3 Words in Noise

Attachment 3

Words-In-Noise (WIN)

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX
Name of test: Words-In-Noise (WIN)
Estimated time burden: 5 minutes
Number of items: 70 (Up to 35 for each ear)
Instructions to subjects:1
You will hear a woman asking you to repeat various words. Repeat the words she asks you
to say out loud so that I can hear you. For example, if you hear her say ‘Say the word dog,’
you would say ‘dog.’ If you are not sure what she said, just say what you think you heard.
You will also hear people talking in the background. Do your best to ignore them and to
focus on the woman’s voice asking you to repeat the words. Do you have any questions?
Let’s begin.
Copies of questions/items: See recording forms (below)
Representative screen shots: None

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD
20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address.

# Correct

Recording forms, etc.:
Name_______________________SS#__________Age__________

Date____________By__________Ear___________Level________
Track 25, List 1, Random 1
24-dB S/B

1
2
3
4
5

pain
youth
wheat
dodge
cool

20-dB S/B

6
7
8
9
10

ditch
ring
kick
chair
luck

16-dB S/B

11
12
13
14
15

base
wire
red
time
judge

12-dB S/B

16
17
18
19
20

hate
shack
tool
voice
rush

0-dB S/B

31
32
33
34
35

PROFOUND

gaze
life
get
read
bath

8-dB S/B

21
22
23
24
25

turn
young
bite
pick
half

# Correct

SEVERE

Threshold (50%) dB S/B

4-dB S/B

26
27
28
29
30

far
learn
mood
talk
note

MODERATE

MILD

Ear_________Level______________

NORMAL

Threshold

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

25.2
24.4
23.6
22.8
22.0
21.2
20.4
19.6
18.8
18.0
17.2
16.4
15.6
14.8
14.0
13.2
12.4
11.6
10.8
10.0
9.2
8.4
7.6
6.8
6.0
5.2
4.4

28

3.6

29

2.8

30
31

2.0
1.2

32
33
34
35

0.4
-0.4
-1.2
-2.0

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX
Track 26, List 2, Random 1
24-dB S/B

1
2
3
4
5

food
road
juice
late
hire

20-dB S/B

6
7
8
9
10

tire
such
shawl
haze
gun

16-dB S/B

11
12
13
14
15

live
date
gas
have
dog

12-dB S/B

16
17
18
19
20

good
search
pass
witch
chief

0-dB S/B

31
32
33
34
35

back
dab
kill
nice
calm

8-dB S/B

21
22
23
24
25

sour
doll
deep
soap
make

4-dB S/B

26
27
28
29
30

beg
mess
long
mouse
sheep

Word for Spanish version:

# Correct
Threshold (50%) dB S/B

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX