Appx I_ Incentive Receipt Form

Appx I - Incentive Receipt Form.docx

CDC and ATSDR Health Message Testing System

Appx I_ Incentive Receipt Form

OMB: 0920-0572

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Appendix I: Incentive Receipt Form

I have received $75 for participating in a focus group for CommunicateHealth and the Centers for Disease Control and Prevention (CDC).















Name (print): ________________________________

Name (sign): ________________________________

Date: _________________




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