Recruitment, Reminder and Interview-Individuals/Households

OMB Approval No.: 0584-XXXX

Approval Expires: XX/XX/XXXX

Appendix B-6. FOCUS GROUP

PARTICIPANT RECEIPT FORM

Site: Date:

Time:

By signing below, I confirm that I received $30 as an incentive to participate in a discussion group conducted by the Urban Institute regarding churning in the Supplemental Nutrition Assistance Program (SNAP).

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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 1 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.