D.7 Incentive Receipt Parent

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PARENT/CAREGIVER QUESTIONNAIRE INCENTIVE RECEIPT FORM
Thanks for your participation in a research survey for the U.S. Department of Labor, Bureau of
Labor Statistics, conducted by RTI International. To show our appreciation for the time you
spent completing the survey, we are offering you $50 cash when there is one eligible youth
in your home and $25 for each additional eligible youth. Please indicate whether you received
or refused this payment by checking the appropriate box and signing below.
I received $

cash.

I refused the incentive payment.

Your Name

Interviewer’s Signature

Your Signature

Date

Control ID#