Attachment L_Interview Incentive Receipt

Interview Incentive Receipt

U.S. Department of Health and Human Services
and
RTI International
thank you for participating in the 2022 National Survey on Drug Use and Health.
In appreciation of your participation in this important study, you are eligible to receive $30 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 Suicide
Prevention Lifeline. 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 National 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.gov
Disposition: Top copy to Respondent, yellow to Field Supervisor, pink to Field Interviewer.