3-2326 Federal Subsistence Hunt Application, Permit, and Harves

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

Federal Subsistence Hunt Application
Wildlife - Registration

Permit No.

Federal Land Unit:

Unit(s) & Subunit(s):

AK Hunting License Number:

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

Date of Birth (mm/dd/yy):

Telephone Number:

FEDERAL PERMIT
PERMIT NO:
Regulatory Year:

Mailing Address:

Physical Address:
HUNT NO: UNIT(S):
SEASON:
Community of Primary Residence:

Applicant's Signature

SPECIES:
X _____________________________________________________________________________________
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.

Issuing Agent (Print):
Date Permit Issued (mm/dd/yy):

LEGAL:
CONDITIONS: See Back

NON-TRANSFERABLE

Federal Subsistence Harvest Report Permit Number:
Permittee's Name:
Permit Event:
1. Did you hunt? Yes __

No __

Did you use a designated hunter where allowed? Yes __

No __

UNIT:
SEASON:
LEGAL:

2. A. How many days did you hunt? ____________
B. How did you get to hunt area? (Circle your primary method of getting to where you started walking)
1. Airplane
3. Boat
5. Snow machine
7. Highway Vehicle
2. Horse/Dog Sled
4. 3/4-Wheeler
6. Other off road vehicle
8. No vehicle used
C. Specific Locations______________________________

D. Subunit Hunted ___________________

E. Did you take an animal? Yes ___ No ___

Successful Harvest: Must
return permit Harvest Report
within 5 days day(s) after taking
an animal.
Unsuccessful or did not Hunt :
Must return permit Harvest
Report within 15 days after the
close of the season.

3. A. Date taken _______________ (mm/dd/yy)
B. Sex of animal: Male ____ Female ____

INTERNET REPORTING
http://fws.gov/alaska/harvestreport
UNIQUE CODE

Print Name :
___________________________
X____________________________________
Hunter's Signature

Not Avalible for this Permit
FWS Form 3-2326

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

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

Remove this Area
Before Mailing

Conditions of the Permit:

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

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US FISH AND WILDLIFE SERVICE c/o
USFS Cordova Ranger District
PO Box 280
Cordova, AK 99574-9985

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES