An affidavit is statement of facts which is sworn to (or affirmed) before an officer who has authority to administer an oath (e.g. a notary public). The person making the signed statement (affiant) takes an oath that the contents are, to the best of their knowledge, true. It is also signed by a notary or some other judicial officer that can administer oaths, affirming that the person signing the affidavit was under oath when doing so. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction
District of Columbia Affidavit with Answers to Questions Regarding Observations of the Health of a Family Member - Hearing Loss
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If you have hearing loss you qualify as disabled if have: An average air conduction hearing threshold of 90 decibels or more in the good ear. An average bone conduction hearing threshold of 60 decibels in the better ear. A word recognition score of 40% or less in the better ear, as determined by standardized tests.
Mild hearing loss: Hearing loss of 20 to 40 decibels. Moderate hearing loss: Hearing loss of 41 to 60 decibels. Severe hearing loss: Hearing loss of 61 to 80 decibels. Profound hearing loss or deafness: Hearing loss of more than 81 decibels.
Stage 4: Severe hearing loss Severe, or stage 4, hearing loss is the diagnosis when the quietest sounds you can detect fall between 65 and 79 dB. With severe hearing loss, you need strong hearing aids to navigate daily life since this stage is considered very hard of hearing.
Degrees of Hearing Loss Degrees of Hearing LossHearing Threshold in Decibels (dB)Mild Hearing Loss25-40 dBModerate Hearing Loss40-60 dBSevere Hearing Loss60-80 dBSevere-to-Profound Hearing Loss80-90 dB2 more rows
For some people, power hearing aids might not be the best option. Other treatments for severe-to-profound hearing loss include bone-anchored hearing systems and cochlear implants. Contrary to common perception, cochlear implants can be used in older adults.
Mild hearing loss is defined by being unable to hear sounds that are quieter than about 25 decibels (dB) for adults and 15 dB for children. This includes sounds like whispered conversations, dripping water, leaves rustling, feet shuffling on floors/carpets, and birds chirping.
Hearing Loss Ranges (in decibels) There are different levels of hearing loss. Some forms of hearing loss can be treated with a hearing aid. If your hearing falls into the 26-70 dB range (mild to moderate), a hearing aid can be very effective in restoring sounds for your daily life.
Not every person with hearing loss can receive a cochlear implant. Good candidates are patients who are deaf, have moderate-to-profound hearing loss in both ears, or have profound and severe hearing loss in one ear.