Intercept Interview Receipt Form

Att 20 Intercept Receipt Form.docx

CDC and ATSDR Health Message Testing System

Intercept Interview Receipt Form

OMB: 0920-0572

Document [docx]
Download: docx | pdf

Form Approved

OMB No. 0920-0572

Expiration Date 03/31/2018









Submission under

0920-0572 Health Message Testing System




Attachment 20: Intercept Interview Receipt Form





























Attachment 20 Intercept Interview Receipt Form


High Impact Prevention Message Testing

I acknowledge receiving $10 as a token of appreciation for participating in an interview for the [INSERT TITLE] project conducted by RTI.



_____________________________________________________________

Participant Initials Date




_____________________________________________________________

Interviewer Signature Date



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSocial Marketing Websites Project
AuthorJennifer Uhrig
File Modified0000-00-00
File Created2021-01-25

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