Form 3-2327 Federal Subsistence Designated Hunter Application

Federal Subsistence Hunt Application

Permit No.

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

DESIGNATED HUNTER
Federal Land Unit:

FEDERAL PERMIT

Unit(s) & Subunit(s):

PERMIT NO: PERMIT_NUMBER
Applicant’s Name (First, Middle Initial, Last):

Date of Birth (mm/dd/yy):

Mailing Address:

Physical Address: PHY_ADDR_SAME

UNIT: State wide specific to
permit being designated
SPECIES:
SEASON:

AK Hunting License Number:

Telephone Number:

Community of Primary Residence:
Name of Recipient

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

Hunting
License #

Permit /
Ticket #

__________________ ________ _________
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__________________ _________ _________

comply with them and applicable regulations as found in 50 CFR 100 and 36 CFR 242 .

__________________ _________ _________
NON-TRANSFERABLE:

Federal Subsistence Harvest Report

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Permit Number:
Permittee’s Name:
Did you hunt as a Designated Hunter?
Yes ___ No ___
List All Persons for Whom You Hunted:
Permit /
Name of Recipient
Ticket #
Harvest Location

SPECIES:
C = Caribou S = Sheep
D = Deer
X = Muskox
M = Moose G = Goat
Unit /
# Harvested
Subunit Species Male Female

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4. PLEASE MAIL - Thank you for your cooperation.

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SEASON END:

HUNT CONDITIONS: See Back

DUE DATE:

USER_NAME

Designated Hunter: means a
Federally qualified subsistence
hunter who may take all or a portion of another Federally qualified
hunter’s harvest limit(s) only under situations approved by the
Board.

_________________________________
Print Name
X___________________________________
Hunter’s Signature

FWS Form 3-2327 Rev. 05/2018

Conditions of the Permit:

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.

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

Cut along the dotted line

Wildlife needs your cooperation
Good management helps ensure that animals
will be available to hunt in future years.
Harvest information is a tool that can be used
to help understand and maintain healthy wildlife populations, there-by providing for continued subsistence opportunity.

Remove this Area
Before Mailing

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 Info_Coll@fws.gov. Please do not send your completed form to this address.

OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE $300

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

US FISH AND WILDLIFE SERVICE

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES