Receipt of Payment Form - Los Angeles Site

Understanding the Dynamics of Disconnection from Employment and Assistance

Appendix A-5 - Receipt of Payment Form - Los Angeles Site

Receipt of Payment Form - Los Angeles Site

OMB: 0970-0434

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OMB Control No.: 0970-xxxx

Expiration Date: xx/xx/20xx


Appendix A-5: Receipt of Payment Form—Los Angeles site



Receipt of Payment

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Initialing below indicates that you were offered $40 as a token of appreciation for your time participating in an interview for the Family Coping Strategies Study conducted by the Urban Institute.



I accepted the $40 token of appreciation. I refused the $40 token of appreciation.



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Respondent’s Initials



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Date



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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDHHS
File Modified0000-00-00
File Created2021-01-30

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