Fws Form 3-2359 - Big Game Harvest Report - U.s. Fish And Wildlife Service printable pdf download

OMB Control Number

U.S. Fish and Wildlife Service

Big Game Harvest Report

1018-0140

National Wildlife Refuge System

Expires 05/31/2018

Name of Refuge: ______________________________

Hunt area (unit, zone, description): ____________________________________________________________

Hunter name:

___________________________________________________________________________

City, State, ZIP: ___________________________________________________________

Date of hunt: ________________________

Time: From:______ am/pm to: __________ am/pm

Total Hours hunted:__________

Number in party (please circle):

other: ________________

Species

Number harvested

Male/Female

Size*

Note: Not all species are hunted on this refuge.

Check refuge regulations for details.

Deer

Feral Hog

Turkey

Other (specify):

*points, approximate weight, beard length or other appropriate measure.

Comments:

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Notice

In accordance with the Privacy Act (5 U.S. C. 552a) and the Paperwork Reduction Act (44 U.S. C. 3501), please note the following information:

1. We estimate the public reporting burden on the applicant for information collection to be 15 minutes. This burden estimate includes time for reviewing

instructions, gathering and maintaining data and completing and reviewing the form. You may direct comments regarding the burden estimate or any

other aspect of the form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, Mail Stop BPHC, U.S. Department

of the Interior, 1849 C Street, NW, Washington D.C. 20240.

2. Routine use disclosures may be made: (a) to the U.S. Department of Justice when related to litigation or anticipated litigation; (b) of information

indicating a violation or potential violation of a statute, rule, order, or license to appropriate Federal, State, local, or foreign agencies responsible for

investigating or prosecuting the violation or for enforcing or implementing the statute, rule, regulations, order, or license; (c) from the record of the

individual in response to an inquiry from a Congressional office made at the request of the individual (42 FR 19083; April 11, 1977); and (d) to provide

addresses obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a debtor to collect or compromise a Federal

Claim against the debtor, or to consumer reporting agencies to prepare a commercial credit report for use by the Department (48 FR 54716; December

6, 1983).

3. 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. This information collection has been approved by OMB and assigned control number 1018-0140.

FWS Form 3-2359

(0515)