FORM SFA-2
SPONSORED FUNDS
ADMINISTRATION
DIVISION OF RESEARCH
State University of New York at Binghamton
HUMAN SUBJECT/PARTICIPANT PAYMENT FORM
I have completed the interview portion of the ___________________ study and have been given a questionnaire to
complete. I have completed the questionnaire. As compensation for my time, a payment of $___________ will be
rendered.
Name:
Address:
City: State:
Zip:
Social Security Number:
Participants' signature
Date
Interviewer (print):
Interviewers'
signature
Date
Project Number:
Project Directors' signature
Date
PO Box 6000, Binghamton, NY, 13902-6000. Ph: (607) 777-6752. Fax: (607) 777-4354
FORM SFA-2
Revised 01/31/05