Nicotine Education Project: Qualitative Study to Gain Insights from Adult Current and Former Smokers to Educate the General Public about Changing Nicotine Standards

Generic Clearance for the Collection of Qualitative Data on Tobacco Products and Communications

Appendix F_Check Out Form

Nicotine Education Project: Qualitative Study to Gain Insights from Adult Current and Former Smokers to Educate the General Public about Changing Nicotine Standards

OMB: 0910-0796

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OMB# 0910-0796

Exp. 07/31/2021

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FG ID:_____________

PARTICIPANT

CHECK OUT FORM

#	Incentive Amount	Initial
1	$75
2	$75
3	$75
4	$75
5	$75
6	$75
7	$75
8	$75
9	$75
10	$75

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 1 minutes per response to complete the Check out form (the time estimated to read, review, and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to [email protected].

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Roditis, Maria
File Modified	0000-00-00
File Created	2021-01-13