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Registry of Persons with Hearing Loss

The Nebraska Commission for the Deaf and Hard of Hearing (NCDHH) is conducting a voluntary registry of all the deaf and hard of hearing residents in Nebraska. Knowing the number of deaf and hard of hearing people in Nebraska helps NCDHH plan for needed services. If you are deaf or hard of hearing, please fill out this form.

Registry Submit Form

Please submit a new form for each person who is at the same address.

Section 71.4728(5) of the Revised Statutes of Nebraska requires the Nebraska Commission for the Deaf and Hard of Hearing (NCDHH) to conduct and maintain a voluntary census of Nebraska citizens who have a hearing loss. All information provided to the Commission on this form will be held strictly confidential.

Registering with NCDHH:

  • Helps NCDHH make better planning decisions
  • Helps NCDHH improve services

Entries marked with an * is required information.

First Name: *

Last Name: *

Business Name:

Year of Birth: *

Mailing Address: *

City: *

State: *

Zip Code: * (please include the four number extension)

County: *

Home Phone: - (please include the area code)

Cell Phone: - (please include the area code)

Video Phone: - (please include the area code)

E-Mail Address:

Do you consider yourself? (select only one)






If Other please explain:

(if you select Yes, please include your email address)

How did you hear about our program?







Thank you for your time in participating in our Registry