FMCS OMB E9 Focus Group Incentive Receipt form English

APPENDIX E9. Focus Group Incentive Receipt Form -- English

OMB Number: 0584-0564

Expiration Date: 11/30/2014

For participation in a focus group conducted for USDA’s Food and Nutrition Services, I received $60 from Westat.

Signature: _________________________________

Date: ___________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 0584-0564. The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the information collected.

OMB Number: 0584-0564

Expiration Date: 11/30/2014

For participation in a focus group conducted for USDA’S Food and Nutrition Services, I received $60 from Westat.

Signature: _________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 0584-0564. The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the information collected.

Date: ___________________________