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Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

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OMB: 0920-0733

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Early Hearing Detection and Intervention

Hearing Screening and Follow-up Survey


Reinstatement with Change


Marcus Gaffney

Project Officer

1600 Clifton Rd. MS E-88

Atlanta, GA 30333

(404) 498-3031

[email protected]



Attachment 10:


Proposed Data Reports






































Proposed Data Reports

  • Denote sub reports

  • Annual Summary of Screening, Diagnostic, and Intervention Data

  • Total Infants Screened for Hearing Loss

    • Infants Screened for Hearing Loss Before One Month of Age

    • Infants Screened for Hearing Loss After One Month but Before Three Months of Age

    • Infants Screened for Hearing Loss After Three Months of Age

  • Total Infants Not Screened for Hearing Loss

  • Infants Passing the Final Hearing Screening before One Month of age

    • Infants Passing the Final Hearing Screening before One Month of age

    • Infants Passing the Final Hearing Screening After One Month but Before Three Months of Age

    • Infants Passing the Final Hearing Screening After Three Months of Age

  • Infants Not Passing the Final Hearing Screening before One Month of age

    • Infants Not Passing the Final Hearing Screening before One Month of age

    • Infants Not Passing the Final Hearing Screening After One Month but Before Three Months of Age

    • Infants Not Passing the Final Hearing Screening After Three Months of Age

  • Infants Found to have Normal Hearing

    • Infants Found to have Normal Hearing Before Three Months of Age

    • Infants Found to have Normal Hearing After Three Months of Age but Before Six Months of Age

    • Infants Found to have Normal Hearing After Six Months of Age

  • Infants Identified with Hearing Loss

    • Infants Identified with Hearing Loss Before Three Months of Age

    • Infants Identified with Hearing Loss After Three Months of Age but Before Six Months of Age

    • Infants Identified with Hearing Loss After Six Months of Age

  • No Diagnosis Reported

  • Number of Infants with Hearing Loss Referred for Part C Early Intervention Services

    • Number of Infants Eligible for Part C Early Intervention Services

    • Number of Infants Not Eligible for Part C Early Intervention Services

  • Infants with Hearing Loss Enrolled in Part C Early Intervention Services

    • Infants with Hearing Loss Enrolled in Part C Early Intervention Services Before six Months of Age

    • Infants with Hearing Loss Enrolled in Part C Early Intervention Services After six Months but Before Twelve Months of Age

    • Infants with Hearing Loss Enrolled in Part C Early Intervention Services After Twelve Months of Age

  • Infants with Hearing Loss Enrolled in Non-Part C Early Intervention Services

    • Infants with Hearing Loss Enrolled in Early Intervention Services Other than Part C Before six Months of Age

    • Infants with Hearing Loss Enrolled in Early Intervention Services Other than Part C After six Months but Before Twelve Months of Age

    • Infants with Hearing Loss Enrolled in Early Intervention Services Other than Part C After Twelve Months of Age

  • Type and Severity for Cases of Unilateral Hearing Loss

  • Type and Severity for Cases of Bilateral Hearing Loss

  • Hearing Screening by Age and Maternal Demographics

  • Diagnosis by Age and Maternal Demographics

  • Receipt of Early Intervention Services by Age and Maternal Demographics










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