17b 17b_MCH Jurisdictional Survey Leave-Behind Consent_Marsh

PEBA IN KŌMĀLIM ILO AN MEḶEḶE IKIJJEEN AN BŌK KOṆ
AAN ILO JERBAL IN ALLO

Etan Būrojāāk eo: Jōrpe ikijjeen Joñan Ājmuur eo ilo Kūrae im Ajri ro

Armej eo Ej Tōl Jerbalin Etale/Ekkatak in: Caitlin Oppenheimer, Baij Būreejtōn eo Eutiej, NORC ilo University of Chicago

Etke kwōj kōṃṃane Jerbalin Etale/Ekkatak in? Kōmij kōṃṃane jōrpe in etale in ikijjeen ājmuur eo an kūrae im ajri ro. Kōmij kōṃṃane jōrpe in etale in ilo American Samoa, Federated States of Micronesia ak FSM, Guam, Ṃajeḷ, Northern Mariana Islands, Palau, Puerto Rico, im U.S. Virgin Islands. Men kein rej jabokan Title V MCH Block Grant būrookraaṃ eo. Būrookraaṃ ko ijin an MCH renaaj kōjerbal kajjitōk kein ñan aer meḷeḷe kōn ājmuur eo an ajri im kōrā ro jineer. Menin enaaj jipañer ejaak jerbal in jipañ ko ñan baaṃle ko.

1. Wōnej kōḷḷāik oṇāān Jerbalin Etale/Ekkatak in? Health Resources and Services Administration eo ej kōḷḷāik oṇāān jerbalin etale ekkatak in.

2. Ta eo renaaj kajjitōk bwe in kōṃṃane eḷaññe inaaj bōk koṇaō ilo jerbal in etale/ekkatak in? Naaj kajjitōk bwe kwōn uwaake kajjitōk ko ilo jōrpe in etale eo. Renaaj riiti waj kajjitōk kein ñan kwe. Kajjitōk kein rej kōn ājmuur eo aṃ im an ajri eo nejūm. Ñan waan joñak, jenaaj lewaj kajjitōk ko kōn ajri eo nejūm ke ej niñniñ, kajjitōk ko ikijjeen aṃ kar lale ak kōjparok ajri eo, im kōn an ajri eo nejūm katak. Jenaaj barāinwōt kajjitōk kōn nañinmej ko im remaroñ kar jelōt eok ak ajri eo, taktō ro im raar lale eok ak ajri eo nejūm, meḷeḷe ko ikijjeen armej ro ilo ṃweo kwōj jokwe ie, im bar kajjitōk ko jet rāinjuon ḷọk.

3. Anemkwōj in Kāālōt ñe Kwōj Bōk Koṇaaṃ: Komaroñ jab bōk koṇaaṃ ilo jerbalin etale/ekkatak in. Komaroñ kōṃṃan koṇ ñan aṃ bōk koṇaaṃ ilo etale/ekkatak in innām ukōt aṃ ḷōmṇak tokālik. Komaroñ jab uwaake jabdewōt kajjitōk kwōjjab kōṇaan uwaake. Ejjeḷọk men eṇ enaaj waḷọk ñe kwōnaaj kāālōt bwe kwōn jab uwaaki kajjitōk ko ak bwe en bōjrak aṃ uwaaki kajjitōk ko.

4. Abṇōṇō in Kōḷmānḷọkjeṇ ak Menin Uwōta ko: Ejjeḷọk menin uwōta ikijjeen uwaake kajjitōk kein an jōrpe in etale in ijellọkwin menin uwōta ko an mour in jej pād ie jān raan ñan raan. Jet iaan kajjitōk ko ikijjeen ājmuur, uno ko rōkajoor, ak ikijjeen kōjerbal dānnin karōk, ak kajjitōk ko ikijjeen bōklōkōt ko ad (men ko jej eñjaaki itulowa) rej jet meḷeḷe ko im rej ad wōt im remaroñ kaabṇōṇōik kōḷmānḷọkjeṇ ko ad.

5. Menin Jeraaṃṃan ko: Ejjeḷọk jāān in jipañ ak menin jeraaṃṃan ko jet renaaj iwōj ñan eok ñe kwōnaaj uwaaki kajjitōk kein, ak uwaak ko aṃ remaroñ jipañ letok meḷeḷe ko rōṃṃanḷọk ikijjeen ājmuur eo an kūrae ro im ajri ro nejier im jerbal ko an Title V MCH Block kūrāān eo.

6. Ewi toon aō naaj pād ilo jerbalin etale/ekkatak in? Enaaj bōk 50 im men minit ñan uwaake kajjitōk ko.

7. “Confidentiality”: Armej ro de rein im ewōr aer mālim in lo uwaak ko aṃ: Armej ro im rej jerbale etale/ekkatak in im armej ro im rej lale bwe en jiṃwe am kajjeikik jerbalin etale/ekkatak in. Eban pād etaṃ ilo peba in etale eo im uwaak ko aṃ rej pād ie. Jenaaj kōjerbal jet nōṃba ñan ad jeḷā uwaak ko rej etal ia ḷọk, im jab etaṃ.

Jōrpe in etale eo ejjab kajjitōk ñe ej nana an juon lale ajri ak ñe ewōr ej kōjool ajri. Ñe jenaaj jeḷā ke ewōr jorāān ej waḷọk ilo tōre eṇ eṃ jōrpe eṇ ej bōk jikin ñan juon ajri ak ke ewōr ej kōjool juon ajri ilo iien jerbale jōrpe en, jenaaj aikuj ripooti ñan ro tōllọkier.

Naaj kakoṇi uwaak ko aṃ ilo computer eo aō im juon arin (ak kape) jōrpe in enaaj etal ñan wōpij ko am ilo Chicago, Illinois. Jenaaj kōjparok meḷeḷe ko aṃ joñan wōt ad maroñ bwe en jab diwōjḷọk meḷeḷe ko aṃ, bōtaab ejjeḷọk emaroñ kalliṃur bwe renaaj bōbrae an maroñ dōḷọk meḷeḷe ko aṃ ilo aer naaj etal ilo internet ḷọk. Eḷaññe enaaj bōjrak am uwaak kajjitōk ṃokta jān an jeṃḷọk jōrpe in, komaroñ kajjitōk bwe jen jeeri uwaak ko aṃ.

8. Jiṃwe eo Aṃ ikijjeen Eḷḷeḷọk Kajjitōk: Jouj im kepaak X ilo (XXX) XXX-XXXX ak XXX kōn kajjitōk, abṇōṇō, ak inepata ikijjeen jerbalin etale/ekkatak in. Ñe ewōr am kajjitōk am abṇōṇō ikijjeen jiṃwe ko aṃ āinwōt juon eo ear bōk koṇaan ilo jerbal in allo (research), juon im kepaak NORC Institutional Review Board Mānija eo ilo talboon nōṃba in: (866) 309-0542.

9. Oṇāān Aṃ Bōk Koṇaaṃ: Enaaj iwōj jidik kein kaṃṃoolol eok kōn aṃ kar bōk koṇaaṃ ilo iien kajjitōk im uwaak in.

Jouj im likit peba in ilo rekoot ko aṃ ak kakoṇe ñan aṃ etale ilo ilju im jekḷaj.

Naan ko Kōn Eddo ko Ikijjeen Pabḷik:  Juon doulul ak wōpij ejjab maroñ kōṃṃane ak jibaanjōr, im juon armej ejjab aikujin eọroñ ak uwaake, juon jepjep in meḷeḷe ko ijellọkwin wōt ñe ej waḷọk juon OMB kantūrool nōṃba eo eṃṃan im ejjañin jeṃḷọk kitien. OMB kantūrool nōṃba eo ñan būrojāāk in ej 0906-0042.  Jej antọọne bwe eddo eo ñan kōṃṃane juon keeañ ñan pabḷik ikijjeen jepjep in meḷeḷe kein enaaj joñan ṇe .27 awa ñan kajjojo jepjep in uwaak, ekūtbuuj iien etale kōmmeḷeḷe ko, etale jikin teta ko rej pād rainin, and iien kadedeḷọk im bar etale juon jepjep in meḷeḷe. Jilkintok meḷeḷe ko ikijjeen joñan eo kar antọọne ikijjeen eddo in ak jabdewōt jabokan laajrakin meḷeḷe ko, ekūtbuuj ḷōmṇak ko ñan wāween kadikḷọk eddo in ñan HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

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