6 B questionnaire RMI marshallese

Title V Maternal and Child Health (MCH) Block Grant Jurisdictional MCH Survey Instrument RMI
OMB Control number: 0906-0042; Expiration date: XX/XX/202X

CASE ID:

^{Jabok A [}Ri-etale (Ri-kajjeikik Būrookraaṃ: Likit Awa im Iien eo)]

A1. Ewōr ke ajri 0-17 iiō dettan im ekkā an jokwe ak pād ilo mwiin?

1. ☐ JAAB [ÑE JAAB, BŌJRAK IJIN. EÑIN EJ JEṂḶỌKIN JŌRPE EO]

2. ☐ AAET

A2. Jete ajri 0-17 iiō dettan im ekkā aer jokwe ak pād ilo mwiin?

ORAN AJRI RO IM REJ JOKWE AK PĀD ILO MWIIN?

A3. Kajin ta eo ekkā kōjerbale ilo iṃōn jokwe in?

1. ☐ KAJIN PĀLLE

2. ☐ KAJIN JIPĀNIJ

3. ☐ KAJIN EO ĀINJUONḶỌK,

JOUJ IM KAALIKKAR:

Ñan kajjojo iaan ajri ro 0-17 iiō im ekkā aer jokwe ak pād ilo atōrej in, uwaake kajjitōk kein jet im renaaj wanlōñtak.

Jino kōn ajri eo ediktata, eo im jenaaj ṇae etan "Ajri 1" im wōnṃaanḷọk wōt kōn ajri eo edittoḷọk jāne im etal wōt ñan ñe eṃōj aṃ letok uwaak ikijjeen aolep ajri ro im ekkā aer jokwe ak pād ilo atōrej in.

A4. AJRI 1

Ewi lukkuun etan ajri in/Ta bōōj “name” eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A5. Ewōr ke bōtōktōkin Hispanic, Latino, ak Jipānij ippān?

1. ☐ Jaab, ejjeḷọk bōtōktōkin Hispanic, Latino, ak Jipānij ippān

2. ☐ Aaet, ri-Mājjiko, ri-Mājjiko in Amedka, Jikano (Chicano)

3. ☐ Aaet, ri-Puerto Rico

4. ☐ Aaet, ri-Kuba

5. ☐ Aaet, armej ro jet im ewōr bōtōktōk in Hispanic, Latino, ak Jipānij ippān, jouj im kaalikkar:

A6. Ajri in ej bōk nemāmeen armej in ia? KĀĀLŌT JUON AK ELŌÑḶỌK.

1. ☐ RI-MOUJ

2. ☐ KILMEJ AK RI-APRIKA ILO AMEDKA

3. ☐ RI-INTIEN ILO AMEDKA AK ARMIJ IN ALEJKA, JOUIJ IM KELET:

4. ☐ INTIEN ILO EJIA

5. ☐ RI-JAINA

6. ☐ PILIBINO

7. ☐ RI-JEBAN

8. ☐ RI-KOREA

9. ☐ VIETNAAMIIJ

10. ☐ RI-EJIA RO JET, JOUIJ IM KELET:

11. ☐ ARMIJ IN AWAII

12. ☐ RI-KUAM AK JAMORO

13. ☐ JAMUA

14. ☐ RI-TONKA

15. ☐ RI-JAIBAN

16. ☐ RI-MOTLOK

17. ☐ RI-KUJAI

18. ☐ RI-KEROLAIN

19. ☐ RI-POLAU

20. ☐ RI-PONPEI

21. ☐ RI-IAAB

22. ☐ RI-JUUK

23. ☐ RI-MAJOL

24. ☐ RO JET ILO AILON JIDIK ILO PAJIPIIK, JOUIJ IM KELET:

A7. Ta ajri eo?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A8. Jete an ajri in iiō? Eḷaññe edik jān juon allōñ ajri eo, lelōñḷọk allōñ eo an ajri eo im likit 1 allōñ.

IIŌ (AK) ALLŌÑ

EḶAÑÑE EDIKḶỌK IIŌ IN AN AJRI IN JĀN EMĀN, ETAL ÑAN A10.

A9. POTO RIKO: Ewi joñan an ajri jeḷā Kajin Jipānij?

AOLEPEN IJOKO JET: Ewi joñan an jeḷā KAJIN PĀLLE?

1. ☐ Eḷap an jeḷā

2. ☐ Ejeḷā

3. ☐ Ejjab kanooj jeḷā

4. ☐ Ejjab jeḷā ñan jidik

A10. Ilo tōre in, ajri in ej ke idaak ak bōk uno ko, ijellọkwin ōn ko (vitamin) āinwōt an kar taktō kipel bwe en āindein?

1. ☐ Aaet

2. ☐ Jaab [ETAL ÑAN A11]

[ÑE AAET] aikuj in an ajri in ñan an bōk uno kein taktō ear kipel bwe en būki, ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

1. ☐ JAAB [ETAL ÑAN A11]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

1. ☐ JAAB

A11. Ajri in ej ke aikuji eḷapḷọk jipañ ikijjeen taktō, taktō ikijjeen bōklōkōt, ak jipañ ikijjeen jeḷā ḷọkjeṇ eḷapḷọk jān joñan eo ekkā an ajri ro dettan wōt aikuji?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A12]

[ÑE AAET] aikuj in an ajri in ikijjeen taktō, taktō ikijjeen bōklōkōt, ak menin jipañ ikijjeen jeḷā ḷọkjeṇ ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

1. ☐ JAAB [ETAL ÑAN A12]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

1. ☐ JAAB

A12. Ewōr ke likjab ilo ajri in im ej kaapañ/kapene ak bōbrae, ilo jabdewōt wāween, bwe ajri in en pen an ak jab maroñ kōṃṃani men ko im ajri ro jet dettan wōt rej kōṃṃani?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A13]

[ÑE AAET] ban ko an ajri in ikijjeen ta ko ej maroñin kōṃṃani rej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

1. ☐ JAAB [ETAL ÑAN A13]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

1. ☐ JAAB

A13. Ajri in ej ke aikuj “therapy” (kiltōn jipañ ko ñan kamour jān jorrāān ko ilo e) ñan ānbwinnin, “occupational,” ak “therapy” ikijjeen kōnono?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A14]

[ÑE AAET] menin ej ke itok jān jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

1. ☐ JAAB [ETAL ÑAN A14]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

1. ☐ JAAB

A14. Ewōr ke ippān ajri in jabdewōt kain menin abṇōṇō ko ikijjeen bōklōkōt eo an, wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin eṃ enaaj aikuj jerbal in jipañ ko ñan kemouri ak bōk an jipañ jān kaunjeḷōr ro.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A15]

[ÑE AAET] ekar ke būki ak ewōr ke ej kōtmāne ke menin abṇōṇō ko ikijjeen bōklōkōt eo an, ilo wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin rōkar jelōte ak renaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

1. ☐ JAAB

EḶAÑÑE EBAR WŌR NEJIN ARMEJ EO EJ UWAAKE KAJJITŌK KEIN, WŌNṂAANḶỌK WŌT KŌN A15. ÑE EJJEḶỌK, WŌNṂAANḶỌK WŌT KŌN JABOK B.

A15. AJRI 2

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A16. Ewōr ke bōtōktōkin Hispanic, Latino, ak Jipānij ippān?

1. ☐ Jaab, ejjeḷọk bōtōktōkin Hispanic, Latino, ak Jipānij ippān

2. ☐ Aaet, ri-Mājjiko, ri-Mājjiko in Amedka, Jikano (Chicano)

3. ☐ Aaet, ri-Puerto Rico

4. ☐ Aaet, ri-Kuba

5. ☐ Aaet, ro jet armej im ewōr bōtōktōk in Hispanic, Latino, ak Jipānij ippān, jouj im kaalikkar:

A17. Ajri in ej bōk nemāmeen armej in ia? KĀĀLŌT JUON AK ELŌÑḶỌK.

1. ☐ RI-MOUJ

2. ☐ KILMEJ AK RI-APRIKA ILO AMEDKA

3. ☐ RI-INTIEN ILO AMEDKA AK ARMIJ IN ALEJKA, JOUIJ IM KELET:

4. ☐ INTIEN ILO EJIA

5. ☐ RI-JAINA

6. ☐ PILIBINO

7. ☐ RI-JEBAN

8. ☐ RI-KOREA

9. ☐ VIETNAAMIIJ

10. ☐ RI-EJIA RO JET, JOUIJ IM KELET:

11. ☐ ARMIJ IN AWAII

12. ☐ RI-KUAM AK JAMORO

13. ☐ JAMUA

14. ☐ RI-TONKA

15. ☐ RI-JAIBAN

16. ☐ RI-MOTLOK

17. ☐ RI-KUJAI

18. ☐ RI-KEROLAIN

19. ☐ RI-POLAU

20. ☐ RI-PONPEI

21. ☐ RI-IAAB

22. ☐ RI-JUUK

23. ☐ RI-MAJOL

24. ☐ RO JET ILO AILON JIDIK ILO PAJIPIIK, JOUIJ IM KELET:

A18. Ta ajri eo?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A19. Jete an ajri in iiō? Eḷaññe edik jān juon allōñ ajri eo, lelōñḷọk allōñ eo an ajri eo im likit 1 allōñ.

IIŌ (AK) ALLŌÑ

EḶAÑÑE EDIKḶỌK IIŌ IN AN AJRI IN JĀN 4, ETAL ÑAN A21.

A20. POTO RIKO: Ewi joñan an jeḷā Kajin Jipānij?

AOLEPEN IJOKO JET: Ewi joñan an jeḷā KAJIN PĀLLE?

1. ☐ Eḷap an jeḷā

2. ☐ Ejeḷā

3. ☐ Ejjab kanooj jeḷā

4. ☐ Ejjab jeḷā ñan jidik

A21. Ilo tōre in, ajri in ej ke idaak ak bōk uno ko, ijellọkwin ōn ko (vitamin) āinwōt an kar taktō kipel bwe en āindein?

1. ☐ Aaet

2. ☐ Jaab [ETAL ÑAN A22]

[ÑE AAET] aikuj in an ajri in ñan an bōk uno kein taktō ear kipel bwe en būki, ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A22]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A22. Ajri in ej ke aikuji eḷapḷọk jipañ ikijjeen taktō, taktō ikijjeen bōklōkōt, ak jipañ ikijjeen jeḷā ḷọkjeṇ eḷapḷọk jān joñan eo ekkā an ajri ro dettan wōt aikuji?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A23]

[ÑE AAET] aikuj in an ajri in ikijjeen taktō, taktō ikijjeen bōklōkōt, ak menin jipañ ikijjeen jeḷā ḷọkjeṇ ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A23]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A23. Ewōr ke likjab ilo ajri in im ej kaapañ/kapene ak bōbrae, ilo jabdewōt wāween, bwe ajri in en pen an ak jab maroñ kōṃṃani men ko im ajri ro jet dettan wōt rej kōṃṃani?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A24]

[ÑE AAET] ban ko an ajri in ikijjeen ta ko ej maroñin kōṃṃani rej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A24]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A24. Ajri in ej ke aikuj “therapy” (kiltōn jipañ ko ñan kamour jān jorrāān ko ilo e) ñan ānbwinnin, “occupational,” ak “therapy” ikijjeen kōnono?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A25]

[ÑE AAET] menin ej ke itok jān jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A25]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A25. Ewōr ke ippān ajri in jabdewōt kain menin abṇōṇō ko ikijjeen bōklōkōt eo an, wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin eṃ enaaj aikuj jerbal in jipañ ko ñan kemouri ak bōk an jipañ jān kaunjeḷōr ro.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A26]

[ÑE AAET] ekar ke būki ak ewōr ke ej kōtmāne ke menin abṇōṇō ko ikijjeen bōklōkōt eo an, ilo wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin rōkar jelōte ak renaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

177. ☐ JAAB

EḶAÑÑE EBAR WŌR NEJIN ARMEJ EO EJ UWAAKE KAJJITŌK KEIN, WŌNṂAANḶỌK WŌT KŌN A26. ÑE EJJEḶỌK, WŌNṂAANḶỌK WŌT KŌN JABOK B.

A26. AJRI 3

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A27. Ewōr ke bōtōktōkin Hispanic, Latino, ak Jipānij ippān?

1. ☐ Jaab, ejjeḷọk bōtōktōkin Hispanic, Latino, ak Jipānij ippān

2. ☐ Aaet, ri-Mājjiko, ri-Mājjiko in Amedka, Jikano (Chicano)

3. ☐ Aaet, ri-Puerto Rico

4. ☐ Aaet, ri-Kuba

5. ☐ Aaet, ro jet armej im ewōr bōtōktōk in Hispanic, Latino, ak Jipānij ippān, jouj im kaalikkar:

A28. Ajri in ej bōk nemāmeen armej in ia? KĀĀLŌT JUON AK ELŌÑḶỌK.

1. ☐ RI-MOUJ

2. ☐ KILMEJ AK RI-APRIKA ILO AMEDKA

3. ☐ RI-INTIEN ILO AMEDKA AK ARMIJ IN ALEJKA, JOUIJ IM KELET:

4. ☐ INTIEN ILO EJIA

5. ☐ RI-JAINA

6. ☐ PILIBINO

7. ☐ RI-JEBAN

8. ☐ RI-KOREA

9. ☐ VIETNAAMIIJ

10. ☐ RI-EJIA RO JET, JOUIJ IM KELET:

11. ☐ ARMIJ IN AWAII

12. ☐ RI-KUAM AK JAMORO

13. ☐ JAMUA

14. ☐ RI-TONKA

15. ☐ RI-JAIBAN

16. ☐ RI-MOTLOK

17. ☐ RI-KUJAI

18. ☐ RI-KEROLAIN

19. ☐ RI-POLAU

20. ☐ RI-PONPEI

21. ☐ RI-IAAB

22. ☐ RI-JUUK

23. ☐ RI-MAJOL

24. ☐ RO JET ILO AILON JIDIK ILO PAJIPIIK, JOUIJ IM KELET:

A29. Ta ajri eo?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A30. Jete an ajri in iiō? Eḷaññe edik jān juon allōñ ajri eo, lelōñḷọk allōñ eo an ajri eo im likit 1 allōñ.

IIŌ (AK) ALLŌÑ

EḶAÑÑE EDIKḶỌK IIŌ IN AN AJRI IN JĀN 4, ETAL ÑAN A32.

A31. POTO RIKO: Ewi joñan an jeḷā Kajin Jipānij?

AOLEPEN IJOKO JET: Ewi joñan an jeḷā KAJIN PĀLLE?

1. ☐ Eḷap an jeḷā

2. ☐ Ejeḷā

3. ☐ Ejjab kanooj jeḷā

4. ☐ Ejjab jeḷā ñan jidik

A32. Ilo tōre in, ajri in ej ke idaak ebbōk uno, ijellọkwin ōn ko (“vitamin”) āinwōt an kar taktō kipel bwe en āindein?

1. ☐ Aaet

2. ☐ Jaab [ETAL ÑAN A33]

[ÑE AAET] aikuj in an ajri in ñan an bōk uno kein taktō ear kipel bwe en būki, ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A33]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A33. Ajri in ej ke aikuji eḷapḷọk jipañ ikijjeen taktō, taktō ikijjeen bōklōkōt, ak jipañ ikijjeen jeḷā ḷọkjeṇ eḷapḷọk jān joñan eo ekkā an ajri ro dettan wōt aikuji?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A34]

[ÑE AAET] aikuj in an ajri in ikijjeen taktō, taktō ikijjeen bōklōkōt, ak menin jipañ ikijjeen jeḷā ḷọkjeṇ ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A34]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A34. Ewōr ke likjab ilo ajri in im ej kaapañ/kapene ak bōbrae, ilo jabdewōt wāween, bwe ajri in en pen an ak jab maroñ kōṃṃani men ko im ajri ro jet dettan wōt rej kōṃṃani?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A35]

[ÑE AAET] ban ko an ajri in ikijjeen ta ko ej maroñin kōṃṃani rej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A35]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A35. Ajri in ej ke aikuj “therapy” (kiltōn jipañ ko ñan kamour jān jorrāān ko ilo e) ñan ānbwinnin, “occupational,” ak “therapy” ikijjeen kōnono?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A36]

[ÑE AAET] menin ej ke itok jān jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

177. ☐ JAAB [ETAL ÑAN A36]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A36. Ewōr ke ippān ajri in jabdewōt kain menin abṇōṇō ko ikijjeen bōklōkōt eo an, wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin eṃ enaaj aikuj jerbal in jipañ ko ñan kemouri ak bōk an jipañ jān kaunjeḷōr ro.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A37]

[ÑE AAET] ekar ke būki ak ewōr ke ej kōtmāne ke menin abṇōṇō ko ikijjeen bōklōkōt eo an, ilo wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin rōkar jelōte ak renaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

177. ☐ JAAB

EḶAÑÑE EBAR WŌR NEJIN ARMEJ EO EJ UWAAKE KAJJITŌK KEIN, WŌNṂAANḶỌK WŌT KŌN A37. ÑE EJJEḶỌK, WŌNṂAANḶỌK WŌT KŌN JABOK B.

A37. AJRI 4

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A38. Ewōr ke bōtōktōkin Hispanic, Latino, ak Jipānij ippān?

1. ☐ Jaab, ejjeḷọk bōtōktōkin Hispanic, Latino, ak Jipānij ippān

2. ☐ Aaet, ri-Mājjiko, ri-Mājjiko in Amedka, Jikano (Chicano)

3. ☐ Aaet, ri-Puerto Rico

4. ☐ Aaet, ri-Kuba

5. ☐ Aaet, ro jet armej im ewōr bōtōktōk in Hispanic, Latino, ak Jipānij ippān, jouj im kaalikkar:

A39. Ajri in ej bōk nemāmeen armej in ia? KĀĀLŌT JUON AK ELŌÑḶỌK.

1. ☐ RI-MOUJ

2. ☐ KILMEJ AK RI-APRIKA ILO AMEDKA

3. ☐ RI-INTIEN ILO AMEDKA AK ARMIJ IN ALEJKA, JOUIJ IM KELET:

4. ☐ INTIEN ILO EJIA

5. ☐ RI-JAINA

6. ☐ PILIBINO

7. ☐ RI-JEBAN

8. ☐ RI-KOREA

9. ☐ VIETNAAMIIJ

10. ☐ RI-EJIA RO JET, JOUIJ IM KELET:

11. ☐ ARMIJ IN AWAII

12. ☐ RI-KUAM AK JAMORO

13. ☐ JAMUA

14. ☐ RI-TONKA

15. ☐ RI-JAIBAN

16. ☐ RI-MOTLOK

17. ☐ RI-KUJAI

18. ☐ RI-KEROLAIN

19. ☐ RI-POLAU

20. ☐ RI-PONPEI

21. ☐ RI-IAAB

22. ☐ RI-JUUK

23. ☐ RI-MAJOL

24. ☐ RO JET ILO AILON JIDIK ILO PAJIPIIK, JOUIJ IM KELET:

A

40. Ta ajri eo?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A41. Jete an ajri in iiō? Eḷaññe edik jān juon allōñ ajri eo, lelōñḷọk allōñ eo an ajri eo im likit 1 allōñ.

IIŌ (AK) ALLŌÑ

EḶAÑÑE EDIKḶỌK IIŌ IN AN AJRI IN JĀN 4, ETAL ÑAN A43.

A42. POTO RIKO: Ewi joñan an jeḷā Kajin Jipānij?

AOLEPEN IJOKO JET: Ewi joñan an jeḷā KAJIN PĀLLE?

1. ☐ Eḷap an jeḷā

2. ☐ Ejeḷā

3. ☐ Ejjab kanooj jeḷā

4. ☐ Ejjab jeḷā ñan jidik

A43. Ilo tōre in, ajri in ej ke aikuj ak idaak uno, ijellọkwin ōn ko (“vitamin”) āinwōt an kar taktō kipel bwe en āindein?

1. ☐ Aaet

2. ☐ Jaab [ETAL ÑAN A44]

[ÑE AAET] aikuj in an ajri in ñan an bōk uno kein taktō ear kipel bwe en būki, ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A44]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A44. Ajri in ej ke aikuji eḷapḷọk jipañ ikijjeen taktō, taktō ikijjeen bōklōkōt, ak jipañ ikijjeen jeḷā ḷọkjeṇ eḷapḷọk jān joñan eo ekkā an ajri ro dettan wōt aikuji?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A45]

[ÑE AAET] aikuj in an ajri in ikijjeen taktō, taktō ikijjeen bōklōkōt, ak menin jipañ ikijjeen jeḷā ḷọkjeṇ ej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A45]

[ÑE AAET] ekar ke pād ippān menin ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A45. Ewōr ke likjab ilo ajri in im ej kaapañ/kapene ak bōbrae, ilo jabdewōt wāween, bwe ajri in en pen an ak jab maroñ kōṃṃani men ko im ajri ro jet dettan wōt rej kōṃṃani?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A46]

[ÑE AAET] ban ko an ajri in ikijjeen ta ko ej maroñin kōṃṃani rej ke itok ikijjeen jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A46]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A46. Ajri in ej ke aikuj “therapy” (kiltōn jipañ ko ñan kamour jān jorrāān ko ilo e) ñan ānbwinnin, “occupational,” ak “therapy” ikijjeen kōnono?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A47]

[ÑE AAET] menin ej ke itok jān jabdewōt nañinmej ak jorrāān ilo ānbwinnin, ṃwil āinwōt juon utaṃwe, ak men ko jet im rejjelōt ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A47]

[ÑE AAET] ekar ke pād ippān men in ejelōte iuṃwin 12 allōñ ak aetokḷọk ak ewōr ke ej kōtmāne ke menin enaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

A47. Ewōr ke ippān ajri in jabdewōt kain menin abṇōṇō ko ikijjeen bōklōkōt eo an, wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin eṃ enaaj aikuj jerbal in jipañ ko ñan kemouri ak bōk an jipañ jān kaunjeḷōr ro.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN A48]

[ÑE AAET] ekar ke būki ak ewōr ke ej kōtmāne ke menin abṇōṇō ko ikijjeen bōklōkōt eo an, ilo wāween an ejaak ak dittoḷọk, ak jabdewōt kain jorrāān ilo ṃwilin rōkar jelōte ak renaaj jelōte iuṃwin 12 allōñ ak aetokḷọk?

1. ☐ AAET

2. ☐ JAAB

EḶAÑÑE EJJEḶỌK BAR NEJIN AJRI, WŌNṂAANḶỌK ÑAN JABOK B.

EḶAÑÑE ELŌÑ JĀN EMĀN AJRI 0-17 IIŌ DETTAER RO IM REJ EKKĀ AER JOKWE AK PĀD ILO ATŌREJ IN, LIKIT IIŌ EO AN KAJJOJO IAER IM ÑE E ḶADDIK AK LEDDIK. JAB ĀLIJI MEḶEḶE KO AN AJRI RO IM EṂŌJ KADEDE LIKIT ER ILO AJRI 1 ÑAN AJRI 4.

A48. AJRI 5

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A49. Jete an ajri in iiō?

IIŌ (AK) ALLŌÑ

A50. Ta ajri in?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A51. AJRI 6

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A52. Jete an ajri in iiō?

IIŌ (AK) ALLŌÑ

A53. Ta ajri in?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A54. AJRI 7

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A55. Jete an ajri in iiō?

IIŌ (AK) ALLŌÑ

A56. Ta ajri in?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A57. AJRI 8

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A58. Jete an ajri in iiō?

IIŌ (AK) ALLŌÑ

A59. Ta ajri in?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A60. AJRI 9

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A61. Jete an ajri in iiō?

IIŌ (AK) ALLŌÑ

A62. Ta ajri in?

1. ☐ ḶADDIK

2. ☐ LEDDIK

A63. AJRI 10

Ewi lukkuun etan ajri in/Ta bōōj neiṃ eo an, “initials” (lōta eo jinointata ilo etan, miteḷneiṃ, im laajneiṃ eo an), ak riabin etan?

A64. Jete an ajri in iiō?

IIŌ (AK) ALLŌÑ

A65. Ta ajri in?

1. ☐ ḶADDIK

2. ☐ LEDDIK

YY

Jabok B [Ājmuur eo an Ajri in (Ri-kajjeikik Būrookraaṃ: Likit Awa im Iien eo)]

Kiiō, ewōr jet am kajjitōk ñan kameejḷọk meḷeḷe ko ḷọk iṃaan [KAALIKKAR AJRI TA]. Kajjitōk kein renaaj ae meḷeḷe ko rōḷḷapḷọk ikijjeen ājmuur eo an ajri in ekūtbuuj ewi joñan an ājmuur, meḷeḷe kōn iien an etal ñan jikin taktō, oṇāān an bōk jipañ ikijjeen taktō, im injuran ak menin joortoklik in taktō eo/ko ej pād iuṃwin/iuṃwier. Eṃōj am kāālōt juon wōt ajri jān juon eṃ jān wōt ad kajjioñ kōjparok iien joñan wōt ad maroñ ñan ad kadedeḷọk kajjitōk kein im renaaj kameejḷọk meḷeḷe ko ḷọk iṃaan.

B1. Ilo laleḷọk, ewi wāween aṃ kōmeḷeḷeiki joñan ājmuur eo an ajri in?

1. ☐ Jejjet/Weeppān

2. ☐ Eḷap an eṃṃan

3. ☐ Eṃṃan

4. ☐ Ebwe

5. ☐ Enana

₇₇☐ IJAJE/IJJAB JEḶĀ

₉₉☐ EṂṂANḶỌK IPPA ÑE IJAB UWAAK

B2. Ewi wāween aṃ naaj kar kōmeḷeḷeik joñan jorrāān ak eṃṃan in ñiin ajri in?

1. ☐ Jejjet/Weeppān

2. ☐ Eḷap an eṃṃan

3. ☐ Eṃṃan

4. ☐ Ebwe

5. ☐ Enana

6. ☐ EJJEḶỌK ÑIIN AJRI EO

₇₇☐ IJAJE/IJJAB JEḶĀ

₉₉☐ EṂṂANḶỌK IPPA ÑE IJAB UWAAK

B3. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ewōr ke iaan men kein ilo laajrak in im ear ak raar jelōt ajri in im ear emmakijkij an būki ak eḷap an aetok kitien an/aer kar jelōte ak ekkutkut an/aer jako illọk waḷọk?

	AAET	JAAB	IJAJE	EṂṂANḶỌK ÑE IJAB UWAAK
B3a. Emmenono ak jorrāān ko jet ilo jikin memenono (āinwōt kajjinōk ilo an wōr ainikien ak kajjinōk im pen an menono)	1 ☐	2 ☐	77 ☐	99 ☐
B3b. Ṃōñā ak orañḷọk ṃōñā im dān jān wōt an jab eṃṃan an mour	1 ☐	2 ☐	77 ☐	99 ☐
B3c. Kōjerbal ōn ko jān ṃōñā ko, ekūtbuuj an pen ak pidodo bwidej eo an	1 ☐	2 ☐	77 ☐	99 ☐
B3d. Ej metak ilo iien eo aetok kitien ak ekkutkut an metak, ekūtbuuj metak bar ak metak ko jet ilo likin ak ānbwinnin	1 ☐	2 ☐	77 ☐	99 ☐
B3e. Kōjerbal pā ko pein	1 ☐	2 ☐	77 ☐	99 ☐
B3f. Kiltōn peḷane make ak an ṃōṃakūtkūt	1 ☐	2 ☐	77 ☐	99 ☐
B3g. Metak ñi	1 ☐	2 ☐	77 ☐	99 ☐
B3h. Bōtōktōk ñaddin	1 ☐	2 ☐	77 ☐	99 ☐
B3i. Ñino im jorrāān ñiin	1 ☐	2 ☐	77 ☐	99 ☐
B3j. Jorrāān lọjilñin	1 ☐	2 ☐	77 ☐	99 ☐

B4. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-5 AN IIŌ]

Ewōr ke ippān ajri in jabdewōt iaan men kein?

	AAET	JAAB	IJAJE	EṂṂANḶỌK ÑE IJAB UWAAK
B4a. Jarroñroñ ak ejjab eṃṃan an roñ ḷọkjeṇ	1 ☐	2 ☐	77 ☐	99 ☐
B4b. Pilo ak ejjab eṃṃan an lo ḷọkjeṇ, jekdoon ñe ej kōjerbal māj kilaaj	1 ☐	2 ☐	77 ☐	99 ☐

B5. Enañin ke wōr taktō ak bar juon ri-jerbal ikijjeen ājmuur eṇ enañin kar ba ñan kwe bwe ewōr an ajri in jabdewōt iaan men kein? Eḷaññe aaet, ej pād wōt ke menin ippān ajri in rainin/kiiō.

	Enañin ke?	Rainin ak kiiō?	IJAJE	EṂṂAN ÑE IJAB UWAAK
B5a. “Asthma”	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5b. “Diabetes”/ Nañinmej in tōñal	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5c. “Down Syndrome”	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5d. Ekkutkut ak eḷap an metak bōran, ekūtbuuj “Migraine”	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5e. Jorrāān ñan kōmālij , “Concussion” or Jorrāān Bōran	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5f. “Anxiety”	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5g. “Depression” ak jorrāān in bōklōkōt	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5h. “Autism, ASD, Autism Spectrum Disorder (ASD), Asperger’s Disorder,” ak “Pervasive Developmental Disorder (PDD)”	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5i. “Attention Deficit Disorder (ADD)” or “Attention Deficit/Hyperactivity Disorder (ADHD)”	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5j. Ḷōbbat ak ruṃwij an ejaak	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5k. Jorrāān ko ilo ṃwilin ak kiltōn kōṃṃan ko an	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5l. Jorrāān in kōmālij (āt eo juon ej “mental retardation”)	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5m. Jipiij ak likjab ak jorrāān ko jet ikijjeen kōnono ak kōjerbal kajin ko	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5n. Likjab ikijjeen kilen ekkatak	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	99 ☐
B5o. Bar jorrāān ko jet ikijjeen kōmālij/kōḷmānḷọkjeṇ	1 ☐ AAET 2 ☐ JAAB	1 ☐ AAET 2 ☐ JAAB	77 ☐	☐

B6. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ewi ikkutkut in an nañinmej ak jorrāān ko jet jelōt an ajri eo maroñ kōṃṃani men ko jet im ajri ro jet dettan wōt rej kōṃṃani?

1. ☐ EJJEḶỌK AN AJRI IN NAÑINMEJ AK JORRĀĀN KO JET IKIJJEEN ĀJMUUR [ETAL NĀN B8]

2. ☐ EJJAÑIN KAR [ETAL ÑAN B8]

3. ☐ Jet iien

4. ☐ Ekkā an waḷọk

5. ☐ Aolep iien

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B7. Ewi joñan an nañinmej ak jorrāān ko jelōt an ajri in maroñ kōṃṃane men ko jabdewōt?

1. ☐ Elukkuun dik

2. ☐ Ewōr iien an jelōte

3. ☐ Eḷap an jelōte

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B8. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 6-17 AN IIŌ]

Ewōr ke taktō ak ri-lale ājmuur eṇ enañin kar jiroñ eok ak ba ñan eok ke ewōr an ajri in “Substance Abuse Disorder”? “Substance Abuse Disorder” ej waḷọk ñe ej ekkutkut ak ettōr an kōjerbal dānnin karōk im/ak men ko rōkkajjoor im rej kōṃṃan an wōr jorrāān ilo ājmuur eo an, en wōr an nañinmej in utaṃwe ak “disability,” im bwe en ḷap an likjab jān eddo ko an ilo jerbal, jikuuḷ, ak ilo ṃweo ṃōn.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN B9]

1. ☐ IJAJE [ETAL ÑAN B9]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN B9]

[ÑE AAET] menin ej ke jelōt ajri eo rainin/kiiō?

1. ☐ AAET

1. ☐ JAAB [ETAL ÑAN B9]

1. ☐ IJAJE [ETAL ÑAN B9]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN B9]

[ÑE AAET] ej ke āindein:

1. ☐ Edik

1. ☐ Ebwe

2. ☐ Eḷap

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B9. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 6-17 AN IIŌ]

Ewōr ke iaan men kein ilo laajrak in rej jelōte ajri in?

	Aaet	Jaab	IJAJE	EṂṂAN ÑE IJAB UWAAK
B9a. Lukkuun pen an leḷọk an liñūr jabdewōt, keememej, ak kōṃṃan kāālōt kōn nemāmeen ānbwinnin, bōklōkōt, ak men ko ej eñjaaki itulowa	1 ☐	2 ☐	77 ☐	99 ☐
B9b. Lukkuun pen an etetal ak an kōjerbal jikin uwe	1 ☐	2 ☐	77 ☐	99 ☐
B9c. Epen an ekkōṇak nuknuk ak tutu	1 ☐	2 ☐	77 ☐	99 ☐
B9d. Epen an ito itak im kōṃṃani jerbal ko make iaan, āinwōt etal ñan wōpij eo an taktō eo ak kaikujkuj kōn kiltōn ānbwinnin, kōḷmānḷọkjeṇ, ak men ko ej eñjaaki itulowa	1 ☐	2 ☐	77 ☐	99 ☐
B9e. Jarroñroñ ak ejjab eṃṃan an roñ ḷọkjeṇ	1 ☐	2 ☐	77 ☐	99 ☐
B9f. Pilo ak ejjab eṃṃan an lo ḷọkjeṇ, jekdoon ñe ej kōjerbal māj kilaaj	1 ☐	2 ☐	77 ☐	99 ☐

B10. Ewōr ke taktō ak ri-jerbal in ājmuur enañin kar jiroñ eok ak ba ñan kwe ke ajri in ear wōr an …

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
B10a. Nañinmej in menono eo im ej “Rheumatic”	1 ☐	2 ☐	77 ☐	99 ☐
B10b. “Rheumatic” pipa	1 ☐	2 ☐	77 ☐	99 ☐
B10c. Impetigo (ak nañinmej in kil ak “skin” ko jet)	1 ☐	2 ☐	77 ☐	99 ☐

[ÑE AAET ÑAN “RHEUMATIC” NAÑINMEJ IN MENONO AK “RHEUMATIC” PIPA] Kwōj ke idaak ak bōk wūno kōn nañinmej in?

1. ☐ AAET

2 ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[ÑE AAET] Rej idaak batin ke rej wā?

1. ☐ WŪNO KO JEJ IDAAK (BATIN) [ETAL ÑAN B11]

1. ☐ WĀ [ETAL ÑAN B11]

[ÑE JAAB] Etke kwōjjab? KAKŌḶḶEIK AOLEP MEN KO IM REJELŌT EOK.

1. ☐ Ijjab maroñ kōḷḷāik oṇāān in.

1. ☐ Ejjeḷọk iiaḷ.

2. ☐ Ejjeḷọk emaroñ bōk ajri eo nejū ñan aujpitōḷ.

3. ☐ Ejjab aorōk

4. ☐ BAR JUON WŪN, JOUJ IM KAALIKKAR

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB IWAAK

B11. Enañin ke wōr juon taktō ak ri-jerbal in ājmuur ej ba ñan eok ke ewōr an ajri eo nañinmej in bōtōktōk āinwōt “leukemia, anemia” ak “sickle cell disease”? Jouj im jab kobaik “Sickle Cell Trait.”

[RIITI ÑE EJ AIKUJIN]: Ajri ro im ewōr aer “anemia” ewōr jorrāān ilo bōtōktōkier im ej kōṃṃan bwe ren lukkuun ṃōk.

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Kiiō ij itōn lewaj jet kajjitōk ikijjeen bōbrae an jorrāān ajri eo jān menin jirilọk ko.

B12. Kwonañin ke ak bar juon ilo mour eo an ajri eo nejiṃ enañin ke kōnono ippān kōn wāween bōbrae menin kametak, kakkure, ak men ko remaroñ bōk mour eo an ak bōbrae menin jirilọk ko im renaaj kajorrāān ajri eo? Ñan waan joñak, an kauwōtata ilo iaḷ, tallōñ wōjke, ak aō ilo lọjet.

1. ☐ Aaet, bōbrae menin kametak, kakkure, ak men ko remaroñ bōk mour eo an

2. ☐ Aaet, bōbrae menin jirilọk ko

3. ☐ Men kein jiṃor

4. ☐ Ejjeḷọk iaer

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B13. Kwōj ke etal ippān ajri eo ilo iien an kōṃṃan ṃakūtkūt ko nabōj āinwōt aō ak ikkure?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B14. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 6-17 AN IIŌ]

Ñe ajri eo nejiṃ ej baajkōḷ, ewi ikkutkut in an ekkōṇak atin baajkōḷ?

1. ☐ Ajri eo nejū ejjab baajkōḷ

2. ☐ Ejjañin kar ekkōṇak atin baajkōḷ

3. ☐ Ejeja an ekkōṇak atin baajkōḷ

4. ☐ Jet iien ej ekkōṇak atin baajkōḷ

5. ☐ Ekkā wōt an ekkōṇak atin baajkōḷ

6. ☐ Aolep iien ej ekkōṇak atin baajkōḷ

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B15. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-11 AN IIŌ]

Ewi ikkutkut in an ajri eo iuwe ilo wa ilo an kōjerbal jea in kōjparok ajri ak “booster” jea?

1. ☐ Aolep iien

2. ☐ Enañin aolep iien

3. ☐ Jet iien

4. ☐ Ejeja

5. ☐ Ejjañin kar [ELAÑÑE AJRI EO EJ 0-5 IIŌ, ETAL ÑAN B17; EḶAÑÑE AJRI EO EJ 6-11 IIŌ, ETAL ÑAN C1]

6. ☐ AJRI EO NEJŪ EJJAB IUWE ILO KAAR [EḶAÑÑE AJRI EJ 0-5, ETAL ÑAN B17; EḶAÑÑE AJRI EO EJ 6-11 IIŌ, ETAL ÑAN C1]

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B16. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-11 AN IIŌ]

Ej pād ia ilo wa eo jea in kōjparok ajri eo?

1. ☐ Iṃaan ilo ijo jikin bajinjea

2. ☐ Likin bajinjea eo iṃaan

3. ☐ Likin ri-kattōr eo

4. ☐ Ioḷap ilo jea eo lik

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

B17. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-5 AN IIŌ]

Elikjab ke wā in ajri ko an ajri eo nejiṃ?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok C. [Ajri in ke ej niñniñ (RI-KAJJEIKIK BŪROOKRAAṂ: Likit Awa im Iien eo)]

C1. Ajri in ear ke ḷotak elōñḷọk jān jilu wiik ṃokta jān kar iien ḷotak eo an?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

C2. Ewi joñan eddoin ke ear ḷotak? Letok uwaak eo ilo aṃ kōjerbal baun im aunij ak
“kilogram” ak “gram.” Antọọne joñan wōt aṃ maroñ. [ÑE EJ AIKUJIN, RIITI: EṂṂAN JOÑAN EO WŌT KWŌNAAJ AṆTỌỌNE. JEJJAB AIKUJ BWE EN JEJJET].

BAUN IM AUNIJ

“KILOGRAM” IM “GRAM”

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

C3. Jete aṃ iiō ke ej ḷotak ajri in?

IIŌ

C4. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-1 AN IIŌ]

Ñe kwōj kōbabuuk ajri eo bwe en kiki, tu ia eo ajri eo ej babu kake?

1. ☐ Ajri eo ej babu kōn katin

2. ☐ Ajri eo ej jedelañ

3. ☐ Ajri eo ej pedo

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

C5. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-5 AN IIŌ. ÑE EJJAB ETAL ÑAN JABOK D]

Ajri in enañin ke kar ninnin jān ippān jinen ak kōrā ro jet?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN C6]

1. ☐ IJAJE [ETAL ÑAN C6]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN C6]

[ÑE AAET] ewi dettan ajri in ke ej bōjrak im jab ninnin ñan jidik jān jinen ak idaak milik jān kōrā?

RAAN (AK)

WIIK (AK)

ALLŌÑ (AK)

IIŌ

AJRI IN EKABDE NINNIN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

C6. Ewi dettan ajri in ke ej jino aer naajdik jabdewōt ṃōñā ijellọkwin milik jān kōrā ro ak ninnin bato? Ekūtbuuj juuj, milik jān kau, jukwa ṃōḷo (jukwa ippān aebōj), “baby” buut ak jiriaḷ, ak bar jabdewōt kain ṃōñā ak dān im kar maroñ leḷọk ñan ajri eo, jekdoon ñe aebōj.

RAAN (AK) WIIK (AK) ALLŌÑ

ILO IIEN EO EJ ḶOTAK

KĀĀLŌT BỌỌK IN EḶAÑÑE AJRI IN EJJAÑIN KAR ṂŌÑĀ AK IDAAK JABDEWŌT

MEN IJELLỌKWIN MILIK JĀN KŌRĀ AK BATO

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok D. [Jerbal in Jipañ ko ikijjeen Ājmuur (RI-KAJJEIKIK BŪROOKRAAṂ: Likit Awa im Iien eo)]

D1. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ajri in ear ke lo taktō, nōōj, ak ri-jerbal kapeel ro jet ilo ājmuur ñan bōk jipañ ikijjeen ajri nañinmej, iien etale ājmuur an ajri, iien etale ānbwinnin ajri, ikijjeen an ajri eo delọñ aujpitōḷ ak kōn bar jabdewōt kain jipañ ko ikijjeen taktō?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN D2]

1. ☐ IJAJE [ETAL ÑAN D2]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN D2]

[EḶAÑÑE AET] Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, jete kattōn an ajri in loḷọk taktō, nōōj, ak ri-jerbal kapeel ro jet ilo ājmuur ñan bōk jipañ ikijjeen etale in “check-up” ko im rej ñan kiltōn BŌBRAE? Juon iien etale eo im ej ilo kiltōn bōbrae ej ilo iien eo ajri eo ejjab nañinmej ak jorrāān, āinwōt juon iien etale joñan an ājmuur ānbwinnin ñan an maroñ ikkure ilo “sport” ko ak etale eo ilo kajjojo iiō, ak iien loḷọk in “well-child” (ajri ājmuur) ko.

1. ☐ 0 IIEN LOḶỌK

1. ☐ 1 IIEN LOḶỌK

2. ☐ 2 AK ELŌÑḶỌK IIEN LOḶỌK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

D2. Ewōr ke aṃ uwōta ikijjeen joñan an ajri in eddo?

1. ☐ Aaet, eḷap an ḷap an eddo

2. ☐ Aaet, eḷap an mera

3. ☐ Jaab, ijjab uwōta

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

D3. Ewi joñan aetokan ajri in kiiō? Jouj im antọọnetok aetokan joñan wōt aṃ maroñ. ÑE EJ AIKUJIN, RIITI: EṂṂAN JOÑAN EO WŌT KWŌNAAJ AṆTỌỌNE. JEJJAB AIKUJ BWE EN JEJJET].

ṆE IM INIJ

MITA IM JENTIMITA

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[DO NOT READ TO RESPONDENT] How was the measurement taken?

1. ☐ RESPONDENT ESTIMATE

2. ☐ MEASURED ON SITE

D4. Ewi joñan an ajri in eddo kiiō? Jouj im antọọnetok aetokan joñan wōt aṃ maroñ. [ÑE EJ AIKUJIN, RIITI: EṂṂAN JOÑAN EO WŌT KWŌNAAJ AṆTỌỌNE. JEJJAB AIKUJ BWE EN JEJJET].

BAUN IM AUNIJ

“KILOGRAM” IM “GRAM”

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[DO NOT READ TO RESPONDENT] How was the measurement taken?

1. ☐ RESPONDENT ESTIMATE

177. ☐ MEASURED ON SITE

D5. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-5 AN IIŌ]

Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, taktō eo an ajri in ak ri-jerbal in ājmuur ro jet raar ke kajjitōk eḷaññe ewōr aṃ inepata kōn an ajri eo katak, ejaak, ak ikijjeen ṃwilin?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

D6. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 0-5 AN IIŌ]

[EḶAÑÑE AJRI IN EDIKḶỌK JĀN 9 ALLŌÑ, ETAL ÑAN D7]

Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, taktō eo an ajri in ak ri-jerbal in ājmuur ro jet raar ke kanne juon peba in kajjitōk im uwaak kōn jet menin ekkōl ak kōn jabdewōt men kwōj lo ikijjeen an ajri in ejaak, kōnono ak kōmmeḷeḷe, ak ṃwilin ikijjeen ṃakūtkūt ko an ipeḷaakin ak ilo kapijuknen eo? Jet iien taktō eo an ajri eo ak bar juon ri-jerbal ilo ājmuur enaaj kajjitōk ippān jinen ak jemān ajri eo bwe en kōṃṃane menin ilo ṃweo ak ilo iien an ajri eo loḷọk er.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN D7]

1. ☐ IJAJE [ETAL ÑAN D7]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN D7]

[ÑE AJRI IN EJ 9-23 AN ALLŌÑ]

Peba in kajjitōk im uwaak eo ear ke kajjitōk menin ekkōl ak kōn jabdewōt men kwōj lo ikijjeen: KAKKŌḶḶEIK AOLEP MEN KO IM REJJELŌTE

1. ☐ Wāween an ajri in kōnnaan ak kōṃṃan ainikien ko jej kōjerbali ilo ad kōnono?

1. ☐ Wāween an ajri in iiāio ippaṃ im ippān ro jet?

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB IWAAK

[ÑE AJRI IN EJ 2-5 AN IIŌ]

Peba in kajjitōk im uwaak eo ear ke kajjitōk menin ekkōl ak kōn jabdewōt men kwōj lo ikijjeen: KAKKŌḶḶEIK AOLEP MEN KO IM REJJELŌTE

1. ☐ Naan im jabokan jantōj ko im ajri in ej kōjerbali im meḷeḷe kaki?

2 ☐ Kiltōn ṃwilin ajri in im wāween an iiāio ippaṃ im ippān ro jet?

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

D7. Ewōr ke juon jikin eo im ekkā an ajri in etal ñane eḷaññe ej nañinmej ak kwe im bar juon ri-lale ajri in ej aikuj naan in rōjañ ko ikijjeen ājmuur eo an?

1. ☐ AAET

2. ☐ JAAB [ETLA ÑAN D8]

1. ☐ IJAJE [ETAL ÑAN D8]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN D8]

[ÑE AAET] ia eo im ekkā an ajri in etal ñane?

1. ☐ Wōpij eo an juon taktō eo ejjab jerbal ñan kien

1. ☐ Ruuṃ in “emergency” ak iṃōrjenji eo an aujpitōḷ

2. ☐ Ra eo an “outpatient” ak autpeijen ilo aujpitōḷ

3. ☐ Jikin pukot ājmuur an kapijuknen, jikin taktō ko an kapijuknen ko, ak jikin pukot ājmuur

ko an jikin pukot ājmuur ko an kien

4. ☐ Jikuuḷ (wōpij ko an nōōj ro ak ri-kajjeikik “sport” ro)

5. ☐ Jikin ebbōk wūno ko ilo kapijuknen eo

6. ☐ Bar juon jikin, JOUJ IM KAALIKKAR

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

D8. Ewōr ke juon jikin eo im ekkā an ajri in etal ñane ñe ej aikuj jipañ ikijjeen bōbrae nañinmej ak jorrāān ko jet ikijjeen ājmuur, āinwōt etale ājmuur eo ilo ānbwinnin ak kiltōn etale ko an ajri (well-child).

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN D9]

1. ☐ IJAJE [ETAL ÑAN D9]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN D9]

[EḶAÑÑE AAET] ejja ijo in ke im ajri eo ej etal ñane ñe ej nañinmej?

1. ☐ AAET

1. ☐ JAAB

D9. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ajri in ekar ke bōk jabdewōt kain jerbal in jipañ ikijjeen ājmuur? Kakōḷḷeik aolep men ko rejjelōte. Ilo bar jet wāween rāinjuonḷọk, jerbalin jipañ ikijjeen ājmuur remaroñ bar kūtbuuj taktō kōn nitōl (acupuncture), jerbal in taktō ko ñan diin armej (chiropractic care), kilen lale ko im rej kōṃṃan bwe en aenōṃṃan im jokane (relaxation therapies), wūno in Ṃajeḷ ak ko jet ikijjeen ṃanit (traditional herbal medicine), and im bar ko jet. Jet jerbal in lale ājmuur (therapy) ej ko im naaj aikuj loḷọk ri-lale ro, ak komaroñ make lale ājmuur eo aṃ ilo jet bar jerbal in lale ājmuur.

1. ☐ Jipañ ko ilo jikin ājmuur

2. ☐ Taktō in māj im jerbalin jipañ ko jet ikijjeen ājmuur in māj

3. ☐ Taktō in lọjilñi im jerbalin jipañ ko jet ikijjeen ājmuur in lọjilñi

4. ☐ Taktō in lọñiid im jerbalin jipañ ko jet ikijjeen ājmuur in lọñiid

5. ☐ Jerbalin jipañ ko ilo ājmuurin bōklōkōt ko ad ak ājmuur in kōḷmānḷọkjeṇ

6. ☐ Kilen leḷọk jipañ in ak lale ājmuur ko rāinjuonḷọk

1. ☐ Ejjeḷọk iaan men kein [ETAL ÑAN D10]

IJAJE [ETAL ÑAN D10]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN D10]

[TAKTŌ IN MĀJ] Kain jikin ta eo ajri in ear etal bwe ren etale ak lale mejān ie? Kakōḷḷeik aolep men ko im rejjelōte.

1. ☐ Wōpij an ri-taktō māj (ophthalmologist, optometrist)

1. ☐ Wōpij an ri-taktō ajri ak taktō ro jet im rejjab jerbal ñan kien

2. ☐ Jikin pukot ājmuur an kapijuknen, jikin taktō ko an kapijuknen ko, ak jikin pukot ājmuur

ko an jikin pukot ājmuur ko an kien

3. ☐ Jikuuḷ

4. ☐ Bar juon jikin, JOUJ IM KALLIKKAR

D10. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ekar ke wōr iien im ear jab etal jipañ ikijjeen ājmuur ñan ajri eo ak ear ejjeḷọk jipañ ikijjeen ājmuur. Ilo ad ba jipañ ikijjeen ājmuur jej kōnnaan kōn jerbalin taktō ko ekoba jerbal in jipañ ko āinwōt taktō ak karreo lọñiid, taktō ak lale mejād, jerbalin jipañ ko jet ikijjeen ājmuur in bōklōkōt ak kōḷmānḷọkjeṇ.

1. ☐ AAET

2. ☐ JAAB [Etal ñan D12]

1. ☐ IJAJE [Etal ñan D12]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [Etal ñan D12]

[EḶAÑÑE AAET] kain jerbal in jipañ rot ko ear jab etal ñane ak ear ejjeḷọk? Kakōḷḷeik aolep men ko rejjelōte.

1. ☐ Jipañ ko ilo jikin ājmuur

2. ☐ Taktō in lọñiid im jerbalin jipañ ko jet ikijjeen ājmuur in lọñiid

3. ☐ Taktō in māj im jerbalin jipañ ko jet ikijjeen ājmuur in māj

4. Taktō in lọjilñi im jerbalin jipañ ko jet ikijjeen ājmuur in lọjilñi

5. ☐ Jerbalin jipañ ko ilo ājmuurin bōklōkōt ko ad ak ājmuur in kōḷmānḷọkjeṇ

6. ☐ Bar juon jikin, JOUJ IM KALLIKKAR

D11. Ewi iaan men kein ewōr an ilo kōṃṃan bwe en jab etal jipañ ikijjeen ājmuur ñan ajri eo im ear aikuj jipañ:

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
D11a. Ear jab wōr an ajri in jiṃwe ak maroñ ilo menin jipañ eo?	1 ☐	2 ☐	77 ☐	99 ☐
D11b. Ear ejjeḷọk menin jipañ kein ilo ijoko kwōj jukjuk im amṇak ie?	1 ☐	2 ☐	77 ☐	99 ☐
D11c. Ear pād ad kōṃṃan iien etal ñan jikin jipañ ko (appointment) ilo iien eo im ajri eo ear aikuj in etal?	1 ☐	2 ☐	77 ☐	99 ☐
D11d. Ekar wōr apañ ilo eppok iaḷ ak ri-lale ajri?	1 ☐	2 ☐	77 ☐	99 ☐
D11e. Wōpij in (“clinic”/taktō) eo ear jab peḷḷọk ke ajri ej aikuj jipañ?	1 ☐	2 ☐	77 ☐	99 ☐
D11f. Ewōr kar apañ ikijjeen jāān ko kar aikuj ñan menin?	1 ☐	2 ☐	77 ☐	☐

D12. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ajri in enañin ke delọñ ilo aujpitōḷ? Jouj im kūtbuuj an kar etal ñan iṃōrjenji ak pād ilo autpeijen.

• Aaet

• Jaab

• IJAJE

• ṂAKOKO

[ÑE AAET Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, jete de kattōn an ajri in delọñ ilo aujpitōḷ jān jorrāān (accident) ko? Ilo am ba “jorrāān” jej kōnnaan kōn jorrāān ko ñan ānbwinnin im raar waḷọk jān jirilọk ak jān aer kar mane. Jorrāān ko rej kūtbuuj, im emaroñ bar lōñḷọk kain jorrāān, bwilọk di, iñrōk, mwijmwij, bwil, an menin mour kar kiji ak mane, or jorrāān ko jet jān an kar itaak ilo juon men.

ALEN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok E. [Kiltōn kar ad loḷọk Ri-jerbal ro ilo Ājmuur im Raar Lale Ajri in (RI-KAJJEIKIK BŪROOKRAAṂ: Likit Awa im Iien eo)]

E1. Ewōr ke juon ak elōñḷọk taktō ak nōōj kwōj ḷōmṇak bwe ej/rej an ajri eo taktō/nōōj? Juon taktō ak nōōj eo an ajri eo ej juon ri-jerbal ilo jikin ājmuur im eḷap an jeḷā kajjeen ajri eo im emeḷeḷe kōn ājmuur im mour eo an ajri eo ilo kar ṃaantak. Emaroñ juon taktō, taktō in ajri, juon taktō eo im ewōr an kapeel ikijjeen jabokan jerbalin taktō ko, juon nōōj “practitioner,” ak juon rijjipañ taktō.

1. ☐ AAET, JUON ARMEJ

2. ☐ AAET, ELŌÑ JĀN JUON ARMEJ

3. ☐ JAAB

E2. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ajri in ear ke aikuj peba in “referral” ko jān jabdewōt taktō ñan an maroñ etal menin jipañe?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN E3]

1. ☐ IJAJE [ETAL ÑAN E3]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN E3]

[ÑE AAET] ewi joñan an kar pen an bōk an “referral”?

1. ☐ Ear jab pen

1. ☐ Ear pen jidik

2. ☐ Eḷap an pen

E3. [UWAAKE WŌT KAJJITŌK KEIN EḶAÑÑE AJRI EO EAR LOḶỌK RI-JERBAL IN ĀJMUUR RO ILOWAAN ALLŌÑ KO JOÑOUL REJ JEṂḶỌK ḶỌK. EḶAÑÑE JAAB ETAL ÑAN E4.]

Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ewi ikkutkut in an taktō ro ak ri-jerbal in jikin ājmuur ro:

	Aolep iien	Ekkā wōt	Jet iien	Ejjañin kar	IJAJE	EṂṂANḶỌK ÑE IJAB UWAAK
E3a. Ebwe aer iien ippān ajri eo?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3b. Lukkuun kanooj roñjake men ko kwōj ba	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3c. Kwaḷọk aer kea kōn tōmak im ṃanit ko an baaṃle eo am?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3d. Lewaj tujejjetin meḷeḷe ko im kwaar aikuji kōn ajri in?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3e. Jipañ bwe kwōn jeḷā ke koṃij jerbal ippān doon ilo lale ajri in?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	☐

E4. Ewōr ke en ej jipañ eok kōṃṃan iien ak kajjeikik iien ko an ajri eo ilubwiljin iien etal ñan taktō im bōk jerbal in jipañ ko jet ñan ajri in?

1. ☐ AAET

2. ☐ JAAB

3. ☐ EAR JAB LOḶỌK ELŌÑḶỌK JĀN JUON RI-JERBAL IN ĀJMUUR ALLŌÑ KEIN 12 REJ

JEṂḶỌK ḶỌK [ETAL ÑAN E7]

E5. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ewōr ke iien kwaar kōṇaan bwe en kar wōr eḷapḷọk jipañ ej iwōj ikijjeen kōṃṃan iien ak kajjeikik iien ko an ajri eo ilubwiljin iien etal ñan taktō im bōk jerbal in jipañ ko jet ñan ajri in?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN E6]

[ÑE AAET] Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ewi ikkutkut in an kar iwōj jipañ ñan eok ilo joñan eo im kwaar kōṇaan ikijjeen kōṃṃan iien ak kajjeikik iien ko ajri in ear pukot ājmuur?

1. ☐ Ekkā wōt

1. ☐ Jet iien

2. ☐ Ijjañin kar

E6. Ilo aṃ lale aolep men, ewi joñan aṃ po buruōm kōn wāween an taktō im ri-jerbal ro jet ilo jikin bōk ājmuur kōnono ippān doon ak leto letak meḷeḷe ko ikōtaaer kōn ajri eo?

1. ☐ Eḷap an po buruō

2. ☐ Ejaad po buruō

3. ☐ Ejjab po buruō ilo jet wāween

4. ☐ Eḷap an jab po buruō

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

E7. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 12-17 AN IIŌ]

Ewōr ke iaan taktō ak ri-jerbal in jikin bōk ājmuur rein rej lale wōt ajri?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN E8]

177. ☐ IJAJE [ETAL ÑAN E8]

178. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN E8]

[EḶAÑÑE AAET] raar ke kōnono ippaṃ kōn an ajri in naaj juon iien maroñ loḷọk taktō ro ak ri-jerbal in jikin pukot ājmuur ro im rej lale ditto?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

E8. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 12-17 AN IIŌ]

Taktō eo ak ri-jerbalin jikin pukot ājmuur eo enañin ke kar jerbal ippān ajri in ñan an:

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
E8a. Ḷōmṇak kōn im kōpeḷaak ilju im jekḷaj eo an. Ñan waan joñak, ilo an bōk an iien ñan kōnono kōn men ko ej karōk ñan ilju im jekḷaj eo an ikijjeen jeḷā ḷọkjeṇ, jerbal, kōta eo an ippān armej ro jet, im kōn an naaj ejaak kiltōn kapeel ko ñan an maroñ make mour ḷọk iaan?	1 ☐	2 ☐	77 ☐	99 ☐
E8b. Kōṃṃan kāālōt ko rōṃṃan ikijjeen ājmuur eo ilo e. Ñan waan joñak, ilo an ṃōñā men ko eṃṃan ñan ājmuur eo an, “exercise,” jab kōjerbal jikka im tip, dānnin karōk ak men ko rōkajoor, im kōttar ṃokta im jab jino iioon ak pād ippān armej?	1 ☐	2 ☐	77 ☐	99 ☐
E8c. Bōk kapeel ko ñan mānije ājmuur im pukot jipañ ko ikijjeen ājmuur? Ñan waan joñak, ilo an naaj meḷeḷe kōn aikuj ko an rainin ikijjeen ājmuur, jeḷā ta eo kōṃṃane eḷaññe enaaj wōr menin idiñ ikijjeen ājmuur, ak bōk wūno ko im emaroñ naaj aikuji?	1 ☐	2 ☐	77 ☐	99 ☐
E8d. Meḷeḷe kōn ta ko renaaj oktak ikijjeen kiltōn bōk jipañ ikijjeen ājmuur ilo iien eṇ ej 18 an iiō. Ñan waan joñak, ilo an naaj meḷeḷe kōn oktak ko ikijjeen kōjparok meḷeḷe ko an bwe ren jab diwōjḷọk, jiṃwe im eddo ko an ikijjeen kōṃṃan kāālōt, tōpar meḷeḷe ko, ak kōṃṃan kāālōt.	1 ☐	2 ☐	77 ☐	99 ☐

E9. [LEḶỌK WŌT KAJJITŌK IN EḶAÑÑE AJRI EO EJ 12-17 AN IIŌ]

Taktō im ri-jerbal in ājmuur ro jet renañin ke kar jerbal ippaṃ im ajri in ñan aer jeik juon peba im enaaj kōṃṃan kōppeḷaak ko ñan katōprak kōttōpar im aikuj ko an ajriin ikijjeen ājmuur?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN E10]

1. ☐ IJAJE [ETAL ÑAN E10]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN E10]

[ÑE AAET] būḷāān in ej ke kaalikkar jet kōttōpar ko ikijjeen ājmuur ñan ajri in im jabdewōt aikuj ak jorrāān ko im remaroñ jelōt ājmuur eo an ajri in im kilen an naaj tōpar jipañ ikijjeen aikuj kein?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Ekar ke iwōj juon aṃ im an ajri in arin ak kape in būḷāān in jej kōnono kake?

1. ☐ AAET

2. ☐ JAAB

177. ☐ IJAJE

177. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Epād ke meḷeḷe ko im rej an raan kein kōn ajri in ilo būḷāān in?

1. ☐ AAET

177. ☐ JAAB

177. ☐ IJAJE

177. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

E10. An juon maroñ pād iuṃwin juon injuran in taktō ekkā an oktak ilo iien eṇ ej juon likao ak jiroñ jidikdik. Kōjjeḷā ke ewi wāween an naaj ajri in bōk an injuran in taktō ñe enaaj dittoḷọk im erom juon ditto?

1. ☐ AAET [ETAL ÑAN F]

2. ☐ JAAB

[ÑE JAAB] enañin ke wōr eṇ ej kōnnaan ippaṃ kōn wāween bōk im dāpij jet kain injuran in taktō ilo an ajri in naaj erom juon ditto?

1. ☐ AAET

1. ☐ JAAB

Jabok F. [Injuran in Taktō eo an Ajri in (RI-KAJJEIKIK BŪROOKRAAṂ: Likit Awa im Iien eo)]

F1. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ajri in enañin ke kar pād iuṃwin jabdewōt kain Injuran in Taktō ak būḷāān in joortoklik ikijjeen ājmuur? Menin ej kūtbuuj akkaun in kakkoṇ jāān ñan taktō, “supplemental health,” im būrookraaṃ in injuran ko ak būrokraaṃ in injuran ko im kien ej kōḷḷāik oṇāer ak ej jipañ kōḷḷāik oṇāer.

1. ☐ Aaet, ajri in ear pād iuṃwin juon ak elōñḷọk iaan men kein ilo aolepen allōñ ko rej jeṃḷọk ḷọk ak, ñe edik jān 1 iiō dettan [ETAL ÑAN F4]

2. ☐ Aaet, bōtaab ear wōr kōta ilo iien an kar pād iuṃwin juon ak elōñḷọk iaan men kein

3. ☐ Jaab

F2. Jouj im kaalikkar eḷaññe kajjojo iaan men kein ilo laajrak in ilaḷ ej wūnin an kar jab pād iuṃwin Injuran in Taktō ilowaan allōñ ko 12 rej jeṃḷọk ḷọk:

	AAET	JAAB
F2a. Oktak ijo ej jerbal ie ak nemāmeen an pād āinwōt juon ri-jerbal	1 ☐	2 ☐
F2b. Ear bōjrak injuran eo jān wōt an kar jab maroñ kōḷḷāik oṇāān	1 ☐	2 ☐
F2c. Ear joḷọk injuran eo an kōn an jab eṃṃan oṇāān injuran eo	1 ☐	2 ☐
F2d. Ear joḷọk injuran eo an kōnke ejabwe men ko injuran eo ej maroñ kōḷḷāiki	1 ☐	2 ☐
F2e. Ear joḷọk injuran eo an kōnke eiiet jikin pukot ājmuur ko im emaroñ kar kōjerbale injuran eo ie	1 ☐	2 ☐
F2f. Apañ ko ikijjeen kanne peba (apply) ñan injuran ak apañ ko ikijjeen kanne peba in kōkāāl injuran eo	1 ☐	2 ☐
F2g. Ñe bar juon wūn, jouj im kaalikkar	1 ☐	☐

F3. Ajri in ej ke pād iuṃwin jabdewōt kain injuran rainin ak būḷāān in joortoklik ko ikijjeen ājmuur?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN JABOK G]

1. ☐ IJAJE [ETAL ÑAN JABOK G]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN JABOK G]

F4. Ajri in ej ke pād iuṃwin jabdewōt iaan injuran kein ak iuṃwin būḷāān in joortoklik ko ikijjeen ājmuur kein rej laajrak ijin? [Ñan ri-kajjitōk eo: Riiti wōt kain injuran ko im rej itok ikijjeen ijoko jej pād ie im rejjelōt ijoko koṃij jukjuk im amṇak ie].

	AAET	JAAB
F4a. Injuran in Taktō ko jān peejnej in injuran ko	1 ☐	2 ☐
F4b. Injuran eo ej itok ikijjeen jikin jerbal eo aṃ ak doulul in ri-jerbal (union) eo aṃ (ak an eo ri-turrum) kiiō ak ṃoktaḷọk.	1 ☐	2 ☐
F4c. “Medicaid,” Menin Jipañ ko ñan Taktō, ak bar juon kain būḷāān in jipañ jān kien (ekūtbuuj Guam Medical Indigent Program, Palau National Health Insurance Program, im “Puerto Rico Government Health Plan)	1 ☐	2 ☐
F4d. Būrokraaṃ in injuran ko im kien ej kōḷḷāik oṇāer ak ej jipañ kōḷḷāik oṇāer (ekūtbuuj Micronesia MiCare ak Chuuk State, Marshall Islands Public Insurance, im Marshall Islands Supplemental Health Fund)	1 ☐	2 ☐
F4e. Akkaun in kakkoṇ jāān ñan taktō	1 ☐	2 ☐
F4f. Būrookraaṃ in injuran eo an ajri ilo Amedka ṇae etan “CHIP (Children’s Health Insurance Program)”	1 ☐	2 ☐
F4g. TRICARE ak būrookraaṃ in lale ājmuur ko jet im rej an ri-tarinae	1 ☐	2 ☐
F4h. Būrokraaṃ in Lale Ājmuur eo an ri-Indian ṇae etan Indian Health Service	1 ☐	2 ☐
F4i. Bar juon kain, jouj im kaalikkar	1 ☐	☐

F5. Ewi ikkutkut in an Injuran in Taktō in an ajri in leḷọk menin jipañ ko ak kōḷḷāik jerbal in jipañ ko im rej kabwe aikuj ko an ajri in? Waan joñan ko rej kūtbuuj jerbalin lale ñiin ak lọñiin, ak mejān, wūno ko im taktō ej aikuj kōmālim būki, iien etal ñan iṃōrjenji ruuṃ eo, jerbal in lale kūrae, jerbal in lale ājmuur eo ilo bōklōkōt ak kōmālij, ak iien ko ñan etale ājmuur im ej kōṃṃan ilo kajjojo iiō.

1. ☐ Aolep iien

2. ☐ Enañin aolep iien

3. ☐ Jet iien

4. ☐ Ejjañin kar

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

F6. Ewi ikkutkut in an injuran in taktō in an ajri in kōtḷọk bwe en loḷọk jikin pukot ājmuur ilo iien ko im ej aikuj bwe en loḷọk er?

1. ☐ Aolep iien

2. ☐ Enañin aolep iien

3. ☐ Jet iien

4. ☐ Ejjañin kar

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok G. [Kiltōn Leḷọk Iaḷ ñan an Ajri eo Ājmuur (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

G1. Ñe ekobatok "co-pay" ko im joñan ko jān akkaun in kakkoṇ jāān ñan taktō, ewi joñan jāān eo kwaar joḷọk ñan aṃ kōḷḷāik oṇāān an taktō, pukot ājmuur, taktō in ñi ak lọñiin, taktō in māj ilowaan allōñ ko 12 rej jeṃḷọk ḷọk? Jab kobaiktok oṇāān injuran eo ilo kajjojo iien, ak oṇāān ko im injuran ak ijoko jet renaaj kōrọọlwaj ñan eok.

1. ☐ $0 (EJJEḶỌK JĀĀN KAR JOḶỌK ÑAN TAKTO AK IKIJJEEN ĀJMUUR) [ETAL ÑAN G4]

2. ☐ $1-$249

3. ☐ $250-$499

4. ☐ $500-$999

5. ☐ $1,000-$5,000

6. ☐ EḶAPḶỌK JĀN $5,000

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

G2. Ewi ikkutkut in an eṃṃan joñan oṇāān kein?

1. ☐ Aolep iien

2. ☐ Enañin aolep iien

3. ☐ Jet iien

4. ☐ Ejjañin kar

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

G3. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ekar ke wōr an baaṃle eo aṃ apañ ikijjeen kōḷḷāik oṇāān jabdewōt iaan biiḷ in taktō ak pukot ājmuur ko an ajri in?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

G4. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, kwaar ke ak ro jet ilo baaṃle eo raar ke:

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB IWAAK
G4a. Bōjrak jān jerbal kōn an nana an ajri eo mour ak ikijjeen ājmuur?	1 ☐	2 ☐	77 ☐	99 ☐
G4b. Kaiietḷọk awa in jerbal kōn an nana an ajri eo mour ak ikijjeen ājmuur?	1 ☐	2 ☐	77 ☐	99 ☐
G4c. Jab oktak ñan bar juon jerbal kāāl itok jān an ekkōl ñe ejako injuran in taktō in an ajri in?	1 ☐	2 ☐	77 ☐	99 ☐
G4d. Bōk jipañ jān ro ilo baaṃle eo?	1 ☐	2 ☐	77 ☐	99 ☐

G5. Ilo juon wiik eo im ej ekkā an āinwōt wiik ko jet, jete awa ko kwe ak juon ilo baaṃle eo ej joḷọk ñan an lale ajri eo ilo ṃweo? Jerbal in lale emaroñ kūtbuuj ukōt teep in kinej ko, ak leḷọk wūno ko ak menin jipañ ko jet ikijjeen ājmuur ṇae etaer “therapy.”

1. ☐ Ajri in ejjab aikuj ri-jipañe kōn ājmuur eo an ilo kajjojo wiik

2. ☐ Ejjeḷọk jerbal in lale ri-nañinmej ak juon eo utaṃwe jaar kōṃṃane ilo ṃweo

3. ☐ Dik jān 1 awa ilo juon wiik

4. ☐ 1-4 awa ilo juon wiik

5. ☐ 5-10 awa ilo juon wiik

6. ☐ 11 ak elōñḷọk awa ilo juon wiik

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

G6. Ilo juon wiik eo im ej ekkā an āinwōt wiik ko jet, jete awa ko kwe ak juon ilo baaṃle eo ej joḷọk ñan kōṃṃan an iien ippān ak jerbal ippān ri-jerbal in jikin ājmuur ro ñan kōṃṃan an ajri eo iien loḷọk er ak pukot kiltōn jipañ ko jet?

1. ☐ Ajri in ejjab aikuj ri-jipañe kōn ājmuur eo an ilo kajjojo wiik

2. ☐ Ejjeḷọk jerbal in lale ri-nañinmej ak juon eo utaṃwe jaar kōṃṃane ilo ṃweo

3. ☐ Dik jān 1 awa ilo juon wiik

4. ☐ 1-4 awa ilo juon wiik

5. ☐ 5-10 awa ilo juon wiik

6. ☐ 11 ak elōñḷọk awa ilo juon wiik

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok H. [An Ajri in Katak (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

H1. Ilo juon raan in jikuuḷ ak jerbal eo im ej ekkā an āinwōt raan ko jet, ewi joñan iien ko im ekkā an ajri in joḷọk iṃaan “TV” im alwōj būrookraaṃ in “TV”, “video,” ak ikkure “video game”?

1. ☐ Ejjeḷọk

2. ☐ Dik jān 1 awa

3. ☐ 1 awa

4. ☐ 2 awa

5. ☐ 3 awa

6. ☐ 4 ak lōñḷọk awa

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H2. Ilo juon raan in jikuuḷ ak jerbal eo im ej ekkā an āinwōt raan ko jet, ewi joñan iien ko im ekkā an ajri in joḷọk ñan “computer, jeeḷboon, “video game” ko im ej jibwi kōn pein im kein alwōj ak ikkure in jarom ko jet im ej kōjerbali ñan men ko jet ijellọkwin kōṃṃan katak?

1. ☐ Ejjeḷọk

2. ☐ Dik jān 1 awa

3. ☐ 1 awa

4. ☐ 2 awa

5. ☐ 3 awa

6. ☐ 4 ak lōñḷọk awa

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H3. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ewi joñan an eṃṃan an ajri in katak kilen lale e make?

1. ☐ Eḷap an eṃṃan

2. ☐ Ebwe

3. ☐ Enana

4. ☐ Ejjab ñan jidik

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H4. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ewi joñan aṃ kōjatdikdik bwe ajri in enaaj eṃṃan an katak ak jikuuḷ ilo eḷmāntōre?

1. ☐ Eḷap kōjatdikdik

2. ☐ Ekkā an wōr aō kōjatdikdik

3. ☐ Ebwe joñan aō kōjatdikdik

4. ☐ Ejjeḷọk aō kōjatdikdik ñan jidik

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H5. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 6-17 AN IIŌ]

Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, emaroñ jete raan in an ajri in jab jikuuḷ kōnke enañinmej ak ewōr jorrāān ear waḷọk ñan ānbwinnin?

1. ☐ EJJEḶỌK RAAN IN JIKUUḶ EAR JOḶỌK

2. ☐ 1-3 RAAN

3. ☐ 4-6 RAAN

4. ☐ 7-10 RAAN

5. ☐ 11 AK ELŌÑḶỌK RAAN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H6. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 6-17 AN IIŌ]

Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, emaroñ jete kattōn an jikuuḷ eo kūrwaj eok ak juon ilo ṃweo kōn an jorrāān katak ko an ak kōn bar jet kain jorrāān ilo jikuuḷ?

1. ☐ EJJEḶỌK

2. ☐ 1 ALEN

3. ☐ 2 AK ELŌÑḶỌK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H7. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 12-17 AN IIŌ]

Kajjitōk kein ruo tokālik rej kōn kaamijak ajri ak “bullying.” “Bullying” ej ñe 1 ak elōñḷọk ri-jikuuḷ rej kakūtōtōik, ba renaaj mane, kōnnaan kake ijoko wōj, deñōt, wūni, ak kametak bar juon ri-jikuuḷ im rej āliji men kein. Ejjab “bullying” ñe ruo ajri im ej joñan wōt juon aer kajoor im maroñ rej akweel ak kakūtōtōik doon ilo aer kōṃṃan kōjak. Ewōr ke en enañin kar kaamijak ajri eo nejūm ilo joko jikin jikuuḷ?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H8. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 12-17 AN IIŌ]

Enañin ke wōr ej kaamijak ajri eo nejūm ilo “online”? (Bar būne kiltōn kaamijak ko ilo “text, Instagram, Facebook,” ak “social media” ko jet.)

1. ☐ AAET

2. ☐ JAAB

3. ☐ IJAJE

4. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H9. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 6-17 AN IIŌ]

Jino jān kilaj 0, ajri in enañin ke kar āliji juon kilaj?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

H10. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 6-17 AN IIŌ]

Ilo wiik eo ej jeṃḷọk ḷọk, jete iaan raan kein ajri eo ear ṃōṃakūtkūt, ikkure “sport,” ak bōk koṇaan im kōṃakūtkūt ānbwinnin iuṃwin diktata 60 minit?

1. ☐ 0 RAAN

2. ☐ 1-3 RAAN

3. ☐ 4-6 RAAN

4. ☐ AOLEP RAAN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok I. [Kōn Kwe im Ajri in (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

I1. Jete de kattōn an ajri in eṃṃakūt ñan bar juon atōrej kāāl ak jikin jān ke ear ḷotak?

KATTŌN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

I2. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ilo wiik eo ej jeṃḷọk ḷọk, jete iaan raan ko kwe ak juon ilo baaṃle eo ear riit ñan ajri in?

1. ☐ 0 RAAN

2. ☐ 1-3 RAAN

3. ☐ 4-6 RAAN

4. ☐ AOLEP RAAN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

I3. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ilo wiik eo ej jeṃḷọk ḷọk, jete iaan raan ko kwe ak juon ilo baaṃle eo ear bwebwenato ak al ñan ajri in?

1. ☐ 0 RAAN

2. ☐ 1-3 RAAN

3. ☐ 4-6 RAAN

4. ☐ AOLEP RAAN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

I4. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ewōr ke ijellọkwin jinen, jemān, ak armej eo ej bōk eddoin ajri in ear lale ajri in iuṃwin 10 awa ak iuṃwin juon iien eo aetokḷọk? Armej in emaroñ kar pād ilo ṃōn kaajjiriri ajri in raan (daycare center), kilaj in kamminene ko (preschool), “Head Start” būrookraaṃ eo, iṃōn kaajjiriri ko an baaṃle, ri-jerbal ro im rej kaajjiriri ajri (nanny), juon eo im ej kaajjiriri ajri ro nejin ro eoktak kajin eo aer jāne ñan an katak kajin eo (au pair), “babysitter,” ak eo juon nukwier.

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

I5. IUMWIN ALLON KO 12 REMOTLOK, enanin wor ke takto ear lolok ajri in ilo video ak phone?

1. ☐ AAET

2. ☐ JAAB

[IF YES] Ilo aoleb lolok kein ilo video ak phone ej kin un in kin coronavirus naninmij eo?

1. ☐ AAET

2. ☐ JAAB

I6. IUMWIN ALLON KO 12 REMOTLOK, ajri in ear ke jako jen, karumwin ak jolok jabrewot KEJBAROK KO ikijen check-up kin wot un eo coronavirus naninmij in?

1. ☐ AAET

2. ☐ JAAB

I7. IUMWIN ALLON KO 12 REMOTLOK, ilo jikin kejbarok ko ilo ran ak jet karok ko ikijen arji rar kilok ak rejab jerbal ilo jabrewot ien kein kin wot un in coronavirus naninmij?

1. ☐ AAET

2. ☐ JAAB

Jabok J. [Kōn Baaṃle eo aṃ im Ṃweo (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

J1. Ewōr ke ilo ṃweo ṃōm ej kōjerbal jikka, jikka jarom, kein kabbaatat ko, jikka ko rōkilep, baib in tōbako, ju, ak meme bitōl nat? [RIIT ÑE EJ AIKUJ: Jouj im uwaak joñan wōt aṃ maroñ. Bitōl nat ej ineen juon ni ṇae etan areca. Rej bar ṇae etan areca nat. Ju bitōl nat ej juon men eo im aorōk ilo ṃanit ko an ro ilo laḷ ko turōk im turōk turear in Ajia im ilo Ajia Pacific. Ekkā aer kūtimi kōn būlkōn areca ni eo (paan) ak ippān tōbako (bitōl quid)].

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN J3]

1. ☐ IJAJE [ETAL ÑAN J3]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN J3]

J2. Ewōr ke eṇ ej kōbaatat ilowaan ṃweo ṃōm?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

ÑE PUERTO RICO, ETAL ÑAN J5

J3. Ajri eo nejiṃ enañin ke kar meme bitōl nat? [RIIT ÑE EJ AIKUJ: Jouj im uwaak joñan wōt aṃ maroñ. Bitōl nat ej ineen juon ni ṇae etan areca. Rej bar ṇae etan areca nat. Ju bitōl nat ej juon men eo im aorōk ilo ṃanit ko an ro ilo laḷ ko turōk im turōk turear in Ajia im ilo Ajia Pacific. Ekkā aer kūtimi kōn būlkōn areca ni eo (paan) ak ippān tōbako (bitōl quid)].

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

J4. Kwōjeḷā ke ta eo ej waḷọk jān meme bitōl nat?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Kajjitōk kein jilu ilaḷ rej itok ikijjeen jāān.

J5. Jān ke ajri in ear ḷotak, ewi ikkutkut in an baaṃle eo mour kōn joñan jāān eo an baaṃle eo – epen loloodjake aikuj ko āinwōt ṃōñā im jikin jokwe?

1. ☐ Ejjañin kar

2. ☐ Ejeja

3. ☐ Ejaad ikkutkut

4. ☐ Eḷap an ikkutkut

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

J6. Kajjitōk in tokālik ej kajjitōk ñe kwaar maroñe oṇāān ṃōñā ko kwaar aikuji. Ewi iaan meḷeḷe kein ejejjet tata an kōmeḷeḷeik kiltōn aikuj ko ikijjeen ṃōñā ilo ṃweo ILO ALLŌÑ KEIN 12 REJ JEṂḶỌK ḶỌK?

1. ☐ Aolep iien koṃij maroñe oṇāān ṃōñā ko rōṃṃan im ḷap ōn ie.

2. ☐ Aolep iien koṃij maroñe oṇāān ṃōñā ko bōtaab ejjab aolep iien rej jet ṃōñā ko im koṃij aikuj

ṃōñā.

3. ☐ Jet iien, koṃijjab maroñ wiia joñan ṃōñā ko koṃij aikuji.

4. ☐ Elōñ iien, koṃijjab maroñ wiia joñan ṃōñā ko koṃij aikuji.

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

J7. Ilo jabdewōt iien ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, jekdoon ñe juon wōt allōñ, ewōr ke ilo baaṃle eo aṃ ear etal ñan er:

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
J7a. Jāān in jipañ jān juon būrookraaṃ in jipañ (welfare) an kien?	1 ☐	2 ☐	77 ☐	99 ☐
J7b. [Kōjjeḷā ikijjeen būrookraaṃ in: Jab kwaḷọk ilo Puerto Rico] “Food Stamp” ko ak benebet in “Supplemental Nutrition Assistance Program (SNAP)” ko? [Kōjjeḷā ikijjeen būrookraaṃ in: Ñan Puerto Rico kwaḷọk men kein tok] Nutrition Assistance Program (NAP) (ṇae etan PAN)	1 ☐	2 ☐	77 ☐	99 ☐
J7c. Ṃōñā in jibboñ ak raelep ko ilo jikuuḷ im ejjeḷọk ak edik wōṇāer?	1 ☐	2 ☐	77 ☐	99 ☐
J7d. [Kōjjeḷā ikijjeen būrookraaṃ in: Jab kwaḷọk ilo RMI, Palau, FSM, im Puerto Rico] Benebet ko jān Woman, Infants, and Children (WIC) Program (Būrookraaṃ)?	1 ☐	2 ☐	77 ☐	99 ☐

Jabok K. [Kōn Kwe (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

KADEDEḶỌK KAJJITŌK KEIN ÑAN KAJJOJO IAAN DITTO RO RUO ILO ṂWEO IM REJ BŌK EDDOIN AJRI EO. ÑE JUON WŌT DITTO EṆ, LETOK UWAAK KO AN ARMEJ EṆ.

K1. DITTO 1

Teem ajri in?

1. ☐ LUKKUUN JINEN AK JEMĀN

2. ☐ JUON EO EAR KAAJJIRIRIIKI AJRI IN

3. ☐ ARMEJ EO RITTURIN JINEN AK JEMĀN

4. ☐ JIBWIN AK JIṂṂAAN

5. ☐ JINEN AK JEMĀN IUṂWIN “FOSTER” BŪROOKRAAṂ KO

6. ☐ JEIN AK JATIN JINEN AK JEMĀN (ENEJ JINEN AK ENEJ JEMĀN AJRI IN)

7. ☐ BAR JUON: NUKWIN

8. ☐ BAR JUON: EJJAB NUKWIN

K2. Ta Eṃṃaan ke kōrā?

1. ☐ EṂṂAAN

2. ☐ KŌRĀ

K3. Jete aṃ iiō?

JETE AN IIŌ

K4. Kilaj ta ak iiō in jikuuḷ ta eo kwaar kadedeḷọk? KAKŌḶḶEIK WŌT JUON.

1. ☐ KILAJ RALITŌK AK DIKḶỌK

2. ☐ KILAJ 9-12, EJJEḶỌK PEBA IN KADDIWŌJḶỌK

3. ☐ RI-KADDIWŌJḶỌK IN “HIGH SCHOOL” AK GED

4. ☐ EAR KAJEṂḶỌK JUON BŪROOKRAAṂ IN “VOCATIONAL, TRADE,” AK BŪROOKRAAṂ IN JIKUUḶ IN PEEJNEJ

5. ☐ JET “CREDIT” IN KALEJ, EJJEḶỌK PEBA IN KADDIWŌJḶỌK

6. ☐ “ASSOCIATE” TIIKRI (AA, AS)

7. ☐ “BACHELOR” TIIKRI (BA, BS, AB)

8. ☐ “MASTER” TIIKRI (MA, MS, MSW, MBA)

9. ☐ “DOCTORATE” (PHD, EDD) AK TIIKRI KO AN “PROFESSIONAL” RO (MD, DDS, DVM,

JD)

K5. Kwe ke ri-ṃare?

1. ☐ RI-ṂARE [ETAL ÑAN K7]

2. ☐ JAÑIN KAR MARE

3. ☐ “DIVORCE”

4. ☐ JEPEL

5. ☐ EJAKO ARMEJ EO ṂŌTTAN

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN K7]

K6. Kwōj jokwe ke ippān juon aṃ ri-yokwe?

1. ☐ AAET

2. ☐ JAAB

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

K7. Ilo laleḷọk, eājmuur ke ānbwinnim?

1. ☐ Jejjet/Weeppān

2. ☐ Eḷap an eṃṃan

3. ☐ Eṃṃan

4. ☐ Ebwe

5. ☐ Enana

₇₇☐ IJAJE/IJJAB JEḶĀ

₉₉☐ EṂṂANḶỌK IPPA ÑE IJAB UWAAK

K8. Ilo laleḷọk, ejet ājmuur eo aṃ ikijjeen bōklōkōt, kōḷmānḷọkjeṇ, ak men ko kwōj eñjaaki tulowa?

1. ☐ Jejjet/Weeppān

2. ☐ Eḷap an eṃṃan

3. ☐ Eṃṃan

4. ☐ Ebwe

5. ☐ Enana

₇₇☐ IJAJE/IJJAB JEḶĀ

₉₉☐ EṂṂANḶỌK IPPA ÑE IJAB UWAAK

K9. Ekar ke wōr aṃ jerbal ilo diktata 50 iaan 52 wiik ko rej jeṃḷọk ḷọk?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

K10. Ebar wōr ke juon ditto ilo ṃweo im ej ri-lale ajri eo ak bōk eddoin ajri eo?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN JABOK L]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN JABOK L]

Naaj ṇae armej in juon im ej lale ak bōk eddoin Ditto 2.

K11. Teen Ditto 2 ajri in?

1. ☐ LUKKUUN JINEN AK JEMĀN

2. ☐ JUON EO EAR KAAJJIRIRIIKI AJRI IN

3. ☐ ARMEJ EO RITTURIN JINEN AK JEMĀN

4. ☐ JIBWIN AK JIṂṂAAN

5. ☐ JINEN AK JEMĀN IUṂWIN “FOSTER” BŪROOKRAAṂ KO

6. ☐ JEIN AK JATIN JINEN AK JEMĀN (ENEJ JINEN AK ENEJ JEMĀN AJRI IN)

7. ☐ BAR JUON: NUKWIN

8. ☐ BAR JUON: EJJAB NUKWIN

K12. Ta Eṃṃaan ke kōrā Ditto 2?

1. ☐ EṂṂAAN

2. ☐ KŌRĀ

K13. Jete an Ditto 2 iiō?

JETE AN IIŌ

K14. Kilaj ta ak iiō in jikuuḷ ta eo kwaar kadedeḷọk? KAKŌḶḶEIK WŌT JUON.

1. ☐ KILAJ 8 AK DIKḶỌK

2. ☐ KILAJ 9-12, EJJEḶỌK PEBA IN KADDIWŌJḶỌK

3. ☐ RI-KADDIWŌJḶỌK IN “HIGH SCHOOL” AK GED

4. ☐ EAR KAJEṂḶỌK JUON BŪROOKRAAṂ IN “VOCATIONAL, TRADE,” AK BŪROOKRAAṂ

IN JIKUUḶ IN PEEJNEJ

5. ☐ JET “CREDIT” IN KALEJ, EJJEḶỌK PEBA IN KADDIWŌJḶỌK

6. ☐ “ASSOCIATE” TIIKRI (AA, AS)

7. ☐ “BACHELOR” TIIKRI (BA, BS, AB)

8. ☐ “MASTER” TIIKRI (MA, MS, MSW, MBA)

9. ☐ “DOCTORATE” (PHD, EDD) AK TIIKRI KO AN “PROFESSIONAL” RO (MD, DDS, DVM,

JD)

K15. Ri-ṃare ke Ditto 2?

1. ☐ RI-ṂARE [ETAL ÑAN K17]

2. ☐ JAÑIN KAR MARE

3. ☐ JEPEL ILO JIKIN EKAJET

4. ☐ JEPEL

5. ☐ EJAKO ARMEJ EO ṂŌTTAN

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN K17]

K16. Ditto 2 ej ke jokwe ippān juon an ri-yokwe?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

K17. Ilo laleḷọk, eājmuur ke ānbwinnin Ditto 2?

1. ☐ Jejjet/Weeppān

2. ☐ Eḷap an eṃṃan

3. ☐ Eṃṃan

4. ☐ Ebwe

5. ☐ Enana

₇₇☐ IJAJE/IJJAB JEḶĀ

₉₉☐ EṂṂANḶỌK IPPA ÑE IJAB UWAAK

K18. Ilo laleḷọk, ejet ājmuur eo an Ditto 2 ikijjeen bōklōkōt, kōḷmānḷọkjeṇ, ak men ko ej eñjaaki tulowa?

1. ☐ Jejjet/Weeppān

2. ☐ Eḷap an eṃṃan

3. ☐ Eṃṃan

4. ☐ Ebwe

5. ☐ Enana

₇₇☐ IJAJE/IJJAB JEḶĀ

₉₉☐ EṂṂANḶỌK IPPA ÑE IJAB UWAAK

K19. Ekar ke wōr an Ditto 2 jerbal ilo diktata 50 iaan 52 wiik ko rej jeṃḷọk ḷọk?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok L. [Ājmuur eo an Jinen Ajri in (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

L1. “Routine checkup” ej juon iien etale ājmuur eo im ej ikijjeen tarlepin ājmuur, im jab ikijjeen etale juon kain jorrāān, nañinmej, ak nemāme ko jet. Emaroñ ewi toon aṃ jab loḷọk taktō eo aṃ ikijjeen “routine checkup”?

1. ☐ Ilowaan iiō eo ej jeṃḷọk ḷọk (JABDEWŌT JOÑAN IIEN EO IM EKADUḶỌK JĀN 12 ALLŌÑ EMOOTḶỌK)

2. ☐ Ilowaan iiō ko 2 rej jeṃḷọk ḷọk (1 IIŌ AK DIK JĀN 2 IIŌ EMOOTḶỌK)

3. ☐ Ilowaan iiō ko 5 rej jeṃḷọk ḷọk (2 IIŌ AK DIK JĀN 5 IIŌ EMOOTḶỌK)

4. ☐ 5 ak elōñḷọk iiō

5. ☐ Ejjañin kar

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L2. Ilowaan allōñ ko 12 rej jeṃḷọk ḷọk, ewōr ke “professional” in ājmuur eo ilo kōḷmānḷọkjeṇ ak ḷōmṇak ear lale eok ak rōjañ eok? “Professional” in ājmuur eo ilo kōḷmānḷọkjeṇ ak ḷōmṇak ekūtbuuj “psychiatrist, psychologist, psychiatric nurse” ro im “clinical” ri-jerbal in jikin jipañ armej ikijjeen kiltōn mour (social worker).

1. ☐ Aaet

2. ☐ Jaab, bōtaab iar aikuj loḷọk juon “professional” in ājmuur eo ilo kōḷmānḷọkjeṇ ak ḷōmṇak

3. ☐ Jaab, bōtaab ijjab aikuj kar loḷọk juon “professional” in ājmuur eo ilo kōḷmānḷọkjeṇ ak ḷōmṇak

[ETAL ÑAN L4]

1. ☐ IJAJE [ETAL ÑAN L4]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN L4]

L3. Ewi joñan an kar pen tōpar menin jipañ ko ikijjeen ājmuur eo ilo kōḷmānḷọkjeṇ ak ḷōmṇak ak bōk naan in rōjañ eo im kwaar aikuji?

1. ☐ Ear jab pen

2. ☐ Ear pen jidik

3. ☐ Eḷap an kar pen

L4. Ilo kar iien eo im kwaar bōrọro āliktata, ewōr ke taktō ak ri-karreo ñi ear karreoik ñiim?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L5. Wōnej kōṃṃan kāālōt ikijjeen kiltōn pukot ājmuur ñan kwe?

1. ☐ Kwe

2. ☐ Armej eo ri-turūṃ

3. ☐ Komiro jiṃor armej eo ri-turūṃ

4. ☐ Ditto ro jinōm im jemam

5. ☐ Bar juon, JOUJ IM KAALIKKAR

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L6. Wōnej kōṃṃan kāālōt ikijjeen kiltōn pukot ājmuur ñan ajri eo/ro nejiṃ?

1. ☐ Kwe

2. ☐ Armej eo ri-turūṃ

3. ☐ Komiro jiṃor armej eo ri-turūṃ

4. ☐ Ditto ro jinōm im jemam

5. ☐ Bar juon, JOUJ IM KAALIKKAR

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Kajjitōk kein ilaḷ rej kajjitōk kōn kōbaatat, idaak, im kōjerbal men ko rōkkajjoor. Jouj im keememej bwe aolep uwaak ko kwōnaaj liitok renaaj koṇ im ban diwōjḷọk. Ro uwaan kumiin allo in renaaj maroñ tōpar meḷeḷe kein. Jouj im uwaak joñan wōt aṃ maroñ.

L7. Ilowaan raan ko 30 rej jeṃḷọk ḷọk, jete iaan raan kein kwar kōbaatat ie?

1. ☐ 0 RAAN

2. ☐ 1 AK 2 RAAN

3. ☐ 3 ÑAN 5 RAAN

4. ☐ 6 ÑAN 9 RAAN

5. ☐ 10 NĀN 19 RAAN

6. ☐ 20 ÑAN 29 RAAN

7. ☐ AOLEPEN RAAN KO 30

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L8. Kwōj ke idaak dānnin kadōk, ekūtbuuj dān ko kwōj kōṃṃani ilo ṃweo?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L9. Ilo aṃ kar mour ṃaantak, kwonañin ke kar : [RIIT ÑE EJ AIKUJ: Jouj im uwaak joñan wōt aṃ maroñ. Bitōl nat ej ineen juon ni ṇae etan areca. Rej bar ṇae etan areca nat. Ju bitōl nat ej juon men eo im aorōk ilo ṃanit ko an ro ilo laḷ ko turōk im turōk turear in Ajia im ilo Ajia Pacific. Ekkā aer kūtimi kōn būlkōn areca ni eo (paan) ak ippān tōbako (bitōl quid) Funta, ak fronto, ej juon dark bōlōk eo eddo an maroro rej maroñ kōjerbal ñan kōbaatat].

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
L9a. Bitōl nat	1 ☐	2 ☐	77 ☐	99 ☐
L9b. Jikka jarom	1 ☐	2 ☐	77 ☐	99 ☐
L9c. Funta	1 ☐	2 ☐	77 ☐	99 ☐
L9d. Ṃaruana (barāinwōt ṇae etan “grass, pot, weed, ak reefer”)	1 ☐	2 ☐	77 ☐	99 ☐
L9e. “Cocaine, ekūtbuuj pota, “crack,” im “freebase”	1 ☐	2 ☐	77 ☐	99 ☐
L9f. “Heroin” (barāinwōt ṇae etan smack, junk, ak China White)	1 ☐	2 ☐	77 ☐	99 ☐
L9g. “Methamphetamines” (barāinwōt ṇae etan “speed, crystal, crank,” ak “ice”)	1 ☐	2 ☐	77 ☐	99 ☐
L9h. “Ecstasy” (barāinwōt ṇae etan MDMA)	1 ☐	2 ☐	77 ☐	99 ☐
L9i. Ṃaruana eo im ej kōṃṃānin armej (barāinwōt ṇae etan “K2, Spice, fake weed, King Kong, Yucatan Fire, Skunk,” ak “Moon Rocks”)	1 ☐	2 ☐	77 ☐	99 ☐
L9j. “Steroid” batin ak wā ko im rej itok ilo an ejjeḷọk mālim/peba jān taktō	1 ☐	2 ☐	77 ☐	99 ☐
L9k. Wūno in metak ko rōkkajjoor ej iwōj ilo an ejjeḷọk mālim/peba jān taktō ak eoktak jān an kar taktō ba kwōn kōjerbali (Būne wūno ko rōkkajjoor āinwōt codeine, Vicodin, OxyContin, Hydrocodone,” im Percocet)	1 ☐	2 ☐	77 ☐	99 ☐

EḶAÑÑE RUWAAK EO EJ MEME BITŌL NAT, ETAL ÑAN L10. ÑE RUWAAK EO EAR KŌJERBAL JABDEWŌT IAAN MEN KEIN ILO L9 ETAL ÑAN L11. ÑE EAR JAB KŌJERBAL JABDEWŌT IAAN MEN KEIN, ETAL ÑAN L12.

L10. Ilowaan raan ko 30 rej jeṃḷọk ḷọk, jete iaan raan kein kwar meme Bitōl nat?

1. ☐ 0 RAAN

2. ☐ 1 AK 2 RAAN

3. ☐ 3 ÑAN 5 RAAN

4. ☐ 6 ÑAN 9 RAAN

5. ☐ 10 NĀN 19 RAAN

6. ☐ 20 ÑAN 29 RAAN

7. ☐ AOLEPEN RAAN KO 30

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L11. Ewōr ke enañin jilkinḷọk (refer) eok ñan juon jikin bwe kwōn bōk ak kwonañin ke kar bōk jipañ ko ilo nemāmeen wāween kabōjrak/kapilōk ko ikijjeen kōjerbal men ko rōkajoor?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L12. Taktō eo am ak ri-jerbal ro jet ilo ājmuur renañin ke kar ba ke ewōr aṃ Type 1 ak Type 2 tōñal (DIABETES)?

1. ☐ TYPE 1 TŌÑAL

2. ☐ TYPE 2 TŌÑAL

3. ☐ EJJEḶỌK IAER [ETAL ÑAN L14]

1. ☐ IJAJE [ETAL ÑAN L14]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN L14]

L13. Kwōj ke bōk wūno ak wā ñan menin?

1. ☐ Dānnin Insulin

2. ☐ Wūno

3. ☐ Dānnin Insulin im Wūno

4. ☐ Ijjab bōk wūno ak wā

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L14. Taktō eo am ak ri-jerbal ro jet ilo ājmuur renañin ke kar ba ke ewōr aṃ…?

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
L14a. “Rheumatic” nañinmej in menono	1 ☐	2 ☐	77 ☐	99 ☐
L14b. “Rheumatic” pipa	1 ☐	2 ☐	77 ☐	99 ☐
L14c. “Cancer” in mour eo an juon kōrā	1 ☐	2 ☐	77 ☐	99 ☐
L14d. Anemia	1 ☐	2 ☐	77 ☐	99 ☐

L15. Ewi wāween am kōtmāne joñan eddo eo aṃ?

1. ☐ Eḷap aō mera

2. ☐ Ijaad bōḷaḷ jidik

3. ☐ Eṃṃan joñan aō eddo/bōḷaḷ

4. ☐ Ijaad eddo jidik

5. ☐ Eḷap aō eddo

L16. Ta eo im kwōj kajjioñ kōṃṃane ikijjeen joñan baun eo aṃ?

1. ☐ Kadikḷọk baun eo aō

2. ☐ Kōlapḷọk baun eo aō

3. ☐ Dāpij wōt joñan baun in

4. ☐ EJJEḶỌK MEN EO IM IJ KAJJIOÑ KŌṂṂANE IKKIJJEEN JOÑAN BAUN EO AŌ

L17. Ilowaan raan ko 7 rej jeṃḷọk ḷọk, jete iaan raan kein kwar ṃōṃakūtkūt iuṃwin diktata 60 minit ilo kajjojo iaan raan eo/ko? Kobaik aolep iien ko im kwaar kōṃṃane jabdewōt kain ṃakūtkūt ko im ear kaḷapḷọk an bam menono ṇe aṃ im kōṃṃan bwe kwōn ikkijeḷọk jet iaan iien kane.

1. ☐ 0 RAAN

2. ☐ 1 RAAN

3. ☐ 2 RAAN

4. ☐ 3 RAAN

5. ☐ 4 RAAN

6. ☐ 5 RAAN

7. ☐ 6 RAAN

8. ☐ 7 RAAN

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L18. Kwōj nañinmej ak etta ke?

1. ☐ Aaet

2. ☐ Jaab [ETAL ÑAN M1]

1. ☐ IJAJE [ETAL ÑAN M1]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN M1]

EḶAÑÑE RUWAAK EO EJJAB NAÑINMEJ AK ETTA IM/AK EWŌR NEJIN NIÑNIÑ 12 ALLŌÑ AK DIKḶỌK, ETAL ÑAN M1

Kajjitōk kein tok jet rej ikijjeen ““Zika”” bairōj eo. Nañinmej in ““Zika”” bairōj eo ej juon eo im ekkā an ajeerer kōn kinjān naṃ bōtaab emaroñ bar ajeerer ñe kwonaaj babu ak pād ippān juon eṃṃaan eo im ewōr ““Zika”” bairōj eo ippān.

L19. Ilo iien nañinmej ak etta eo aṃ āliktata, ewi joñan aṃ kar ekkōl ñe kwōn kar iwōj nañinmej in ““Zika”” bairōj eo ñan eok. Kakōḷḷeik juon uwaak.

1. ☐ Lukkuun inepata

2. ☐ Jaadin inepata

3. ☐ Iar jab inepata ñan jidik

4. ☐ IJJAÑIN KAR ROÑ KŌN “ZIKA” BAIRŌJ EO ILO IIEN EO IM IAR NAÑINMEJ AK ETTA ĀLIKTATA [ETAL ÑAN M1]

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L20. Ilo iien kar nañinmej ak etta eo aṃ āliktata, kwaar ke kōnnaan ippān taktō, nōōj, ak bar juon ri-jerbal eo ikijjeen ājmuur kōn “Zika bairōj” eo?

1. ☐ Jaab

2. ☐ Aaet, juon ri-jerbal eo ikijjeen ājmuur ear kōnnaan ippa kake ilo aō jab aikuj kar ṃokta kajjitōk

3. ☐ Aaet, juon ri-jerbal eo ikijjeen ājmuur ear kōnnaan ippa kake ak ear kōnnaan ippa ālikin aō kar ṃokta kajjitōk

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

L21. Ilo iien nañinmej ak etta eo aṃ āliktata, kwaar ke bōk bōtōktōk ñan lale ñe ewōr “Zika” bairōj eo ippam?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN L23]

1. ☐ IJAJE [ETAL ÑAN L23]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN L23]

L22. Raar ke ellolo “Zika” bairōj ippaṃ ilo iien nañinmej ak etta eo aṃ āliktata?

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN M1]

1. ☐ IJAJE [ETAL ÑAN M1]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN M1]

[EḶAÑÑE AAET] ajri ta eo kwar ḷap lọjeem kake?

ÑE Puerto Rico, ETAL ÑAN JABOK M

Kajjitōk ilo iien nañinmej ak etta eo aṃ āliktata.

L23. Ilo iien nañinmej ak etta eo aṃ āliktata, kwaar ke jaṃbo ñan ijoko im ewōr “Zika” bairōj ie?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[ÑE AAET] Ilo iien nañinmej ak etta eo aṃ āliktata, kwaar ke jeḷā ke ewōr menin rōjañ bwe kōrā ro im rōbōrọro ren jab jaṃbo ak ito itak ñan ijoko im ewōr “Zika” bairōj ie?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[ÑE JAAB] Ilo iien nañinmej ak etta eo aṃ āliktata, kwaar ke jeer jān jikin jaṃbo ko ito itak ko im ewōr “Zika” bairōj ie itok wōt jān naan in rōjañ ko im rej ba kōrā ro rōbōrọro ren jab ito itak ñan ijōkaṇ?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok M. [Meḷeḷe ko Ikijjeen Ṃweo (RI-KAJJEIKIK BŪROKRAAṂ: Likit Awa im Iien eo)]

M1. Jete armej rej jokwe ak pād ilo atōrej in? Likit aolep armej ro im ekkā aer kiki im pād ilo atōrej in. Kwōn jab likit bar juon eo im ej jokwe bar juon jikin iuṃwin elōñḷọk jān ruo allōñ, āinwōt juon ri-jikuuḷ in kalej eo im ej jokwe ijoko jet ak juon eo im ej pād ilo jikin tarinae im eṃōj jilkinḷọk ñan jikin tarinae.

ORAN ARMEJ RO

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

M2. Jete iaan armej rein ilo ṃweo ṃōm rej uwaan baaṃle eo aṃ? Jej kōtmāne bwe an ajri in baaṃle armej eo eḷaññe ewōr bōtōktōkin ajri eo ippān, ej nukwin ikijjeen an kar ṃareik juon ilo baaṃle eo, ej nukwin ikijjeen kaajjiriri ak itok jān “foster” būrookraaṃ ko.

UWAAN ARMEJ RO

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

M3. Meḷeḷe kein tokālik ej ñan wōt etale teta ko im ej ñan wōt an MCH maroñ etale ewi an eṃṃan an etal jerbal in jipañ ko men ko im armej remaroñ naaj aikuji ikijjeen menin jipañ ko ikijjeen ājmuur ilubwiljin jepjep in armej ro im rej pād ilo kajjojo laajrak ekkar ñan oṇāer. Ro wōt uwaan kumiin allo in renaaj maroñ tōpar meḷeḷe kein. Ebwe aṃ naaj antọọne joñan wōt aṃ maroñ. Ejjab aikuj in lukkuun in jejjet. Ḷōmṇak kōn kobaan oṇāān aolep ro ilo baaṃle eo ilo juon iiō ñan aolep ro uwaan baaṃle eo. Ewi wōt joñan in ṃokta jān tax? Bar būne jāān ko jān jerbal ko, jāān jān jinen ak jemān ajri eo (child support), jāān jān jojeḷ jikkurity, jāān jān rittaermen, jāān jān būrookraaṃ in leḷọk jāān ñan ri-jerbal eo ejako an jerbal (unemployment payment) ko, jāān in jipañ ko an pabḷik jān kien, im men ko jet. Barāinwōt kobaik jāān ko jān intūrej, tipiten, būrabet ko jān peejnej, jikin lale menin mour ak kallib kein ekkan, ak jāān jān reen, im bar jabdewōt kain jāān ko raar etal ñane āinwōt oṇāān.

, , JOÑAN JĀĀN ($)

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

M4. Ejet ñe ilewaj jet laajrak ko? Koḷọk lale ewi joñan jāān eo im ej etal ñan aolep ro ilo ṃweo…

1. ☐ Dik jān $10,000

2. ☐ $10,000 ñan dikḷọk jān $15,000

3. ☐ $15,000 ñan dikḷọk jān $20,000

4. ☐ $20,000 ñan dikḷọk jān $25,000

5. ☐ $25,000 ñan dikḷọk jān $35,000

6. ☐ $35,000 ñan dikḷọk jān $50,000

7. ☐ $50,000 ñan dikḷọk jān $75,000

8. ☐ $75,000 ak ḷapḷọk

77. ☐ IJAJE

99. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Jabok N. [Jerbalin Katak eo Ikijjeen Wōt Ṃajeḷ]

[LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-1 AN IIŌ IM ÑE EJ LUKKUUN JINEN]

Ij itōn kajjitōk jet kajjitōk ikijjeen ājmuur eo ilo kwe.

1. Ilo iien nañinmej ak etta eo aṃ āliktata, jete kattōn aṃ kar loḷọk taktō, nōōj, ak bar juon ri-jerbal eo ikijjeen ājmuur ñan aer etale kōrā eo ilo iien an nañinmej ak etta?

1. ☐ 0 IIEN LOḶỌK

2. ☐ 1 IIEN LOḶỌK [ETAL ÑAN MI2]

3. ☐ 2 IIEN LOḶỌK [ETAL ÑAN MI2]

4. ☐ 3 IIEN LOḶỌK [ETAL ÑAN MI2]

5. ☐ 4 IIEN AK LŌÑḶỌK [ETAL ÑAN MI2]

1. ☐ IJAJE [ETAL ÑAN MI2]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN MI2]

[ÑE 0 IIEN LOḶỌK] Ewōr ke iaan men kein raar bōbrae aṃ etal bwe ren etale kōrā eo ilo iien an nañinmej ak etta?

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
MI1a. Raar jab maroñ letok aō iien ilo iien eo iar kōṇaan etal	1 ☐	2 ☐	77 ☐	99 ☐
MI1b. Ekar ejjeḷọk aō iaḷ ñan aō tōpar jikin pukot ājmuur eo ak tōpar wōpij eo an taktō eo	1 ☐	2 ☐	77 ☐	99 ☐
MI1c. Taktō eo ak būḷāān in taktō eo ij pād iuṃwin eban kar jino ilo iien eo iar kōṇaan	1 ☐	2 ☐	77 ☐	99 ☐
MI1d. Eḷap aō poub kōn elōñ men ko im ij kōṃṃani	1 ☐	2 ☐	77 ☐	99 ☐
MI1e. Ijjab maroñ in kar kakkije jān jikin jerbal ak jikuuḷ	1 ☐	2 ☐	77 ☐	99 ☐
MI1f. Ear ejjeḷọk aō ri-kaajjiriri	1 ☐	2 ☐	77 ☐	99 ☐
MI1g. Iar jaje ke ij nañinmej ak etta	1 ☐	2 ☐	77 ☐	99 ☐
MI1h. Ejjeḷọk kar aō injuran in taktō eo im emaroñ kar kōḷḷāik oṇāān iien loḷọk eo	1 ☐	2 ☐	77 ☐	99 ☐
MI1i. Eṃṃan aō kar mour im ij ba wōt ke ijjab aikuj in kar loḷọk taktō ak jikin pukot ājmuur	1 ☐	2 ☐	77 ☐	99 ☐
MI1j. Iar jab kōṇaan bwe ren letok jipañ ko an ri-bōrọro ro	1 ☐	2 ☐	77 ☐	99 ☐
MI1k. Iar jab kōṇaan bwe en bar wōr eṇ ejeḷā ke ij nañinmej ak etta	1 ☐	2 ☐	77 ☐	99 ☐
MI1l. Bar juon wūn	1 ☐	2 ☐	77 ☐	99 ☐

Koṃij kōṇaan kajjitōk jet kajjitōk ko im renaaj tipdiki tok men ko im raar waḷọk ñan eok ilo iien aer kakilen ñe ewōr ippaṃ “cancer” in ittin kōrā ak cancer in mour eo an juon kōrā.

2. [KAJJITŌK WŌT KAJJITŌK IN ÑAN KŌRĀ RO 25-49 AER IIŌ IM ÑAN KŪRAE RO]

Ewōr ke taktō ak bar juon ri-jerbal in jikin ājmuur enañin kar kōṃṃan jerbal in “pap smear” ippaṃ?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE [ETAL ÑAN MI3]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN MI3]

[ÑE JAAB] Etke kwaar jab “pap smear”?

[ETAL ÑAN MI3]

[ÑE AAET] Ñāāt eo āliktata kwaar “pap smear”?

1. ☐ JUON IIŌ EMOOTḶỌK AK DIKḶỌK

2. ☐ EḶAPḶỌK JĀN 1 IIŌ, AK EJJAB ḶAPḶỌK JĀN 2 IIŌ

3. ☐ EḶAPḶỌK JĀN 2 IIŌ, AK EJJAB ḶAPḶỌK JĀN 3 IIŌ

4. ☐ EḶAPḶỌK JĀN 3 IIŌ, AK EJJAB ḶAPḶỌK JĀN 5 IIŌ

5. ☐ EḶAPḶỌK JĀN 5 IIŌ EMOOTḶỌK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Ta wūnleplep in aṃ kar?

1. ☐ Ej ṃōttan wōt kar jerbal in etale eo ekkā aō waḷọk

2. ☐ Kōn juon jorrāān

3. ☐ Bar juon wūn

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Ear ke iwōj ñan eok jeṃḷọkin jerbalin etale eo?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

3. [KAJJITŌK WŌT KAJJITŌK IN ÑAN KŌRĀ RO 25-49 AER IIŌ IM ÑAN KŪRAE RO]

Konañin kar etal ke bwe ren etale eok kōn juon “mammogram”? “Mammogram” ej juon kain “x-ray” eo im rej pijaik wōt ittin kōrā eo kōn juon kein jerbalin jarom eo im rej keitaak ṇae ubōm.

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE [ETAL ÑAN MI4]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN MI4]

[ÑE JAAB] Etke kwaar jab men bōk mammogram in etale eo?

[ÑE AAET] Ñāāt eo āliktata in aṃ bōk mammogram in etale eo?

1. ☐ JUON IIŌ EMOOTḶỌK AK DIKḶỌK

1. ☐ EḶAPḶỌK JĀN 1 IIŌ, AK EJJAB ḶAPḶỌK JĀN 2 IIŌ

2. ☐ EḶAPḶỌK JĀN 2 IIŌ, AK EJJAB ḶAPḶỌK JĀN 3 IIŌ

3. ☐ EḶAPḶỌK JĀN 3 IIŌ, AK EJJAB ḶAPḶỌK JĀN 5 IIŌ

4. ☐ EḶAPḶỌK JĀN 5 IIŌ EMOOTḶỌK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

4. [KAJJITŌK WŌT KAJJITŌK IN ÑAN KŪRAE RO]

Konañin ke kar bōk koṇaaṃ ilo jerbal in etale ittiṃ im kappok ebbōj ko im kakōḷḷe in “cancer” in ittin kōrā eo im juon taktō ak juon bar ri-jerbal ilo jikin ājmuur enkar kōṃṃane. Juon iien etale ittin kōrā ej ñe juon taktō ak juon bar ri-jerbal in jikin ājmuur ej talum ittiṃ ñan kappok ebbōj ak kakōḷḷe in “cancer” ko jet.

1. ☐ AAET

2. ☐ JAAB [ETAL ÑAN MI5]

1. ☐ IJAJE [ETAL ÑAN MI5]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN MI5]

[ÑE AAET] Ñāāt eo āliktata kar bōk jerbal in etale ittin kōrā?

1. ☐ JUON IIŌ EMOOTḶỌK AK DIKḶỌK

1. ☐ EḶAPḶỌK JĀN 1 IIŌ, AK EJJAB ḶAPḶỌK JĀN 2 IIŌ

2. ☐ EḶAPḶỌK JĀN 2 IIŌ, AK EJJAB ḶAPḶỌK JĀN 3 IIŌ

3. ☐ EḶAPḶỌK JĀN 3 IIŌ, AK EJJAB ḶAPḶỌK JĀN 5 IIŌ

4. ☐ EḶAPḶỌK JĀN 5 IIŌ EMOOTḶỌK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

5. Kojjeḷā ke ia eo komaroñ lo meḷeḷe ko rōṃṃan im jipañ ikijjeen jet menin apañ ak jorrāān ko ñe kwonaaj aikuj jipañ ikijjeen men kein ilo laajrak in?

   	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
   MI5a. Jeḷā kake im maroñ in tōpar jikin bōk jipañ ñan kōrā rot eṇ im rej lo jorrāān ko rej itok ikijjeen aer mour āinwōt juon kōrā.	1 ☐	2 ☐	77 ☐	99 ☐
   MI5b. Jeḷā kake im maroñ in tōpar jikin bōk jipañ ikijjeen nañinmej in tōñal, kōbaatat, ak kadōk.	1 ☐	2 ☐	77 ☐	99 ☐
   MI5c. Jeḷā kake ōn im ṃōñā im dān ko rekkar ñan kōj im maroñ in tōpar jikin bōk jipañ ñan an ellolo kijen.	1 ☐	2 ☐	77 ☐	99 ☐

6. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ CSHCN]

Kwōjeḷā ke kōn nañinmej kein im ṇam ko rej būkto būktak?

	AAET	JAAB	IJAJE	EṂṂAN ÑE IJAB UWAAK
MI6a. “Zika” Bairōj	1 ☐	2 ☐	77 ☐	99 ☐
MI6b. Dengue Pipa	1 ☐	2 ☐	77 ☐	99 ☐
MI6c. Chikungunya	1 ☐	2 ☐	77 ☐	99 ☐

Kiiō ewōr am jet kajjitōk ikijjeen jerbal in kōjparok ad uwe ilo wa.

7. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ñe ajri eo nejūm ej ki uwe ilo kar, tūrak, or bān, ewi ikkutkut in an iuwe kōn jea in kōjparok niñniñ?

1. ☐ Aolep iien

1. ☐ Ekkā an

2. ☐ Jet iien

3. ☐ Ejeja

4. ☐ Ejjañin kar [ETAL ÑAN MI10]

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

8. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ñe ajri eo nejūm ej ki uwe kōn jea in kōjparok niñniñ, ekkā wōt ke an iuwe ilo ṃaan ke ḷọkan juon kar, tūrak, or bān?

1. ☐ JEA EO ṂAAN

1. ☐ JEA EO LIK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

9. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ñe ajri eo nejūm ej ki uwe kōn jea in kōjparok niñniñ, ekkā wōt ke an jit ṃaanḷọk ke jit likḷọk ilo kar, tūrak, or bān eo?

1. ☐ JIT ṂAANḶỌK

1. ☐ JIT LIKḶỌK

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

10. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ewōr ke “airbag” ilo dābin kar, tūrak, or bān eo im ekkā an ajri eo iuwe ie.?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

11. Ewi ikkutkut in aṃ kōjerbal jiit beeḷ ilo iien aṃ uwe ilo juon kar? Komaroñ ke ba:

1. ☐ Aolep iien

2. ☐ Enañin aolep iien

3. ☐ Jet iien

4. ☐ Ejeja

5. ☐ Ijjañin kar

6. ☐ Ijjañin kar iuwe ak

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[KAJJITŌK WŌT KAJJITŌK IN ÑAN KŪRAE RO]

Kiiō ikōṇaan kajjitōk ippaṃ jet kajjitōk ikijjeen Būḷāān Baaṃle (Kilen būḷāān baaṃle) im taktōn kūrae.

12. Kwōjeḷā ke kōn kilen būḷāān baaṃle? Kilen būḷāān baaṃle ekūtbuuj men ko im kōrā im ro ṃōttāer remaroñ kōjerbali ñan bōbrae bōrọro āinwōt kein kantūrool ko, “condom” ko, men ko jej likit ilowa, ak ñe juon eṃṃan ej ṃōkaj im diwōj.

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE [ETAL ÑAN MI13 (15-43); MI14 (>15, 43<)]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN MI13 (15-43); MI14 (>15, 43<)]

[ÑE AAET] Konañin ke kar kōjerbal kein kilen būḷāān baaṃle kein?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[ÑE JAAB] Konañin ke kar kajjioñ pukot jipañ im meḷeḷe ikijjeen kilen būḷāān baaṃle?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

MI13 [KAJJITŌK WŌT KAJJITŌK IN ÑAN KŌRĀ RO 15-44 AER IIŌ IM ÑAN KŪRAE RO]

Kwōj ke bōk ak kōjerbal jabdewōt menin jipañ ko ikijjeen kilen būḷāān baaṃle, āinwōt kein bōbrae bōrọro, jān “clinic” eo ilo Ministry of Health and Human Services?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

MI14 [KAJJITŌK WŌT KAJJITŌK iN ÑE AJRI EO NEJIN EJ 0-5 AN IIŌ IM ÑAN KŪRAE RO]

Konañin ke kar bōk naan in rōjañ ikijjeen kaninnin ilo iien taktō in kūrae]

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

15. Kwōjeḷā ke kōn wā in bōbrae ko im ewōr ijo im joñan an aorōk bwe ajri eo nejiṃ en bōk wā in bōbrae kein?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

16. Ewōr ke aṃ jeḷā ke ewōr wōpij in jipañ kōrā ro im eṃṃaan ro rej ṃaneer?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

17. Konañin ke kakōlkōl ikijjeen tōñal?

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE [ETAL ÑAN MI18 (CSHCN); MI20 (NOT CSHCN, 0-5); JEṂḶỌKIN (NOT CSHCN, 6-11)]

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK [ETAL ÑAN MI18 (CSHCN); MI20 (NOT CSHCN, 0-5); JEṂḶỌKIN (NOT CSHCN, 6-11)]

[ÑE AAET] Ta jeṃḷọk eo ilo iien kakōlkōl eo?

1. ☐ Ijjab tōñal ak ejjeḷọk aō nañinmej in “diabetes”

2. ☐ itōñal ak ewōr aō nañinmej in “diabetes”

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

[ÑE JAAB] Etke kwaar jab kakōlkōl (check) tōñal?

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Kajjitōk kein tokālik rej ikijjeen jerbalin jipañḷọk ājmuur eo an ajri eo.

18. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ CSHCN]

Ewōr ke aṃ kar jeḷā ke ewōr wōpij ko rej leḷọk jipañ ñan ajri utaṃwe ro?

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

19. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ CSHCN]

Ewōr ke aṃ kar jeḷā ke komaroñ lale ñe ajri eo utaṃwe ilo aujpitōḷ

1. ☐ AAET

1. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

20. [LEḶỌK WŌT KAJJITŌK IN ÑE AJRI EO EJ 0-5 AN IIŌ]

Ewōr ke enañin leḷọk ñan ajri eo nejūm kiltōn etale ñe eṃṃan ak enana an ejaak ajri eo (developmental milestone assessment) ṃokta jān an 6 an iiō? Waan joñan ko rej: Laajrak in kajjitōk eo im ej ikijjeen kiltōn an eddōk ak ejaak ajri eo [Ages and Stages Questionnaire (ASQ),] Jōrpe in etale eo ājmuur eo an ajri jiddik ro [Survey of Well-being of Young Children (SWYC)], Kakōḷḷe ko ilo Ajri ikijjeen Ājmuur ak Nañinmej (Pediatric Symptom Checklist,) “Modified Checklist for Autism in Toddlers (M-CHAT)],” ilubwiljin bar ko jet.

1. ☐ AAET

2. ☐ JAAB

1. ☐ IJAJE

1. ☐ EṂṂANḶỌK ÑE IJAB UWAAK

Koṃṃool kōn am kar bōk koṇaaṃ.

Ilo etan U.S. Department of Health and Human Services, koṃij kaṃṃoolol eok kōn ijo kwaar joḷọk ñan aṃ letok meḷeḷe ko ikijjeen ajri in, kwe, im baaṃle eo aṃ.

Uwaak ko aṃ raorōk ippām im renaaj jipañ ri-allo ro, ri-kien ro, im ro rej jutak kōn maroñ ko an baaṃle ko bwe ren meḷeḷe kōn ājmuur eo an ajri eo im kōn aikuj ko an ikijjeen ājmuur ilo jukjukin pād in im elōñ kain armej ie.

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.