Incentive Receipt

ATTACHMENT 8: INCENTIVE RECEIPT

Interview Incentive Receipt

U.S. Food and Drug Administration

and

RTI International

Thank you for participating in the Point of Sale Intervention for Tobacco Evaluation (POSITEv).

In appreciation of your participation in this important study, you will receive $25 in cash.

Since maintaining the privacy 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.

RTI Project # 213772.003.001.005

___________________________________ _________ __ __ __ __ __ __ __ __ Interviewer Date Case ID

□ Accepted Cash Incentive □ Declined Cash Incentive

Disposition: Send original to supervisor; retain yellow copy; pink copy to respondent.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Beth Riggsbee
File Modified	0000-00-00
File Created	2021-01-20