (BOEM), will help the agency better understand subsistence harvests and sharing in communities nearest to the proposed oil and gas exploration and development in the Outer Continental Shelf (Cook Inlet). As a part of the project, I would like to interview you about the ways your household is supported and the ways subsistence foods come into your household. I am asking you to take part in this research because you live in this community and to learn if you are a subsistence harvester. Please ask questions about anything you do not understand, before deciding whether or not to participate.

1. PURPOSE OF THE STUDY: The purpose of this study is to describe subsistence harvests and sharing networks as they relate to your community. BOEM anticipates offshore oil and gas exploration and development near this area. Many studies have tried to document subsistence, but they have not accounted for the sharing that helps to support families in village Alaska. Similar to these projects, we would like to ask how much fish and game your household harvested last year, who lived in your household, and ranges of jobs and income that you and your family members had in the last year. However, this questionnaire is different in that we would also like to ask you about the ways that subsistence foods came into your household – either through sharing, cooperative hunting, exchanges of equipment, gifting, or other forms of help. We are documenting sharing to understand how households manage for environmental and economic changes, such as oil and gas development and climate change. Having this information now will help this village keep track of the changes in the future. It will also be used by BOEM in Environmental Impact Statements, Environmental Assessments, and policy making.

2. PROCEDURES: Survey questions will ask about your history, education, family, employment and other income sources, subsistence harvests, expenses, crew membership, commercial harvests, sharing, and resource changes. Surveys should take approximately 45 minutes to complete and will only occur once. The survey will take place in a location that is most convenient to you.

3. HOW THE INTERVIEW WORKS: Your participation is completely voluntary. I will read the questions to you and give you a range of answers to select that best fit your household. You may choose not to answer certain questions. If you do not want to answer a question, just say “pass.” No personal names, birthdates, or social security numbers, addresses, including email, or telephone numbers will be documented on the survey form. We will not put your name or the name and location of any households in our reports. Please feel free to ask questions for clarification at any time during the interview. To strengthen protections and maintain confidentiality, we have already assigned codes to everyone in your community, and instead of using personal names, we will use these person codes. We will not personally identify you or your household when describing local opinions to BOEM.

4. AUTHORITIES AND ANTICIPATED BENEFITS: Information collected in the Southern Alaska Subsistence Sharing Network Survey is authorized under the Outer Continental Shelf (OCS) Lands Act of 1953, 43 USC § 1345, (and amendments of 1978) and the National Environmental Policy Act of 1969, 42 USC§ 4321 to monitor and assess the effects of OCS oil and gas activities near human and physical environments. This information will be used to analyze relevant socioeconomic and sociocultural

information from your community to obtain baseline data to accomplish this legal requirement. Some of the information will be used in Environmental Assessments and Environmental Impact Statements. It may help BOEM avoid or reduce impacts of development.

However, you should not expect to benefit directly from participation in this research. You are important to the goal of building an accurate picture of well-being in southern South Central Alaska.

All information collected will be combined with information provided by other members of your community and used in aggregated form. Any information which would permit identification of an individual will be held in strictest confidence and will be used only by persons engaged in conducting the survey on behalf of the U.S. Department of the Interior.

5. PAYMENT FOR PARTICIPATION

You will be given an honorarium for your participation at a rate prearranged with the local Tribal Council.

6. IDENTIFICATION OF INVESTIGATORS

This survey will not place you in physical risk. The identity of every research participant will be kept confidential. If you have any questions about the research, please feel free to contact the interviewer/contractor. You may also contact the Contracting Officer’s Representative, [blank line to record name of BOEM Sociocultural Specialist], BOEM Alaska Region at 907-334-5264 [blank line to record name of Principal Investigator] [and blank line to fill in later, contact information for Principal Investigator].

To summarize:

• Participation in the interview and parts of the interview is voluntary.

• No personal names, social security numbers, birth dates, addresses, telephone numbers, or email addresses will be recorded on the survey.

• Neither your name nor the name of anyone else will appear in any reports or papers.

• The Traditional Councils of each community will review the final report before it is released.

• Results from interviews will be summarized, returned to the communities, and distributed for discussion.

_{►Are you willing to be interviewed? ........................................................................... ・Yes ・No}

PAPERWORK REDUCTION ACT OF 1995 (PRA) STATEMENT: The PRA (44 U.S.C. 3501 et. seq.) requires us to inform you that we collect this information to obtain knowledge of subsistence issues in coastal Alaska communities and how they relate to future oil and gas drilling. Responses are voluntary. 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. Public reporting burden for this study is estimated to average 45 minutes per response. This includes the time for reviewing instructions and answering the questions. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Bureau of Ocean Energy Management, Mail Stop HM-3127, 381 Elden Street, Herndon, VA 20170.

[add the section below if the Privacy Act is invoked]

PRIVACY AND CONFIDENTIALITY: The information the Department is collecting from you in this survey is subject to the Privacy Act of 1974, 5 U.S.C. 552a. Accordingly, the Department will not disclose your information to any person, or to another agency, without your written consent except as authorized under Subsection (b) of the Act and as a "routine use" (see Routine Uses below).

When the results of the research are published or discussed in conferences, no information that would reveal your identity will be included. Your Tribal Council will be given a draft report to review before the final submission to BOEM which will only reflect aggregated data and will not include any information that could identify you. You have the right to request review of the draft report. The final report will be posted on the internet on the BOEM website.

To support the confidentiality of this research the following protocols are in place:

• If collected, your name and the names of those individuals you identify will not remain part of the survey document, and will be kept locked in a separate file. No names will be tracked in the electronic database that we will use to generate the aggregated results we need to perform our analysis. To help protect your identity, we will assign codes to record on the survey in lieu of using names and identifying households.

• Answers to sensitive questions, if asked, will be viewed only by the Study's contractor-researchers and Bureau employees who have a need to access the information in order to perform their official duties. These individuals will be bound by confidentiality agreements and the provisions of the Privacy Act of 1974.

• As a matter of scientific integrity, we must be able to account for your participation in the survey and verify that data entered in the electronic database are accurate and not duplicative. Any documentation included as part of the survey instrument containing personal names and household identification will be removed from the surveys and locked and maintained separately. As researchers write final reports and publish the findings of this research, your coded responses will be combined with responses from other participants so that no single individual may be identified.

ROUTINE USES: The primary use of the records is to assist the Department in determining the environmental impacts, if any, of offshore oil and gas development on coastal Alaska Native and/or Native American communities, and to ensure that the Department fulfills its environmental stewardship mission. In addition to the disclosures generally permitted under Subsection (b) of the Privacy Act of 1974, disclosures of this information outside of the Department will be limited to those situations described in the System of Records Notice covering this information collection.

NOTE: This is a mandatory page that must be attached to all BOEM socio-economic/socio-cultural surveys requiring OMB control numbers.

_{AbouUT SOCIAL NETWORK ANALYSIS}

ABOUT SOCIAL NETWORK ANALYSIS

This diagram shows how wild foods were shared among households in Shungnak in 2002. Each box is a household. The lines between the households show the flow of wild foods from one house to another. At a glance, you can see how much sharing there was. Many of the elder households (brown boxes) and single elder households (triangles) are near the center of the diagram, which means they are near the center of the sharing network. The younger households (yellow) tend to be on the edges of the network. As they age, we would expect them to move towards the center.

This diagram is an example of social network analysis. To draw it, we asked questions like:

- Who killed the moose your household used?

- Who cut the fish your household used?

- Who paid your household bills?

Your answers to these questions help us describe sharing and cooperation, important parts of subsistence life. We do not expect you to remember everyone who helped your household. We hope you can remember the most important people.

We do not use names on our surveys. Instead, we have developed codes for everyone in your community. To properly code people who do not live in this community, we do enter names on a tear-off sheet. After non-local names have been coded, this sheet will be removed from the survey.

Subsistence Study for Cook Inlet

OMB Control Number 1010-0181

Expiration Date: February 28, 2013

Subsistence Study for Cook Inlet

OMB Control Number 1010-0181

Expiration Date: [blank line to be filled in upon issuance by OMB]

Contractor: [Name of Principal Investigator(s), address, contact information, contact number]

Under contract with

U.S. Department of the Interior

Bureau of Ocean Energy Management

Alaska OCS Region

Environmental Studies Section,

3801 Centerpoint Drive, Suite 500

Anchorage, Alaska 99503

GENEALOGY

Because subsistence resources are often shared with relatives, and because relatives often contribute in various ways to the subsistence harvest, including processing, we want to create a visual representation of the immediate relatives for you and your spouse/partner. We will only use pre-assigned person codes. We will add more boxes if necessary. The red boxes represent you and your spouse/partner.

HOUSEHOLD INFORMATION

Between JANUARY and DECEMBER of last year, please list all the members of your household.

PERSON CODE

MALE OR FEMALE

ALASKA NATIVE

OTHER ANCESTRY*

AGE IN RANGES**

HOW IS THIS PERSON RELATED TO HEAD?

LAST GRADE OF SCHOOL COMPLETED?

WHERE BORN?

YEARS IN COMMUNITY?

ID#

(FROM CODE BOOK)

(circle)

(circle)

(ENTER THE LETTER)

(ENTER THE LETTER)

(RELATION)

(ENTER GRADE 1-12/College)

(PLACE)

(YEARS)

01 HEAD

M F

Y N

02 HEAD

M F

Y N

03

M F

Y N

04

M F

Y N

05

M F

Y N

06

M F

Y N

07

M F

Y N

08

M F

Y N

09

M F

Y N

10

M F

Y N

*Ancestry

** Age

a. White

a. 4 and under

j. 45-49

b. American Indian

b. 5-9

k. 50-54

c. Black or African American

c. 10-14

l. 55-59

d. Asian (Filipino, Japanese, etc.)

d. 15-19

m. 60-64

e. Pacific Islander (Hawaiian, Samoan, etc.)

e. 20-24

n. 65-69

f. Other

f. 25-29

o. 70-74

g. 30-34

p. 74-79

h. 35-39

q. 80-84

i. 40-44

r. 85 and above

S UBSISTENCE HARVESTER INFORMATION

Between JANUARY and DECEMBER of last year please list all household members’ subsistence activities

	WAS THIS PERSON AN ACTIVE SUBSISTENCE HARVESTER?	IN WHICH MONTHS OF LAST YEAR WAS THIS PERSON ABLE TO HUNT, FISH, OR GATHER?	IF THIS PERSON WAS NOT ABLE TO HUNT, FISH OR GATHER ANY MONTH BETWEEN JANUARY AND DECEMBER,, …WHY NOT?
ID#	(circle)	(circle)	TOO OLD	TOO YOUNG	IN SCHOOL	WORKING	HEALTH	ABSENT	OTHER	“X” ALL THAT APPLY
01 HEAD	Y N	J F M A M J J A S O N D
02 HEAD	Y N	J F M A M J J A S O N D
03	Y N	J F M A M J J A S O N D
04	Y N	J F M A M J J A S O N D
05	Y N	J F M A M J J A S O N D
06	Y N	J F M A M J J A S O N D
07	Y N	J F M A M J J A S O N D
08	Y N	J F M A M J J A S O N D
09	Y N	J F M A M J J A S O N D
10	Y N	J F M A M J J A S O N D

SALMON HARVESTING

Do you fish for SALMON for subsistence?............................................. ...................................... Y N (circle)

Between January and December of last year, did you USE or TRY TO HARVEST SALMON?.. Y N (circle)

If NO, go to the next page.

________________________________________________________________________________________

If YES, continue on this page…

Please estimate how many SALMON you harvested for subsistence this year, including all methods. If fishing with others, report ONLY YOUR SHARE of the catch. Include SALMON you kept, gave away, lost to spoilage, etc.

		HOW MANY (____) DID YOU HARVEST LAST YEAR				UNITS	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE THAN IN PAST YEARS
	DID YOU HARVEST (_____) LAST YEAR?	CAUGHT WITH GILL NET OR SEINE	CAUGHT WITH ROD AND REEL	KEPT FROM COMMERCIAL FISHING	IF KEPT FROM COMMERICAL, TARGETED?
	(CIRCLE)				(CIRCLE)	(ind, lbs, etc)	(CIRCLE)
CHUM SALMON (Dogs)	Y N				Y N		L S M ?
PINK SALMON (Humpies)	Y N				Y N		L S M ?
COHO SALMON (Silvers)	Y N				Y N		L S M ?
SOCKEYE SALMON (Reds)	Y N				Y N		L S M ?
KING SALMON	Y N				Y N		L S M ?
UNK. SALMON	Y N				Y N		L S M ?
		These columns should include all the salmon harvested by this household.					"?" means "I don't know"

Last year, did you receive salmon from others? Y N (circle). If Yes, complete page 10.

Last year, did you give salmon away to others? Y N (circle). If Yes, complete page 10.

If No, turn to page 11.

SALMON NETWORK

For each network page, list the people who you gave to and/or received from. List the species, amount and the units. Refer to previous page for species list. If you gave more than one type of product to one person, list them separately. If you shared salmon, complete PART I. If you received salmon, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH SALMON DID YOU GIVE THIS PERSON	UNITS/ PRODUCTS	IS THAT AMOUNT A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH SALMON DID YOU GIVE THIS PERSON	UNITS/ PRODUCTS	IS THAT AMOUNT A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	WHOLE FISH, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	WHOLE FISH, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)
1ST SALMON SPECIES				F S L		1ST SALMON SPECIES
2ND SALMON SPECIES				F S L		2ND SALMON SPECIES
3RD SALMON SPECIES				F S L		3RD SALMON SPECIES
4TH SALMON SPECIES				F S L		4TH SALMON SPECIES
5TH SALMON SPECIES				F S L		5TH SALMON SPECIES
6TH SALMON SPECIES				F S L		6TH SALMON SPECIES
7TH SALMON SPECIES				F S L		7TH SALMON SPECIES
8TH SALMON SPECIES				F S L		8TH SALMON SPECIES
9TH SALMON SPECIES				F S L		9TH SALMON SPECIES
10TH SALMON SPECIES				F S L		10TH SALMON SPECIES

Between January and December of last year, did you get enough SALMON for your needs?....... Y N (circle)

If NO, why did you not get enough SALMON for your needs?

Resource__________________________________ Reason____________________________________

Resource__________________________________ Reason____________________________________

Do the people you share with or receive from (that is, your salmon network) change with changes in the availability of salmon? Y N (Circle)

If Yes, how does this network change? _________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

FRESHWATER FISH HARVESTING

Do you fish for FRESHWATER FISH for subsistence?................................................................ Y N (circle)

Between January and December of last year, did you USE or TRY TO HARVEST FRESHWATER FISH? .... …………………………………………………………………………………………………..... Y N (circle)

If NO, go to the next page. __________________________________________________________________________________________

If YES, continue on this page…

Please estimate how many FRESHWATER FISH you harvested for subsistence this year, including all methods. If fishing with others, report ONLY YOUR SHARE of the catch. Include FRESHWATER FISH you kept, gave away, lost to spoilage, etc.

		HOW MANY (____) DID YOU HARVEST LAST YEAR?
	DID YOU HARVEST (_____) ?	CAUGHT WITH GILL NET OR SEINE	CAUGHT WITH ROD AND REEL	ICE FISHING	WITH OTHER GEAR	KEPT FROM COMMERCIAL FISHING	UNITS	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE THAN IN PAST YEARS
	(CIRCLE)						(ind, lbs, etc)	(CIRCLE)
DOLLY VARDEN	Y N							L S M ?
STEELHEAD	Y N							L S M ?
RAINBOW TROUT	Y N							L S M ?
LAKE TROUT	Y N							L S M ?
UNK TROUT	Y N							L S M ?
OTHER FRESH-WATER FISH (NAME)	Y N							L S M ?
OTHER FRESH-WATER FISH (NAME)	Y N							L S M ?
OTHER FRESHWATER FISH (NAME)	Y N							L S M ?
								"?" means "I don't know"

Last year, did you receive FRESHWATER FISH from others? Y N (circle) If Yes, complete page 12.

Last year, did you give FRESHWATER FISH away to others? Y N (circle) If Yes, complete page 12.

If No, turn to page 13.

FRESHWATER FISH NETWORKS

IF you gave away FRESHWATER FISH last year, complete PART I. Refer to previous page for species list.

If you received FRESHWATER FISH from others, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH FISH DID YOU GIVE THIS PERSON	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH FISH DID YOU GIVE THIS PERSON	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	WHOLE FISH, CALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	WHOLE FISH, CALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)
1ST FRESHWATER SPECIES				F S L		1ST FRESHWATER SPECIES				F S L
2ND FRESHWATER SPECIES				F S L		2ND FRESHWATER SPECIES				F S L
3RD FRESHWATER SPECIES				F S L		3RD FRESHWATER SPECIES				F S L
4TH FRESHWATER SPECIES				F S L		4TH FRESHWATER SPECIES				F S L
5TH FRESHWATER SPECIES				F S L		5TH FRESHWATER SPECIES				F S L
6TH FRESHWATER SPECIES				F S L		6TH FRESHWATER SPECIES				F S L
7TH FRESHWATER SPECIES				F S L		7TH FRESHWATER SPECIES				F S L
8TH FRESHWATER SPECIES				F S L		8TH FRESHWATER SPECIES				F S L

Between January and December, did you get enough FRESHWATER FISH for your needs?...... Y N (circle)

If NO, why did you not get enough FRESHWATER FISH for your needs?

Resource___________________________________ Reason ______________________________________

Resource___________________________________ Reason ______________________________________

Do the people you share with or receive from (that is, your freshwater fish network) change with changes in the availability of these fish? Y N (Circle)

If Yes, how does this network change? __________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

MARINE FISH HARVESTING

Do you fish for MARINE FISH for subsistence?........................................................................................ Y N (circle)

Between January and December of last year, did you USE or TRY TO HARVEST MARINE FISH?..... Y N (circle)

If NO, go to the next page. _________________________________________________________________________________________________________

If YES, continue on this page…

Please estimate how many MARINE FISH you harvested for subsistence this year, including all methods. If fishing with others, report ONLY YOUR SHARE of the catch. Include MARINE FISH you kept, gave away, lost to spoilage, etc.

		HOW MANY (____) DID YOU HARVEST LAST YEAR?
	DID YOU HARVEST (_____)?	CAUGHT WITH GILL NET OR SEINE	CAUGHT WITH LONG LINE	CAUGHT WITH ROD AND REEL	WITH OTHER GEAR (POTS?)	KEPT FROM COMMERCIAL FISHING	UNITS	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE THAN IN PAST YEARS
	(CIRCLE)						(ind, lbs, etc)	(CIRCLE)
HALIBUT	Y N							L S M ?
OTHER FLATFISH	Y N							L S M ?
COD	Y N							L S M ?
POLLOCK	Y N							L S M ?
ROCKFISH	Y N							L S M ?
RED (yellow-eyed)	Y N							L S M ?
BLACK	Y N							L S M ?
GREENLING	Y N							L S M ?
LINGCOD	Y N							L S M ?
Flounder	Y N							L S M ?
	Y N							L S M ?
	Y N							L S M ?
	Y N							L S M ?
								"?" means "I don't know"

Last year, did you receive MARINE FISH from others? Y N (circle) If Yes, complete page 14.

Last year, did you give MARINE FISH away to others? Y N (circle) If Yes, complete page 14.

If No, turn to page 15.

MARINE FISH NETWORKS

IF you gave away MARINE FISH last year, complete PART I. Refer to previous page for species list.

If you received MARINE FISH from others, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH FISH DID YOU GIVE THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU RECEIVED FROM	HOW MUCH FISH DID YOU RECEIVE FROM THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)
1ST MARINE SPECIES						1ST MARINE SPECIES
2ND MARINE SPECIES						2ND MARINE SPECIES
3RD MARINE SPECIES						3RD MARINE SPECIES
4TH MARINE SPECIES						4TH MARINE SPECIES
5TH MARINE SPECIES						5TH MARINE SPECIES
6TH MARINE SPECIES						6TH MARINE SPECIES
7TH MARINE SPECIES						7TH MARINE SPECIES
8TH MARINE SPECIES						8TH MARINE SPECIES

Between January and December, did you get enough MARINE FISH for your needs?...................... Y N (circle)

If NO, why did you not get enough MARINE FISH for your needs?

Resource___________________________________ Reason_____________________________________________

Resource___________________________________ Reason_____________________________________________

Do the people you share with or receive from (that is, your marine fish network) change with changes in the availability of these fish? Y N (Circle)

If Yes, how does this network change? __________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

SHELLFISH AND INTERTIDAL HARVESTING

Do you fish for SHELLFISH for subsistence?............................................................................................ Y N (circle)

Between January and December, did you USE or TRY TO HARVEST SHELLFISH?.... ........................ Y N (circle)

If NO, go to the next page. _________________________________________________________________________________________________

If YES, continue on this page…

Please estimate how many SHELLFISH you harvested for subsistence this year, including all methods. If harvesting with others, report ONLY YOUR SHARE of the catch. Include SHELLFISH you kept, gave away, lost to spoilage, etc.

		HOW MANY (____) DID YOU HARVEST LAST YEAR
	DID YOU HARVEST (_____)?	WITH A POT	WITH A SHOVEL	WITH OTHER GEAR	KEPT FROM COMMERCIAL FISHING	HARVESTED WHILE COMMERCIAL FISHING	UNITS	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE THAN IN PAST YEARS
	(CIRCLE)					(CIRCLE)	(ind, lbs, etc)	(CIRCLE)
KING CRAB	Y N					Y N		L S M ?
DUNGENESS CRAB	Y N					Y N		L S M ?
COCKLES	Y N					Y N		L S M ?
SURF CLAMS	Y N					Y N		L S M ?
RAZOR CLAMS	Y N					Y N		L S M ?
CHITONS/BIDARKIS	Y N					Y N		L S M ?
HORSE CLAMS	Y N					Y N		L S M ?
SEA URCHINS	Y N					Y N		L S M ?
Butter Clams	Y N					Y N		L S M ?
OTHER SHELLFISH	Y N					Y N		L S M ?
OCTOPUS / CUTTLEFISH	Y N					Y N		L S M ?
Tanner Crab	Y N					Y N		L S M ?
King Crab	Y N					Y N		L S M ?
	Y N					Y N		L S M ?
								"?" means "I don't know"

Last year, did you receive SHELLFISH from others? Y N (circle) If Yes, complete page 16.

Last year, did you give SHELLFISH away to others? Y N (circle) If Yes, complete page 16.

If No, turn to page 17.

SHELLFISH HARVESTING NETWORKS

If you gave away SHELLFISH last year, complete PART I. Refer to previous page for species list. If you received SHELLFISH from others, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH FISH DID YOU GIVE THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU RECEIVED FROM	HOW MUCH FISH DID YOU RECEIVE FROM THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)
1ST SHELLFISH						1ST SHELLFISH
2ND SHELLFISH						2ND SHELLFISH
3RD SHELLLFISH						3RD SHELLLFISH
4TH SHELLFISH						4TH SHELLFISH
5TH SHELLFISH						5TH SHELLFISH
6TH SHELLFISH						6TH SHELLFISH
7TH SHELLFISH						7TH SHELLFISH
8TH SHELLFISH						8TH SHELLFISH

B etween January and December, did you get enough SHELLFISH for your needs?.......................... Y N (circle)

If NO, why did you not get enough SHELLFISH for your needs?

Resource___________________________________ Reason_____________________________________________

Resource___________________________________ Reason_____________________________________________

Do the people you share with or receive from (that is, your shellfish network) change with changes in the availability of these shellfish? Y N (Circle)

If Yes, how does this network change?__________________________________________________________________

_________________________________________________________________________________________________

SEA MAMMAL HARVESTING

Do you hunt SEA MAMMALS for subsistence?..................................................................................... Y N (circle)

Between January and December, did you USE or TRY TO HARVEST SEA MAMMALS?.................. Y N (circle)

If NO, go to the next page. _________________________________________________________________________________________________

If YES, continue on this page…

Please estimate how many SEA MAMMALS you harvested for subsistence this year, including all methods. If hunting with others, report ONLY YOUR SHARE of the harvest. Include SEA MAMMALS you kept, gave away, lost to spoilage, etc.

		HOW MANY (____) DID YOU HARVEST LAST YEAR?
	DID YOU HARVEST (_____)?	JAN- APRIL	MAY - JUNE	JULY - SEPT	OCT- DEC	SEASON NOT KNOWN	SCAVANGED WHILE DOING OTHER ACTIVITIES	SCAVANGED WHILE COMMERCIAL FISHING	UNITS	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE THAN IN PAST YEARS
	(CIRCLE)								(ind, lbs, etc)	(CIRCLE)
STELLER SEA LION	Y N									L S M ?
NORTHERN FUR SEAL	Y N									L S M ?
HARBOR SEAL	Y N									L S M ?
RINGED SEAL	Y N									L S M ?
BEARDED SEAL	Y N									L S M ?
SEA OTTER	Y N									L S M ?
WALRUS	Y N									L S M ?
WHALE SP. 1 (___ __ __)	Y N									L S M ?
WHALE SP. 2 (___ ____)	Y N									L S M ?
PORPOISE	Y N									L S M ?
	Y N									L S M ?
	Y N									L S M ?

Last year, did you receive SEA MAMMALS from others? Y N (circle) If Yes, complete page 18.

Last year, did you give SEA MAMMALS away to others? Y N (circle) If Yes, complete page 18.

If No, turn to page 19.

SEA MAMMAL NETWORKS

If you gave away SEA MAMMALS last year, complete PART I. Refer to previous page for species list.

If you received SEA MAMMALS from others, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH FISH DID YOU GIVE THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU RECEIVED FROM	HOW MUCH FISH DID YOU RECEIVE FROM THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)
1ST SEA MAMMAL						1ST SEA MAMMAL
2ND SEA MAMMAL						2ND SEA MAMMAL
3RD SEA MAMMAL						3RD SEA MAMMAL
4TH SEA MAMMAL						4TH SEA MAMMAL
5TH SEA MAMMAL						5TH SEA MAMMAL
6TH SEA MAMMAL						6TH SEA MAMMAL
7TH SEA MAMMAL						7TH SEA MAMMAL
8TH SEA MAMMAL						8TH SEA MAMMAL

Between January and December, did you get enough SEA MAMMALS for your needs?................... Y N (circle)

If NO, why did you not get enough SEA MAMMALS for your needs?

Resource__________________________________ Reason_____________________________________________

Resource__________________________________ Reason_____________________________________________

Do the people you share with or receive from (that is, your sea mammal network) change with changes in the availability of these species? Y N (Circle)

If Yes, how does this network change?__________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

LAND MAMMAL HARVESTING

Do you hunt LAND MAMMALS for subsistence?..................................................................................... Y N (circle)

Between January and December, did you USE or TRY TO HARVEST LAND MAMMALS?................. Y N (circle)

If NO, go to the next page. __________________________________________________________________________________________________

If YES, continue on this page…

Please estimate how many LAND MAMMALS you harvested for subsistence this year, including all methods. If hunting with others, report ONLY YOUR SHARE of the harvest. Include LAND MAMMALS you kept, gave away, lost to spoilage, etc.

		HOW MANY (____) DID YOU HARVEST LAST YEAR?
	DID YOU HARVEST (_____)?	Annual HARVEST	TYPICAL ANNUAL HARVEST 2 YEARS AGO	TYPICAL ANNUAL HARVEST 3 YEARS AGO	TYPICAL ANNUAL HARVEST 4 YEARS AGO	UNITS	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE LAST YEAR THAN IN PAST YEARS
	(CIRCLE)					(individuals, lbs)	(CIRCLE)
CARIBOU	Y N						L S M ?
MOOSE	Y N						L S M ?
BEAVER	Y N						L S M ?
RIVER OTTER	Y N						L S M ?
GROUND SQUIRREL	Y N						L S M ?
PORCUPINE	Y N						L S M ?
WOLVERINE	Y N						L S M ?
WOLF	Y N						L S M ?
RED FOX	Y N						L S M ?
BROWN BEAR	Y N						L S M ?
ARCTIC HARE	Y N						L S M ?
WILD CATTLE	Y N						L S M ?
BISON	Y N						L S M ?
Black Bear	Y N						L S M ?
Grizzly/Brown Bear	Y N						L S M ?

Last year, did you receive LAND MAMMALS from others? Y N (circle) If Yes, complete page 20.

Last year, did you give LAND MAMMALS away to others? Y N (circle) If Yes, complete page 20.

If No, turn to page 21.

LAND MAMMAL NETWORKS

If you gave away LAND MAMMALS last year, complete PART I. Refer to previous page for species list.

If you received LAND MAMMALS from others, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MANY (____) DID YOU GIVE THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU RECEIVED FROM	HOW MANY (____) DID YOU RECEIVE FROM THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	IND, GALS, LBS, CASES, JARS, ETC	(CIRCLE ONE)
1ST LAND MAMMAL						1ST LAND MAMMAL
2ND LAND MAMMAL						2ND LAND MAMMAL
3RD LAND MAMMAL						3RD LAND MAMMAL
4TH LAND MAMMAL						4TH LAND MAMMAL
5TH LAND MAMMAL						5TH LAND MAMMAL
6TH LAND MAMMAL						6TH LAND MAMMAL
7TH LAND MAMMAL						7TH LAND MAMMAL
8TH LAND MAMMAL						8TH LAND MAMMAL

Between January and December, did you get enough LAND MAMMALS for your needs?.............. Y N (circle)

If NO, why did you not get enough LAND MAMMALS for your needs?

Resource______________________________________ Reason___________________________________________

Resource______________________________________ Reason___________________________________________

Do the people you share with or receive from (that is, your land mammal network) change with changes in the availability of these species? Y N (Circle)

If Yes, how does this network change?__________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

PLANT HARVESTING

Do you harvest PLANTS for subsistence?.................................................................................................... Y N (circle)

Between January and December, did you USE or TRY TO HARVEST PLANTS? ................................. Y N (circle)

If NO, go to the next page. ________________________________________________________________________________________________

If YES, continue on this page…

Please estimate amounts of PLANTS you harvested for subsistence this year, including all methods. If gathering with others, report ONLY YOUR SHARE of the harvest. Include PLANTS you kept, gave away, lost to spoilage, etc.

	DID YOU HARVEST (_____)?	HOW MUCH PLANT FOODS DID YOU HARVEST?	WERE THERE LESS, SAME, OR MORE (____) AVAILABLE THAN IN PAST YEARS
	(CIRCLE)	GALS, NOS, OR LBS	(CIRCLE)
BLUEBERRIES	Y N		L S M ?
YELLOW SALMON BERRIES	Y N		L S M ?
MOSS BERRIES / BLACK BERRIES	Y N		L S M ?
CRANBERRIES	Y N		L S M ?
STRAWBERRIES	Y N		L S M ?
PUSHKI / COW PARSNIP	Y N		L S M ?
PETRUSHKI / WILD PARSLEY	Y N		L S M ?
MUSHROOMS	Y N		L S M ?
WILD RHUBARB	Y N		L S M ?
FIREWEED	Y N		L S M ?
WILD RICE	Y N		L S M ?
BEACH GREENS	Y N		L S M ?
WINEBERRIES	Y N		L S M ?
HUCKLEBERRIES	Y N		L S M ?
CLOUDBERRIES	Y N		L S M ?
DEWBERRIES	Y N		L S M ?

Last year, did you receive PLANTS from others? Y N (circle) If Yes, complete page 22.

Last year, did you give PLANTS away to others? Y N (circle) If Yes, complete page 22.

If No, turn to page 23.

PLANT NETWORKS

IF you gave away PLANTS and/or BERRIES last year, complete PART I. Refer to previous page for species list.

If you received PLANTS and/or BERRIES from others, complete PART II.

PART I	PERSON CODE FOR WHO YOU GAVE TO	HOW MUCH PLANTS OR BERRIES DID YOU GIVE THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?		PART II	PERSON CODE FOR WHO YOU RECEIVED FROM	HOW MANY PLANTS OR BERRIES DID YOU RECEIVE FROM THIS PERSON?	UNITS/ PRODUCTS	WOULD YOU SAY THAT AMOUNT WAS A FEW, SOME, OR LOTS?
NAME SPECIES	00000	NUMBER	IND, GALS, LBS	(CIRCLE ONE)		NAME SPECIES	00000	NUMBER	IND, GALS, LBS	(CIRCLE ONE)
1ST SPECIES						1ST SPECIES
2ND SPECIES						2ND SPECIES
3RD SPECIES						3RD SPECIES
4TH SPECIES						4TH SPECIES
5TH SPECIES						5TH SPECIES
6TH SPECIES						6TH SPECIES
7TH SPECIES						7TH SPECIES
8TH SPECIES						8TH SPECIES
9TH SPECIES						9TH SPECIES
10TH SPECIES						10TH SPECIES

Between January and December, did you get enough PLANTS for your needs?................................... Y N (circle)

If NO, why did you not get enough PLANTS for your needs?

Resource____________________________________ Reason_____________________________________________

Resource____________________________________ Reason_____________________________________________

Do the people you share with or receive from (that is, your plant network) change with changes in the availability of these species? Y N (Circle)

If Yes, how does this network change?__________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

CREWS

Between JANUARY and DECEMBER, who did you hunt, fish, gather, etc. with?

SPECIES & METHOD	CREW CAPTAIN	IN WHICH MONTHS WAS THIS CREW HUNTING, FISHING, GATHERING, ETC?	WHO WERE THE USUAL CREW MEMBERS FOR THE HUNTING, FISHING, GATHERING ACTIVITIES?
( e.g. Salmon seine crew)	(PERSON CODE)	(circle)	#1 (PERSON CODE)	#2 (PERSON CODE)	#3 (PERSON CODE)	#4 (PERSON CODE)	#5 (PERSON CODE)	#6 (PERSON CODE)
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D
		J F M A M J J A S O N D

Do these crews change from year to year? Y N (Circle)

If yes, what are the reasons?_______________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

How do these crews change?_______________________________________________________________________

________________________________________________________________________________________________________

_______________________________________________________________________________________________________

EMPLOYMENT

We ask about jobs and income because we are trying to understand all parts of the local economy. Wage jobs often support subsistence activities.

Between JANUARY and DECEMBER

Did members of your household earn money from a job or self-employment……………… Y N (circle)

If NO, go to the next page. _________________________________________________________________________________________________

If YES, continue on this page…

Please list each job held by you and other household members between JANUARY and DECEMBER. List each job on a separate line. One person may have several lines.

						WORK SCHEDULE…*
	WHO HAD THIS JOB?	WHAT KIND OF WORK DID HE/SHE DO IN THIS JOB?	IN WHICH MONTHS WAS THIS PERSON ABLE TO HUNT, FISH, OR GATHER?	FULL TIME	PART TIME		SHIFT - FULL TIME	ON CALL, VARIES	SHIFT - PART TIME	INCOME RANGE a. $1-$10,000; b. $10,001-$20,000; c. $20,001-$30,000; d. $30,001 to $40,000; e. $40,001-$50,000; f. $50,001$60,000; g. $60,001-$70,000; h. $70,001-$80,000; i. $80,001-$90,000; j. $90,001-$100,000; k. Greater than $100,000.
	(CODE)		(CIRCLE MONTHS WORKED)	(CIRCLE ONE)						(INSERT LETTER)
1ST JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
2ND JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
3RD JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
4TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
5TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
6TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
7TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
8TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
9TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP
10TH JOB			J F M A M J J A S O N D	FT	PT		SF	OC	SP

*List Self-Employment as a separate job. Work schedule is “On Call.”

Work Schedule:

Fulltime = 35+ hours/week

Part-time = <35 hours/week

Shift fulltime = 2 weeks on/2 weeks off, e.g.

On call = irregular hours

Shift part time = part-time regular schedule

OTHER INCOME SOURCES

		DID ANYONE IN YOUR HH RECEIVE INCOME FROM ______ ?	IF YES, WHO RECEIVED INCOME FROM _____?																			WHAT WAS THE INCOME RANGE YOUR HH RECEIVED?
			HEAD 01		HEAD 02		PERSON 03		PERSON 04		PERSON 05		PERSON 06		PERSON 07		PERSON 08		PERSON 09		PERSON 10	$0 $1-$5,000 c. $5,001-$15,000 $15,001-$20,000 $20,001-$25,000 $25,001-$30,000 $30,001-$35,000 $35,001-$40,000 $40,001-$45,000 Greater than $45,000
		(CIRCLE ONE)	(IF PERSON RECEIVED THIS KIND OF INCOME, CIRCLE THEIR NUMBER)																			(ENTER LETTER)
DIVIDENDS	ALASKA PERMANENT FUND DIVIDEND	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
	NATIVE CORPORATION DIVIDEND	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
JOB BENEFITS	UNEMPLOYMENT	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
	WORKERS' COMPENSATION	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
ASSISTANCE	FOOD STAMPS	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
	ADULT PUBLIC ASSISTANT	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
ELDERS	PENSION AND RETIREMENT	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
	SOCIAL SECURITY	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
CHILD BENEFITS	SUPPLEMENTAL SECURITY	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
	FOSTER CARE*	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
	CHILD SUPPORT*	Y N	1		2		3		4		5		6		7		8		9		10	$/yr
ENERGY	ENERGY ASSISTANCE	Y N	NOT AN INDIVIDUAL BENEFIT																			$/yr
	WEATHERIZATION	Y N	NOT AN INDIVIDUAL BENEFIT																			$/yr
	OTHER (describe)	Y N	1	2		3		4		5		6		7		8		9		10		$/yr

*Payments should be assigned to the primary caregiver, NOT the child.

EXPENSES AND EXPENSE NETWORKS

About how much did you spend on GROCERIES last year? (If given a monthly expense, multiply by 12). $______________per year

Between JANUARY and DECEMBER, did you pay for others’ groceries? Y N (Circle)

If YES, list the most important person first and include people living in the household if relevant.

	PERSON CODE 01	PERSON CODE 02	PERSON CODE 03	PERSON CODE 04	PERSON CODE 05	PERSON CODE 06	PERSON CODE 07	PERSON CODE 08
GROCERIES

Do the people you help with groceries change from year to year? Y N (Circle)

If yes, what are the reasons?_________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How do they change?______________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

HOUSEHOLD EXPENSES

For the following household expenses, please tell me how much your household spent on each last year. (If given a monthly expense, multiply by 12)

HOUSING EXPENSES
RENT OR MORTGAGE	$	PER YR
HEATING FUEL	$	PER YR
PROPANE	$	PER YR
ELECTRICITY	$	PER YR
WATER-SEWER-GARBAGE	$	PER YR
TELEPHONE	$	PER YR
CABLE OR SATELLITE TV	$	PER YR

Between JANUARY and DECEMBER, did you pay others’ household expenses listed above? Y N (Circle)

If YES, list the most important person first and include people living in the household if relevant.

	PERSON CODE 01	PERSON CODE 02	PERSON CODE 03	PERSON CODE 04	PERSON CODE 05	PERSON CODE 06	PERSON CODE 07	PERSON CODE 08
HOUSEHOLD EXPENSES

Do the people you help with household expenses change from year to year? Y N (Circle)

If yes, what are the reasons?_________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

How do they change?_______________________________________________________________________________

__________________________________________________________________________________________________________

SUBSISTENCE EXPENSES

For the following subsistence expenses, please tell me about how much you spent on each last year.

SUBSISTENCE SUPPLIES
GASOLINE	$	PER YR
AMMUNITION	$	PER YR
SUPPLIES	$	PER YR

Between JANUARY and DECEMBER, did you pay others’ SUBSISTENCE EXPENSES listed above?

Y N (Circle)

If YES, list the most important person first and include people living in the household if relevant.

	PERSON CODE 01	PERSON CODE 02	PERSON CODE 03	PERSON CODE 04	PERSON CODE 05	PERSON CODE 06	PERSON CODE 07	PERSON CODE 08
SUBSISTENCE SUPPLIES

Do the people you help with subsistence expenses change from year to year? Y N (Circle)

If yes, what are the reasons? _________________________________________________________________ __________________________________________________________________________________________

__________________________________________________________________________________________

How do they change? _______________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

Between JANUARY and DECEMBER, what supplies, groceries, and other goods did you bring in from outside your community?

ITEM	AMOUNT (UNITS)	FROM WHERE	VALUE ($)

EXPENSES AND EXPENSE NETWORKS CONTINUED

Between JANUARY and DECEMBER, what supplies, groceries, and other goods did you receive from people outside your community?

ITEM	AMOUNT (UNITS)	FROM WHERE	WHO SENT IT (PERSON CODE)	VALUE ($)

Do the people who provide these goods change from year to year? Y N (Circle)

If yes, what are the reasons? ________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

How do they change? _________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

SUBSISTENCE EQUIPMENT AND NETWORKS

Between JANUARY and DECEMBER, did you use subsistence equipment?............................Y N (circle)

If NO, go to the next page.

___________________________________________________________________________________________________________________________________

If YES, continue on this page…

From the following list of equipment, please tell me if you used or owned this equipment, and whether you purchased or repaired this equipment last year.

	LAST YEAR, DID YOU USE?	HOW MANY WORKING _______ DID YOU OWN?	PURCHASES		MAINTENANCE
			HOW MANY DID YOU BUY?	HOW MUCH WERE YOUR TOTAL PURCHASES	DID YOU REPAIR?	HOW MUCH DID PARTS & REPAIRS COST
	(CIRCLE)	(NUMBER)	(NUMBER)	(DOLLARS)	(CIRCLE ONE)	(DOLLARS)
SKIFF(S)	Y N			$		$
OUTBOARD MOTOR	Y N			$		$
COMMERCIAL > 30' BOAT(S)	Y N			$		$
VESSEL INSURANCE				$
SETNET SITE LEASE	Y N			$
SNOW MACHINE(S)	Y N			$		$
ATVS, 4-WHEELERS	Y N			$		$
CAR(S) OR TRUCKS(S)	Y N			$		$
OTHER (________________)	Y N			$		$

Who owned the equipment you used for subsistence between JANUARY and DECEMBER?

(Please list the most important people first, including yourself and those living in your household.)

	PERSON CODE 01	PERSON CODE 02	PERSON CODE 03	PERSON CODE 04	PERSON CODE 05	PERSON CODE 06	PERSON CODE 07	PERSON CODE 08
SKIFF(S)
COMMERCIAL > 30' BOAT(S)
SNOW MACHINE(S)
ATVS, 4-WHEELERS
CAR(S) OR TRUCKS(S)
OTHER (________________)

Do the people who loan you their equipment change from year to year? Y N (Circle)

If yes, what are the reasons? __________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

How do they change? _____________________________________________________________________

HOUSEHOLD SUPPORT NETWORKS

Between JANUARY and DECEMBER, from whom did you get information? Please list the most important people first, including those living in your household and yourself

	PERSON CODE 01	PERSON CODE 02	PERSON CODE 03	PERSON CODE 04	PERSON CODE 05	PERSON CODE 06	PERSON CODE 07	PERSON CODE 08
FISHING INFORMATION
HUNTING INFORMATION
FINANCIAL INFORMATION (jobs, grants, etc)
SHIPPING AND ORDERING INFORMATION
TRAVEL INFORMATION

From this list of things people might do for your household, who did these things for you between JANUARY and DECEMBER? Please list the most important people first, including those living in your household and yourself.

	PERSON CODE 01	PERSON CODE 02	PERSON CODE 03	PERSON CODE 04	PERSON CODE 05	PERSON CODE 06	PERSON CODE 07	PERSON CODE 08
BUILT, ASSISTED IN PURCHASING, OR REPAIRED SUBSISTENCE EQUIPMENT
BUILT, ASSISTED IN PURCHASING, OR REPAIRED COMMERICAL EQUIPMENT SOMETIMES USED FOR SUBSISTENCE
COOKED & CLEANED FOR YOUR HOUSEHOLD
WATCHED CHILDREN FOR YOUR HOUSEHOLD

Do the people who help you in the ways listed above change from year to year? Y N (Circle)

If yes, what are the reasons? _______________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________

How do they change? _______________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

OIL AND GAS DEVELOPMENT

Do you support the proposed offshore oil/gas exploration and development project? Y N (Circle)

Why or why not? ___________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Please indicate any advantages and disadvantages you anticipate with proposed oil/gas exploration and development and give your reason. List others as necessary.

POTENTIAL IMPACTS	INCREASE	DECREASE	NO CHANGE		IS THIS A POSITIVE?	IS THIS A NEGATIVE?	REASON
Jobs for local people
Village economy
Energy costs
Village population (local)
Village population (non-local)
Business opportunities
Quality of life
Subsistence access
Social problems

OIL AND GAS EXPLORATION AND DEVELOPMENT

This map models the leading scenario for the proposed oil and gas exploration and development for this project. Describe scenario. Given this scenario, please answer the following questions.

Located here is a map showing/listing town/fishing port: former village; proposed offshore drilling and production infrastructure (platforms; pipelines; terminals; and the like).[Scenarios have not yet been conceptualized.]

Do you subsistence harvest in the proposed area?

Y N (Circle)

Of the top ten subsistence species your household consumes, are any of them harvested in these areas?

Y N (Circle)

If yes, which species? _______________________________________________________________________

If there was development in these areas, would this affect your harvest of these key species?

Y N (Circle)

How?_____________________________________________________________________________________

Do you get these resources from another source? Y N (Circle) If yes, where or from whom?

__________________________________________________________________________________________

Do you expect to be employed in this exploration or development project? Y N (Circle)

From the information you have provided about the people you share with and/or rely upon, do you expect any of them to be employed in this development project? Y N (Circle)

You have provided information about your sharing and harvesting activities with subsistence foods, cash expenses, groceries and other goods, equipment, labor and information that involve a certain set of people. This is your subsistence sharing network or networks. Do you believe that there will be changes next year in the people with whom you give and receive things? __________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

WILDLIFE HEALTH

We are interested in knowing any changes in WILDLIFE HEALTH, good and bad—such as skin nodules, hair loss, fat, deformities—that you noticed in your harvesting. These changes may not be linked to the actual harvesting. Please name a resource and describe the change.

FISH, GAME OR PLANT	WHAT WAS WRONG WITH THEM? Or WHAT IMPROVED FOR THEM?	HOW MANY WERE OR HOW MUCH WAS AFFECTED?	LOCATION WHERE YOU OBSERVED THIS CHANGE	HAVE YOU SEEN THIS PROBLEM IN PAST YEARS?
(RESOURCE)	(DESCRIBE THE SYMPTOM)	(NUMBER, GALS, ESTIMATE ETC)	(PLACE)	(CIRCLE ONE)
				Y N
				Y N
				Y N
				Y N
				Y N
				Y N
				Y N
				Y N
				Y N

ADDITIONS AND NOTES

Do you have any additional questions, comments, or concerns? ________________________________________________________________________________________________

__________________________________________________________________________________________________________

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Interview Notes

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