Interview Incentive Receipt

Attachment 15_Interview Incentive Receipt_FU5.docx

Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

Interview Incentive Receipt

OMB: 0910-0788

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ATTACHMENT 15: INTERVIEW INCENTIVE RECEIPT



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OMB No. 0910-0788
Exp. Date 08/31/2021

RIHSC No. 15-052CTP


Interview Incentive Receipt

U.S. Food and Drug Administration

and

RTI International

Thank you for participating in the Evaluation of the Fresh Empire Campaign on Tobacco.

In appreciation of your participation in this important study, you are eligible to receive $25 in cash.

Since maintaining the privacy of your information is important to us, your name will not be entered on this form. However, the interviewer must sign and date this form to certify you received (or declined) the cash incentive.


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___________________________________ _________ __ __ __ __ __ __ __ __

Interviewer Date Case ID

Accepted Cash Incentive Declined Cash Incentive


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBeth Riggsbee
File Modified0000-00-00
File Created2021-01-15

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