Attachment F
Cash Payment Receipt form
Centers for Disease Control and Prevention
National Center for Health Statistics
Questionnaire Design Research Laboratory (QDRL)
3311 Toledo Road, Hyattsville, MD 20782
Cash Payment Receipt
I ______________________________________________ have received $[fill amount] (cash)
Print Name (First Name, Last Name)
for participating in a 60-minute/90-minute One-on-One Interview/Focus Group evaluating survey questions about [fill topics].
_____________________________________________
Signature (First name, Last Name)
________________________
Date (mm/dd/yy)
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For Office Use Only
Project: [fill project name]
File Type | application/msword |
File Title | Centers for Disease Control and Prevention |
Author | Karen Roberta Whitaker |
Last Modified By | CDC User |
File Modified | 2012-02-13 |
File Created | 2012-01-06 |