Incentive Project Sign Up Form

Incentive Project – Sign Up Form

The following form will be used to enroll participants into the Incentives Pilot Project. Because national projections are not being met for enrollment and survey completion, this strategy will be implemented in hopes to increase Registry enrollment and risk factor survey completion. This form will not change any burden hours (OMB), as we are not currently not meeting our anticipated enrollment and hope this monetary incentive promotes enrollment and awareness of the Registry.