Attachments 15, 16

2020 NSDUH Redesign Field Test
Attachment FT-15 – Interview Incentive
Receipt

Interview Incentive Receipt

U.S. Department of Health and Human Services
and
RTI International
thank you for participating in the 2020 National Survey on Drug Use and Health.
In appreciation of your participation in this important study, you are eligible to receive <$30/$50> in cash.
Since maintaining the confidentiality 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.

___________________________________
Interviewer

□

Accepted Cash Incentive

_________
Date

__ __ __ __ __ __ __ __ __ __ - __
Case ID

□

Declined Cash Incentive

If you ever feel that you need to talk to someone about mental health issues, you can call the National Lifeline
Network. Counselors are available to talk at any time of the day or night and they can give you information about
services in your area.
1-800-273-TALK or 1-800-273-8255
1-888-628-9454 (Spanish)
http://suicidepreventionlifeline.org/
If you ever feel that you need to talk to someone about drug use issues, you can call the Substance Abuse and Mental
Health Services Administration’s Treatment Referral Helpline. This is a 24-hour service that will help you locate
treatment options near you.
1-800-662-HELP or 1-800-662-4357
1-800-487-4889 (TTY)
http://findtreatment.samhsa.gov
Disposition: Top copy to Respondent, yellow to Field Supervisor, pink to Field Interviewer.

v. FT 7.20

2020 NSDUH Redesign Field Test
Attachment FT-16 – Certificate of Participation

U.S. Department of Health
and Human Services

Certificate of Participation
The U.S. Department of Health and Human Services and RTI International would like to thank

[Participant’s Signature]

for participating in the National Survey on Drug Use and Health
on
_____________________________
[Date of Interview]

Field Interviewer
FI ID #

Ilona S. Johnson,

National Field Director
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709

This document certifies that the above named individual participated in NSDUH, a voluntary survey for the U.S. Department of Health and
Human Services. Across the country, some participants approach their school teachers or other group leaders to ask about possible special
community service credit as they completed this important national survey. The time commitment for participation in this survey is between 1
and 2 hours. A copy of the NSDUH brochure, which explains the study in more detail, should accompany this certificate. If you need further
information, contact the National Field Director, Ilona Johnson, at [FT TOLL FREE NUMBER].

v. FT 7.20