Qualitative Research to Design Advertising to Encourage Quitting Among Adult Cigarette Smokers (SGM Population) (CTP

OMB# 0910-0796

Exp. 07/31/2021

SCREENER CONTACT SHEET

(Completed by recruiter)

TITLE OF INFORMATION COLLECTION: Qualitative Research to Design Advertising to Encourage Quitting Among Adult Cigarette Smokers (SGM Population)

Respondent’s name: Email address:

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ID: ________________________________

ZIP Code: Mobile phone:

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___________________________________ Home phone:

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Recruited for session number and session type: Recruiter:

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