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Census of Persons with Hearing Loss


3216 Emerald Lane, Suite B Jefferson City, MO 65109

(573) 526-5205 (Voice/TTY)

(573) 526-5209 (Fax)


Section 161.407 of the Revised Statues of Missouri requires the Missouri Commission for the Deaf and Hard of Hearing to conduct and maintain a census of Missouri who have a hearing loss. All information provided to the Commission on a census form will be held strictly confidential, and the Commission will never reveal the identity of any person who fills out a census form. Please email, mail or fax this completed form to the address given below. If you have any questions about this form, please contact our office. The census supports and indicates proactive advocacy needs of our agency. 

There are 12 questions in this survey.