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Census Partnership Program Focus Groups and Interviews

ICR 201103-0607-005 · OMB 0607-0965 · Object 23547301.

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Appendix D: Partnership Program Focus Group Acknowledgement of Receipt of Payment




I acknowledge receipt of the $50 payment for participating in the Partnership Program Focus Group in [city, state] on [date]



Name, printed Signature



OMB Control Number: 0607-XXXX 1

Expiration Date: September 30, 2011

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title Census Partnership Program Focus Groups and Interviews
AuthorICFI
File Modified0000-00-00
File Created2021-02-01