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eligibility consent script_PALAUAN_No Inc
ICR 202211-0906-001 · OMB 0906-0042 · Object 126270601.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | eligibility consent script_PALAUAN_No Inc |
| Author | Clare Davidson |
| Last Modified By | Writer |
| File Modified | 2022-01-19 |
| File Created | 2026-07-14 |
| Conversion State | complete |
Extracted Text
MCH Jurisdictional Survey Eligibility and Consent Scripts
Eligibility
Alii, a ngklek a _________. Tial research study a olngesu er kemam el omtab a ukeruul er a chedil ma rengalk ra beluu er a [American Samoa/Federated States of Micronesia/Marshall Islands/Northern Mariana Islands/Belau]. A rechad el sorir el ngar tial study a kirrir onger a bebil ra ker el kirrel a ukeruulem, kau ma rengelekem.
1. A blim a mla mengilt el mora survey. Sebechek el oker ra kau a bebil ra ker el mesal kmo ke eligible el ngar tial study?
1 Choi [go to 2]
2 Ngdiak [Thank individual for their time and end call]
99 Refused to Answer [Thank individual for their time and end call]
2. Kau ke teruich me a eai a rekim el mor bab?
1 Choi [go to 3]
2 Ngdiak [Thank individual for their time and end call]
99 Refused to Answer [Thank individual for their time and end call]
3. Kau ke delal a ngalk el tolechoi el mo teruich me a euid a rekil em kei ra imol blai (malechub ngidil redil el omekeroul er a ngalek)?
1 Choi [go to screener]
2 Ngdiak [Thank individual for their time and end call]
99 Refused to Answer
4. Maki oldingel a blai el oker el kmo ngarngii a redil el klou ra teruich ma eai a rekil el ou ngalek ra tolechoi ma lechub eng ngalek el kekerei ra teruich ma euid a rekil el sebechek el mengedecheduch er ngii
1 Choi [Go to beginning]
2 Choi engdi ng dibus [Go to 5]
Ngdiak [Thank individual for their time and leave]
Ngdi mlak el onger [Thank individual for their time and leave]
5. Ngungil ak luut el mei era telal klok
1 Choi [go to screener]
2 Ngdiak [Thank individual for their time and leave]
99 Ngdi mlak el onger [Thank individual for their time and leave]
Consent
INFORMED CONSENT OBTAINED AFTER DETERMINING ELIGIBLE CHILD(REN) IN THE HOUSEHOLD]
Aki oldingel a blai e mesuub a teletelel a ukeruul ma klisichel a bedengir a rechedil ma rengelekir. Tial survey a kirel a llach el Title V MCH Block Grant program, el omdoud er ngii a HRSA.
A tekingem a bol ousbech a rechad el ou ngerachel a program el olngeseu ra rechedil ma rengelekir ra beluam el remuul a ungil program el mora telungalk er a beluam –A cheldechedechad er tial survey a mo kakar a okouang el bung. Ma akmo oker a ker el kirel a klisichel a bedengem ma bedengel a ngelekem. Tial survey a bekord el 50 bung eng meketmokl.
Alsekum ngchetim el meruul er a tial survey, eng kmal di ungil e diak om obals. Om konei era chelechang ea uriul eng diak el sebechem, malechub eng mla mo chetim, eng dirrek el di ungil. Al ngar ngii a tekoi el meringel er kau el mesaod malechub eng metacherebesum el mesaod, ng sebechem el ouchais e diak a mondai. Ng diak el metemall a survey alsekum ng ngar ngii a ker el diak el sebechem el onger.
Altang mora ngii a ker el kora kmal mengetiit engdi ngdiak a mo kengtil alsekum e ke kongei er tial survey
A rechad el mo meruul er a tial ureor a diak el uduudel.
A rokui el tekingem ma nger a mo berrotel A rechad el momes a tekingem a di tir kei el oureor er tial survey me a tir kei el ou ngerachel ra llemeltel tial ureor A ngklem a diak el bol lechukl e uldak ngii ma tekingem A ki mo ousbech ra ngodech el olangch, ngdiak el ngklem
Tial survey a diak el bol oker el kirel a chelebedel a ngalek. Alsekum aki meruul er tial survey ea tekoi a mei el kmo ngar ngii a mengeterochel malechub ng mengelebed er a ngalek, eng ngerchelam el mo oltutakel.
Ng sebechem el omkedong er a X er a (XXX) XXX-XXXX malechub e ke email er a [email protected] al ngar ngii a kerim el kirel tial ureor. Al ngar gii a kerim el kirel a llemeltem, ng sebechem el omkedong er a NORC Institutional Review Board Manager el dengua re tir a (866) 309-0542.
Ak mo meskau tial babier me ke mo oba lecheklel a kullekoi el tekoi [Provide the paper copy of the informed consent language]
A. Ngarngii a kerim?
Choi [Answer questions, then go to B]
Ngdiak [Go to B]
Ngdi mlak el onger [Thank individual for their time and leave]
B. Ke kongei el onger el mora ker el ngar tial survey?
Choi [Thank individual and begin the questionnaire]
Ngdiak [Thank individual for their time and leave]
Ngdi mlak el onger [Thank individual for their time and leave]