Interview Incentive Receipt 2025

Interview Incentive Receipt
U.S. Department of Health and Human Services
and
RTI International
thank you for participating in the National Household Survey on Behavioral Health.
In appreciation of your participation in this important study, you are eligible to receive $30.
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 incentive.

___________________________________ _________
Interviewer
Date

□

Accepted Incentive

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

□

Declined Incentive

If you ever feel that you need to talk to someone about mental health issues, you can contact the 988
Suicide & Crisis 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.
988 (call or text)
988lifeline.org
Puerto Rico: 1-800-981-0023; 1-888-672-7622 (TTY); lineapas.assmca.pr.gov
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 (4357); 1-800-487-4889 (TTY)
findtreatment.gov
Disposition: Top copy to Respondent, yellow to Field Supervisor, pink to Field Interviewer.

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