The goal of this project was to increase by 50 percent the number of children with significant hearing impairment identified by 12 months of age. Attainment of this goal was attempted through activities in three major areas: (1) replication and documentation of the benefits of a birth certificate-based screening system; (2) investigation of the feasibility of using transient evoked otoacoustic emissions (TEOAE) to identify hearing loss in infants; and (3) refinement of procedures for operating a birth certificate-based screening system. Project research confirmed that properly implemented birth certificate-based high-risk registers are a feasible and effective means of identifying children with sensorineural hearing impairment at an early age, but the use of a high-risk registry is not enough, as almost 40 percent of hearing-impaired children do not exhibit any of the risk factors. Project data also indicate that it is feasible to use TEOAE as a hearing-screening tool for every live birth, that TEOAE accurately identifies sensorineural hearing loss, and that it indicates those infants most at risk for conductive hearing losses. Appendices comprise over half of the document and contain: (1) project products such as checklists, promotional information, survey forms, a screening protocol, and information for parents; (2) professional papers, including "The Effectiveness of Screening Programs Based on High-Risk Characteristics in Early Identification of Hearing Impairment,""Neonatal Hearing Screening Using Evoked Otoacoustic Emissions: The Rhode Island Hearing Assessment Project," and "Identification of Children with Hearing Impairments: A Baseline Survey"; and (3) a list of over 500 references on early identification of hearing impairment in children. (JDD)