PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Welfare Reform Policy In New York State are requested to complete this reply form as soon as possible and mail it to:

Jill Poklemba
Legislative Associate
Assembly Committee on Social Services
Room 522 - Capitol
Albany, New York 12248
Email: poklemj@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the following public hearing on Welfare Reform Policy In New York State to be conducted by the Assembly Committee on Social Services on July 7, 2005.

box I plan to make a public statement at the hearing. My statement will be limited to 15 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.

box I will address my remarks to the following subjects:



box I do not plan to attend the above hearing.

box I would like to be added to the Committee mailing list for notices and reports.

box I would like to be removed from the Committee mailing list.

box

I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:




NAME:

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