Attachment G-Receipt for Participation

Attachment G Cognitive Receipt for Participation_2010_4_23.docm

National Survey on Drug Use and Health: Methodological Field Tests

Attachment G-Receipt for Participation

OMB: 0930-0290

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Attachment G

Cognitive Interview Receipt for Participation

April 23, 2010

Receipt for Participation

Form 1




The participant has voluntarily taken part in a study to improve the materials used in a national survey on alcohol and drug use, and physical and psychological health. This study is being conducted by RTI International for the Substance Abuse and Mental Health Services Administration (SAMHSA). By my signature below, I confirm that I have given the participant a $75.00 Visa gift card in appreciation for his/her participation in this project.


RTI Staff Signature



Date

Receipt for Participation

Form 2




The participant has voluntarily taken part in a study to improve the materials used in a national survey on alcohol and drug use, and physical and psychological health. This study is being conducted by RTI International for the Substance Abuse and Mental Health Services Administration (SAMHSA). By my signature below, I confirm that I have given the participant a $50.00 Visa gift card in appreciation for his/her participation in this project.


RTI Staff Signature



Date



[NOTE: Form 2 is the receipt form for adolescents.]

April 23, 2010

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