18b 18b_MCH Jurisdictional Survey Leave-Behind Consent_Pohnp

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

18b_MCH Jurisdictional Survey Leave-Behind Consent_Pohnpeian

MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program

OMB: 0906-0042

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Iren Pwungki Kan Pwehn Iang Towehda Douloal


Eden Pirokiram: Douloal en rosoan en nohno oh seri kan.

Kaun en Douloal Wet: Caitlin Oppenheimer, Senior Vice President, NORC nan University of Chicago.


Dahme komw iangki sapeng douloal wet? Douloal wet wiewiada pwen kahlahudela ihrehn wehweki rosoan en nohno kan oh seri kan. Se wiewia douloal wet nan wehi en American Samoa, Federated State of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, oh U.S. Virgin Islands. Wehi pwukat iang pirokram en Title V MCH Block Grant. Pirokiram en MCH nan ehu ehu wehi pahn doadoangki pasapeng pwukat pwen kahlaudehla atail wehwehki irehn pid roson en nohno kan oh neirail seri kan. Douloal wet pahn sewese irail ni arail wiahda sawas ong peneinei kan.


  1. Ihs me Pwainda Douloal Wet? Health Resources and Services Administration pwainda douloal wet.


  1. Ma I iang sapeng douloal wet, dahme I pahn anahne wia? Komw pahn anahne sapeng kalelepak kan me re pahn poahngokinkomwi. Kalelepak pwukat pid duwen ahmw roson oh roson en nomw seri kan.
    Ni karasepe, se pahn idek rehmwi pid duwen nomw seri ni ah pwelel, soang en ahmw apwalih nomw seri, oh en nomw seri ah sukuhl. Se pil pahn idek rehmwi pid duwen soumwahu kan me komwi de nomw seri koahki, toahkte kan me komw kin tuhweng, ire kan pid ahmw peneinei, oh soang en kalelepak tohrohr.


  1. Iang ni Tohnmetei: Komw sohte anahne iang sapeng douloal wet. Insehnomw ma komw pilada en iang douloal wet. Komw sohte anahne sapeng kalelepak kan me komw sohte mwahuki. Mah komw pilada en sohte sapeng kalelepak kan.


  1. Mehn Lokalok oh Keper Kan: Sohte mie mehn keper kan ni ahmw sapeng kalelepak kan nan douloal wet, mehnda mehn keper kan me miher nan ahmw mour. Ekei kalelepak kan pid duwen roson, mehn salihel kan, sakau en wai, oh pehm kan mwein pahn kahrehda komwi en kehn soahn suwed.


  1. Kamwahu Kan: Sohte aramas pahn sewese komwi en sapeng kalelepak pwukat, oh ahmw pasapeng kan pahn sewese pirokiram en Title V MCH Block Grant en wehwekila wekila pid duwen en nohno or neirail seri kan arail roson.


  1. Iah wehn wehrei douloal wet? Komw pahn anahne minit 50 pwehn sapeng douloal wet.


  1. Iren Rir Kan: Ihte aramas me pahn kilang ahmw pasapeng kan iei tohndoadoahk kan en douloal wet or irail me iang tehk me se koasoane douloal wet ni mwahu. Edemwi sohte pahn mih nan douloal wet. Se pahn doadoangki nembe ieu en esehla nain ihs douloal wet, ah kaidehn edemwi.


Douloal wet sohte pahn pekipek duwen wiakawe seri. Ahpw ma se esehla duwen wiakawe seri nan peneinei ieu, kosonned en wehi kan iding kiht en leleki polis.


Ahmw pasapeng kan pahn mih nan nei kampiuter, oh se pahn kadaralahng aht ohpihs nan Chicago, Illinois douloal wet. Se pahn wia uwen aht kak en kolehdi ahmw pasapeng kan ni rir, ahpw mie mehn keper kan ni atail doadoangki internet me re sohte pahn mih ni rir. Ma komw uhdi oh dehr sapeng pil ehu kalelepak, komw kak peki reht en kasehla ahmw pasapeng tohrohr kan.


  1. Ahmw Pwung en Peki Kalelepak Kan: Menlau tuhkiweng X ni (XXX) XXX-XXXX de JMCH@norc.org ahmw kalelepak de mehn nsenoh kan pid douloal wet. Ma mie ahmw kalelepak de mehn nsenoh kan pid amwhi pwung kan ni ahmw iang sapeng douloal wet, menlau koahlih kaun en NORC Institutional Review Board ni nembe sohte pweipwei (866) 309-0542.


  1. Isepen Ahmw Iang Towehda Douloal Wet: Komw pahn ale kisakis tikitik uwen aht kapingki ahmw ansou pweki ahmw iang sapeng douloal wet.


Menlau nekidala doaropwe wet pwe komw kak kilang mwuhr.


Iren Wisik en Mehn Sahpw Kan: Pwhin de kompani sohte kak kaweid de uhki, oh emen sohte anahne sapeng, ire kan ma sohte mie nembe en OMB me saik tokehdiher. Nembe en OMB me kakohng pirokiram wet iei
0906-0042. Iren wisik kan pwehn alehdi ire pwukat pahn kapatpene mwein awa .27 ni ehu ehu sapeng, me iangahki ansou en dawih iren padahk kan, alehdi ire kan tohrohr, kanehkela douloal oh dawih ire kan koaros me mih loale. Ma mie ahmw lamalam pid duwen iren wisik kan en alehdi ire pwukat, de lamalam teikan pid duwen soang en kamalaulaula wisik pwukat, menlau kadaralahng HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleINFORMED CONSENT FORM FOR BEHAVIORAL RESEARCH STUDY
Authorsvp102
File Modified0000-00-00
File Created2021-01-15

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