leave-behind consent_PALAUAN

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Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program

leave-behind consent_PALAUAN.docx

OMB: 0906-0042

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PALAUAN


BABIER EL MELAI A KENGEI EL KIREL TIAL SURVEY


Ngklel Tial Project: Maternal and Child Health (MCH) Jurisdictional Survey

Chad el merredel er a tial survey: Caitlin Oppenheimer, Senior Vice President, Public Health Department NORC er a University of Chicago


Ngera uchul me kom meruul er a tial survey? Aki oldingel a blai e mesuub a teletelel a ukeruul ma klisichel a bedengir a rechedil ma rengelekir. Aki meruul er a tial survey er a beluu er a American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Belau, Puerto Rico, ma U.S. Virgin Islands. Aikal rokui el beluu a ousbech er a Title V MCH Block Grant program. A program er a MCH el ngara Belau a mo ousbech a kekka er a tial survey el olngeseu rar edil ma rengalek.


  1. Ngtecha harau er a cheral tial survey? A Health Resources and Services Administration er a Merikel a harau a cheral tial survey.


  1. Alsekum ak mo olngeseu er a tial survey, ngera mo ngerchelek? A chad el meruul er tial survey el obengkem a mo chiiuii a ker lekor kau. Aikal ker a kmal di kirem kau ma ngelekem. Ng morngii a ker el kirel a ngelekem sera le tolechoi, a kedmeklel a ngelekem, ma subelel a ngelekem. Ng dirrek el mor ngii a ker el kirel a rakt, mar toktang er kemiu, ma delengcheklem, ma lmuut el bebil ra ker.


  1. Bom Modengei: 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.


  1. Kngtil Tial Survey: Ngdiak a meral kngtil tial survey ngdi ngar ngii a ker (mesaod a rrom, mekngit el kar, ma tekoi el mengesang a rengum/uldesuem) el bebil ra rechad a sebechir el mo metecherebeserir el ngii a uchul.


  1. Klungiolel Tial Survey: Aki mereng a sluir a rokui el edil onger a ker ra tial survey le kekka re tial survey a kmal klou a ultutelel. Tial ureor a mo uchul ma tial Title V MCH Block grant program a mo sebechel ungil olngeseu er a rechad er a Belau.


  1. Tiang uangerang a klemengetel el ureor? Tial survey a bekord el 50 bung eng meketmokl.


  1. Confidentiality: Ngdi rechad el oureor el kirel tial survey me tirkel merredel er tial survey a mo mes a okededaol el tekoi el ngar ngii. A ngklem a diak el bol lluches er a tial survey. Aki mo ousbech a lambang el track aikal survey.


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.


A tekingem a mo medechel ra chelsel a computer ra ngak ma copy a modurokl el mor obis er kemam el ngara Chicago, Illinois A ki mo melasm el omart a tekingem engdi sel bebil ra team e a tekoi el marael era Internet a sebechel el mo chemolt Al sekum e ke torbengii tial survey ruchei ra bolmerek eng sebechem el melekoi ma ki chemoit a tekingem.


Al sekum ngdirkak om bom merek er tial survey e mla mo soam el stob, ng sebechem el melekoi re kemam maki shred re tial babier.


  1. Llemeltel el Oker a Ker: 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.


  1. Uduudel: A rechad el mo meruul er a tial ureor a diak el uduudel.


A ki olengit mem lelia tial babier ra reksi el mo uspechal ra ngarmedad el klebesei.


Subed el kirel a babier el omekberaod and mengeuid: A obis a diak el sebechel orrimel a chad, ma chad a diak el morimel, el meruul er tial ureor a lak a bleketakel el control number el lechukl er a babier. A OMB control number re tial babier a 0906-0042. A klemengetel a taem el locha meketmokel tial babier a bekord el tal sikang. Tia ultoi ra omengiuel tial babier, skel a babier el dousbech el henzi a ker, ma omengiuel a nger. Ngidil tekoi malechub ng ker kirel tial chetituokel el tekoi, malechub eng ngidil uldasu el sebechel olngeseu er a tial obis el olngeasek a beraod, a sebechem el uldureklii el moraHRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857.




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


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleINFORMED CONSENT FORM FOR BEHAVIORAL RESEARCH STUDY
Authorsvp102
File Modified0000-00-00
File Created2024-07-22

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