leave-behind consent_MARSHALLESE

PEBA IN KŌMĀLIM ILO AN MEḶEḶE IKIJJEEN AN BŌK KOṆ
AAN ILO JERBAL IN ALLO

Etan Būrojāāk eo: Jōrpe ikijjeen Joñan Ājmuur eo ilo Kūrae im Ajri ro

Armej eo Ej Tōl Jerbalin Etale/Ekkatak in: Caitlin Oppenheimer, Baij Būreejtōn eo Eutiej, NORC ilo University of Chicago

Etke kwōj kōṃṃane Jerbalin Etale/Ekkatak in? Kōmij kōṃṃane jōrpe in etale in ikijjeen ājmuur eo an kūrae im ajri ro. Kōmij kōṃṃane jōrpe in etale in ilo American Samoa, Federated States of Micronesia ak FSM, Guam, Ṃajeḷ, Northern Mariana Islands, Palau, Puerto Rico, im U.S. Virgin Islands. Men kein rej jabokan Title V MCH Block Grant būrookraaṃ eo. Būrookraaṃ ko ijin an MCH renaaj kōjerbal kajjitōk kein ñan aer meḷeḷe kōn ājmuur eo an ajri im kōrā ro jineer. Menin enaaj jipañer ejaak jerbal in jipañ ko ñan baaṃle ko.

1. Wōnej kōḷḷāik oṇāān Jerbalin Etale/Ekkatak in? Health Resources and Services Administration eo ej kōḷḷāik oṇāān jerbalin etale ekkatak in.

2. Ta eo renaaj kajjitōk bwe in kōṃṃane eḷaññe inaaj bōk koṇaō ilo jerbal in etale/ekkatak in? Naaj kajjitōk bwe kwōn uwaake kajjitōk ko ilo jōrpe in etale eo. Renaaj riiti waj kajjitōk kein ñan kwe. Kajjitōk kein rej kōn ājmuur eo aṃ im an ajri eo nejūm. Ñan waan joñak, jenaaj lewaj kajjitōk ko kōn ajri eo nejūm ke ej niñniñ, kajjitōk ko ikijjeen aṃ kar lale ak kōjparok ajri eo, im kōn an ajri eo nejūm katak. Jenaaj barāinwōt kajjitōk kōn nañinmej ko im remaroñ kar jelōt eok ak ajri eo, taktō ro im raar lale eok ak ajri eo nejūm, meḷeḷe ko ikijjeen armej ro ilo ṃweo kwōj jokwe ie, im bar kajjitōk ko jet rāinjuon ḷọk.

3. Anemkwōj in Kāālōt ñe Kwōj Bōk Koṇaaṃ: Komaroñ jab bōk koṇaaṃ ilo jerbalin etale/ekkatak in. Komaroñ kōṃṃan koṇ ñan aṃ bōk koṇaaṃ ilo etale/ekkatak in innām ukōt aṃ ḷōmṇak tokālik. Komaroñ jab uwaake jabdewōt kajjitōk kwōjjab kōṇaan uwaake. Ejjeḷọk men eṇ enaaj waḷọk ñe kwōnaaj kāālōt bwe kwōn jab uwaaki kajjitōk ko ak bwe en bōjrak aṃ uwaaki kajjitōk ko.

4. Abṇōṇō in Kōḷmānḷọkjeṇ ak Menin Uwōta ko: Ejjeḷọk menin uwōta ikijjeen uwaake kajjitōk kein an jōrpe in etale in ijellọkwin menin uwōta ko an mour in jej pād ie jān raan ñan raan. Jet iaan kajjitōk ko ikijjeen ājmuur, uno ko rōkajoor, ak ikijjeen kōjerbal dānnin karōk, ak kajjitōk ko ikijjeen bōklōkōt ko ad (men ko jej eñjaaki itulowa) rej jet meḷeḷe ko im rej ad wōt im remaroñ kaabṇōṇōik kōḷmānḷọkjeṇ ko ad.

5. Menin Jeraaṃṃan ko: Ejjeḷọk jāān in jipañ ak menin jeraaṃṃan ko jet renaaj iwōj ñan eok ñe kwōnaaj uwaaki kajjitōk kein, ak uwaak ko aṃ remaroñ jipañ letok meḷeḷe ko rōṃṃanḷọk ikijjeen ājmuur eo an kūrae ro im ajri ro nejier im jerbal ko an Title V MCH Block kūrāān eo.

6. Ewi toon aō naaj pād ilo jerbalin etale/ekkatak in? Enaaj bōk 40-45 im men minit ñan uwaake kajjitōk ko.

7. “Confidentiality”: Armej ro de rein im ewōr aer mālim in lo uwaak ko aṃ: Armej ro im rej jerbale etale/ekkatak in im armej ro im rej lale bwe en jiṃwe am kajjeikik jerbalin etale/ekkatak in. Eban pād etaṃ ilo peba in etale eo im uwaak ko aṃ rej pād ie. Jenaaj kōjerbal jet nōṃba ñan ad jeḷā uwaak ko rej etal ia ḷọk, im jab etaṃ.

Jōrpe in etale eo ejjab kajjitōk ñe ej nana an juon lale ajri ak ñe ewōr ej kōjool ajri. Ñe jenaaj jeḷā ke ewōr jorāān ej waḷọk ilo tōre eṇ eṃ jōrpe eṇ ej bōk jikin ñan juon ajri ak ke ewōr ej kōjool juon ajri ilo iien jerbale jōrpe en, jenaaj aikuj ripooti ñan ro tōllọkier.

Naaj kakoṇi uwaak ko aṃ ilo computer eo aō im juon arin (ak kape) jōrpe in enaaj etal ñan wōpij ko am ilo Chicago, Illinois. Jenaaj kōjparok meḷeḷe ko aṃ joñan wōt ad maroñ bwe en jab diwōjḷọk meḷeḷe ko aṃ, bōtaab ejjeḷọk emaroñ kalliṃur bwe renaaj bōbrae an maroñ dōḷọk meḷeḷe ko aṃ ilo aer naaj etal ilo internet ḷọk. Eḷaññe enaaj bōjrak am uwaak kajjitōk ṃokta jān an jeṃḷọk jōrpe in, komaroñ kajjitōk bwe jen jeeri uwaak ko aṃ.

8. Jiṃwe eo Aṃ ikijjeen Eḷḷeḷọk Kajjitōk: Jouj im kepaak X ilo (XXX) XXX-XXXX ak XXX kōn kajjitōk, abṇōṇō, ak inepata ikijjeen jerbalin etale/ekkatak in. Ñe ewōr am kajjitōk am abṇōṇō ikijjeen jiṃwe ko aṃ āinwōt juon eo ear bōk koṇaan ilo jerbal in allo (research), juon im kepaak NORC Institutional Review Board Mānija eo ilo talboon nōṃba in: (866) 309-0542.

9. Oṇāān Aṃ Bōk Koṇaaṃ: Enaaj iwōj jidik kein kaṃṃoolol eok kōn aṃ kar bōk koṇaaṃ ilo iien kajjitōk im uwaak in.

Jouj im likit peba in ilo rekoot ko aṃ ak kakoṇe ñan aṃ etale ilo ilju im jekḷaj.

Peba in Kojella Joñan Jāān im Jerbal eo emōj Antoone ñan Opij eo an Kien: Wūnin an aen melele in ej ñan kōmmane juon wāween an jikin ko rej kakien maron aen, kōjella, im lale melele aurok ko rej kalikar nañinmej ko an kurae im ajiri iomwin ien. Juon opij emaron jab kōmmane ak kolla wonnen, im juon armej ejab aikuj uwaak kōn melele ko emōj aen ijellokun ej kwalok juon jejjetin nomba ej kalikar OMB. Nomba in kalikar OMB eo nan melele in emoj boke ej 0915/0906-XXXX im enaj jejjet mae XX/XX/202X. Melele in emoj aen ej an armej make bebe lelok. Kajojo Armej im doulul ko remaron kojatdikdik an jab walok diwojlok uwaak ko rej lelok iomwin Jekjen 934(c) in Public Health Service Act (Kakien eo ñan Komadmod im Kejbarok Nañinmej ko rej Ajeeded, 42 USC 299c-3(c). Renaj lelok melele kon wuñin aer aen melele, im ekkar ñan kakien in, jabdewot melele eo ej kalikar won armej reban kojerbal ak lelok ñan jabdewot bar waween. Kojella eo kon joñan jerbal im jaan eo renaj jolok nan aen melele in emoj antoone an tobare emaron 2 minit ñan kajojo uwaak nan Kajjitokin ko ñan lale elane armej eo emaron bok kwonaan, im 42 minit ñan kajojo uwaak ñan Kajjitokin ko ñan lale uwaak ko jen elon kain kajjitokin ko, ekoba ien etale komelele ko, bukot jikin ko rekkar bok melele, im kadedelok im etale melele ko emoj aen. Jilkinlok enaan ko ikijen wonnen im jonan ien eo emoj antoone wonnen ak jabdewot waween an aen melele in, ekoba rojan in melele ko nan kadiklok jerbal ak wonnen in, ñan HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14NWH04, Rockville, Maryland, 20857 ak paperwork@hrsa.gov. Jouj im lale https://www.hrsa.gov/about/508-resources ñan melele in kamool and aoleb maron loe melele ko an HRSA ilo kombuitor ak talebon. 

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