CASH/PAYMENT LOG

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CASH/PAYMENT LOG

Project Name: ___________________________________________________ Date: __________

Item # Participant Name

Amount of Signature Payment (Participant or Facilitator/Interviewer) $ $ $ $ $ $ $ $ $ $

Principal Investigator

Printed/Typed Name: ______________________________

Signature: ___________________________________ Date: ___________

This log may be used to record payments of cash, gift cards, or non-monetary items valued at $100 or less made to a research participant in conjunction with procedures that follow the Research Participant Incentive Payment Policy.

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