Attachment M - Memory Jogger 10292021

Field Test for the Second National Household Food Acquisition and Purchase Survey (FoodAPS-2)

Attachment M - Memory Jogger 10292021

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Attachment M. Memory Jogger

(To be used by respondents participating by the telephone)

NATIONAL FOOD STUDY PILOT

MEMORY JOGGER FOR PERSONS PARTICIPATING BY PHONE

Foods and Drinks Purchased or Free

Use this form to write down foods and drinks that you don’t have a receipt for.

Food Event #:

Name of PERSON who completed this form


DAY food/drink obtained

Mon Tue Wed Thu Fri Sat Sun

Name of PLACE where food was obtained


Address of PLACE where food was obtained


Name of PERSON who got the food


Enter total paid including tax and tip

$

Write each food and drink you got on a separate line. Please be as specific as possible with the description and size or amount.

Description of food or drink

Size or amount (ounces, grams, large, etc.)

How many?

Total amount paid after coupons, discounts, or savings































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Authortingyan
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File Created2022-06-01

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