Sample text is provided for:

1. A receipt for payment including the information required by Duke's Accounting Office.
2. Consent form language for the required notification of subjects that they will be asked to provide their social security numbers before they can be compensated.

Receipt for Payment:

Research Participant Payment Verification Form

Duke University's Accounting Office requires that researchers obtain the following information from research participants in order to meet its obligations to the Internal Revenue Service.

The Payment Verification Form will be submitted to the University's Accounting Office. It cannot be connected to your responses to the (interview, survey, questionnaire), or even with your participation in this study.

Amount Received: _____

Date:________

Full Name: ______________________________________________

Social Security Number: ____________________________________|

Permanent Home Address:

_________________________________________

_________________________________________

_________________________________________

Signature of Research Personnel: ____________________________  Date: __________________

Sample Consent Form Language:

In order to receive payment for your participation in this study, you will be asked to provide your social secuity number and home address on a Payment Verification Form.  This form will be collected separately from your consent form and will not be linked to any information you provide.  If you don't want to provide your social security  number, you can still be in the study, but you will not receive payment.