Form 7 Incentive distribution log for focus group participants

PROCESS ASSESSMENT REVIEW OF THE DIVISION OF ACQUIRED IMMUNODEFICIENCY SYNDROME (DAIDS) CRITICAL EVENTS POLICY IMPLEMENTATION (CEPI) PROGRAM (NIAID)

Attachment 14 incentive distribution log for focus group participants 952014

Incentive distribution log for focus group participants

OMB: 0925-0712

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OMB No. 0925-XXXX

Exp. Date: XX/XX/20XX

Attachment 14: Incentive distribution log for focus group participants


Burden Disclosure: Public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA# 0925-XXXX. Do not return the completed form to this address.


Date of Focus Group: ___________________ Location: ____________________________________________________________


Name (Please Print)

Incentive

$Amount Received

Participant Signature

Date


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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLahl, Lynda (NIH/NIAID) [E]
File Modified0000-00-00
File Created2021-01-25

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