leave-behind consent_CHUUKESE

C HUUKESE

TAROPWEN MUMUTAN ESILESIL REN EWE PEKIN KAIO

IKA KUTA PORAUSAN NGE IKA KOPWE FITI KICH

Taitelin ei angang: Maternal and Child Health (MCH) Jurisdictional Survey

Ekkewe aramas ra wisan tumunu ekkei angangen kaio. Caitlin Oppenheimer, Senior Vice President, NORC lon ewe University seni Chicago.

Pwata ke fori ei angangen kaio? Am uwa fori ei kaio ren ach sipwe kaio usun tumunun pochokulen ekkewe inelap me nour kewe semirit. Sia fori ei kaio lon American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, me U.S. Virgin Islands. Ekkei leni ir seni ewe pekin Title V MCH Block Grant prokram chochon ei MCH prokram repwe eaea ekkei kapas eis ar repwe weweiti ifa usun tumunun pochokul tumunun ekkewe inelap me nour kewe. Ei angangen kaio epwe alisi ach kewe pekin ren epwe wor alilis fan iten ekkewe famili.

1. Io kewe ra wisan awora moni fan iten ei Kaio? Ei kaio chon ewe pekin Health Resources me Services Administration ra wisan moni.

2. Met repwe aisiniei ika ike nom lon ei kaio? Repwe ais ekkochkapas ren ewe kaio repwe alea ngonuk ekkewe kapas eis lon ukkukun om kopwe weweiti me rong. Ekkewe kapas eis fan iten pochokulen tumunun en me noum we semirit. Awewe choku, sipwe eisinuk usun noum we menukol, tumunun noum we semirit, pwal usun om asukula noum we semirit. Sipwe pwal eis usun ekkoch samau mi tori en me noum we, pwal ie kewe korman en me noum we uwa kan chuchurir, pwal porausan lon imwom, pwal ekkoch kapas eis.

3. Letipom chok ika en mi mochen fiti kich lon ei kaio. Mereom chok ika kosap nom lon ei kaio. Ika ke mochen poputani iei nge ka ekesiwili om mochen iwe en mi pwal tufich siwili om ekiek. Ika kosap mochen polueni ekkoch kapas eis pwal letipom chok. Om filata kopwe kaulo le polueni ekkewe ekkoch kapas eis esap ekesiwili metoch.

4. Om kosap kinamwe le polueni kapas eis pun ke ekieki kopwe feiengaw ika osukosuk ren. Esap wor osukosuken polueni ekkei kapas eis epwe usun osukosuk sia kuna iteitan ran. Ekkoch kapas eis usun pochokulach, ika safeian opuchopuch, ach angei minen unumi, me mefiach ina epwe ekis aweresuk.

5. Feiochun Ese wor alilis epwe weneituk lupwen ka polueni ekkei kapas eis ren ei kaio, nge om polueni a kan alisi an ach silei nonomun pochokulen inisin ewe inelap me noun we me ewe angangen taitel V MCH Block grant prokram.

6. Ia taman ai upwe nom lon ei kaio? Ukkukun chok 50 minich om kopwe polueni ekkei kapas eis.

7. Monomonolon Ekkewe chok aramas mi mumuta ar kuna poluen om kewe kapas eis, ekkewe re angang ngeni ei kaio me ekkewe re apochoka allukun tumunun ei kaio (study). Itom esap nom won noum we taropwe fengen me poluen om kewe kapas eis. Am upwe eaea nampa code ren om kewe poluen kapas eis, nge esap itom we.

Ei kaio ese eis usun om afeiengawa noum ika tumungaw ngeni noum kewe. Nge ika pwe am uwa silei pwe en emon chon tumungaw ika afeiengawa ewe semirit lon ekkei ran nge mi chok soposopolo iwe ina atun am upwele atoura ngeni ekkewe chon nemenem.

Om polueni ekkewe kapas eis epwe nom lon nei ei computer nge kapin ei kaio epwe sent ngeni am we ofes lon Chicago, Illinois. Upwe fori ukkukun am tongeni le tumunu poluen om kewe kapas eis, nge sise tongeni pwon pun met sia tinalo won nouch kewe mecha a pwal tongeni pwa. Ika pwe ke kaulo le polueni ekkewe kapas eis me mwen ewe kaio epwe wes, ka tongeni pwal ereni kich pwe sipwe teluelo om kewe poluen kapas eis.

8. Om pwung me om kapas eis: Kopwe kokori XXXX at (XXX) XXX-XXXX ren kapas eis, pwal met kose sani mi erianuk ika om lolilen usun ei kaio. Ika pwe mi wor om kapas eis ika lolilen mi wor om pwung pokiten en chon nom lon ei kaio, kopwe kokori ewe Manager’in NORC Institutional Review Board esap kamo ei nampa iei (866) 309-0542.

9. Mon om fiti ei kaio: Kopwe angeni ekis mon om fiti ei kaio seni ach kilisou ren om fansoun ren ekkei kapas eis.

Kose mochen tumunu ei rekot fan iten lon ekkan ran mwach ika sipwe pwal eliwini sefali.

Public Burden Statement: Esap pwal wor eu leni epwe pwal fori ei angang, an emon aramas polueni ekkei kapas epwe seni om mochen nge sisap aumesuk. Ewe OMB nampa ren ei angangen kaio iei 0906-0042. Ach we pekin repot ren pekin tumunun inisich ra era ei angangen angei poraus ina pwe ukkukun .27 ren eu memeief, mi pachelong fansoun katol sefal foforun, me kuta ekkewe allen poraus, pwal awesalo me katol sefal ekkewe chommongum porausen emon me emon. Ka tongeni uwato mefiom ikkei ika ke mochen silei fite momon ei kaio ika tichikin porausen ei angang pwal pachelong mefiom uwato, HRSA Reports Clearance Officer, 5600 Fisher Lane, Room 14N39, Rockville, Maryland, 20857.

OMB Control number: 0906-0042; Expiration date: XX/XX/202X