3-2381-4 North Slope Harvest Report

1

North Slope, 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: ______

Common eider

king eider

Spectacled eider

Steller’s eider

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Scaup

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: ______

Eggs: ______

FWS Form 3-2381-4, OMB Control Number 1018-0124. Expires ##/##/20##.

Snow goose

Unknown goose

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Turn to page 2 to continue reporting spring harvest. 

2

North Slope, 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.
Swan

Sandhill crane

Snowy owl

Grouse

Ptarmigan

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Pacific loon
Birds: ______

Pacific loon
nonbreeding

Yellow-billed loon

Red-throated loon

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Birds: ______

Eggs: ______

Tern

Sabine’s gull

Large gull

Murre

Guillemot

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Godwit

Whimbrel

Kuukukiaq

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Black-bellied/Golden
plover
Birds: ______

Eggs: ______

Turnstone
Birds: ______

Eggs: ______

Comments:
Phalarope
Birds: ______

Small sandpiper
Birds: ______

Other/unknown bird:
_________________
Birds: ________

Eggs: ______

Eggs: ______

Eggs: ________

FWS Form 3-2381-4, OMB Control Number 1018-0124. Expires ##/##/20##.

Turn to page 3 to report summer harvest. 

3

North Slope, 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: ______

Common eider

king eider

Spectacled eider

Steller’s eider

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Scaup

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: ______

Eggs: ______

FWS Form 3-2381-4, OMB Control Number 1018-0124. Expires ##/##/20##.

Snow goose

Unknown goose

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Turn to page 4 to continue reporting summer harvest. 

4

North Slope, 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.
Swan

Sandhill crane

Snowy owl

Grouse

Ptarmigan

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Pacific loon
Birds: ______

Pacific loon
nonbreeding

Yellow-billed loon

Red-throated loon

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Birds: ______

Eggs: ______

Tern

Sabine’s gull

Large gull

Murre

Guillemot

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Eggs: ______

Godwit

Whimbrel

Kuukukiaq

Birds: ______

Birds: ______

Birds: ______

Eggs: ______

Eggs: ______

Eggs: ______

Black-bellied/Golden
plover
Birds: ______

Eggs: ______

Turnstone
Birds: ______

Eggs: ______

Comments:
Phalarope
Birds: ______

Small sandpiper
Birds: ______

Other/unknown bird:
_________________
Birds: ________

Eggs: ______

Eggs: ______

Eggs: ________

FWS Form 3-2381-4, OMB Control Number 1018-0124. Expires ##/##/20##.

 Thank you for completing the survey!

FWS Form 3-2381-4, 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 Info_Coll@fws.gov. Please do not send your completed survey to this address.