PUBLIC HEARING REPLY FORM
Persons wishing to present testimony at the public hearing on Early Intervention Fiscal Agent Program Implementation
are requested to complete this reply form as soon as possible, but no later than Tuesday, October 15th, and mail, email or fax it to:
I plan to attend the public hearing on "Early Intervention Fiscal Agent Program Implementation" to be conducted by the Assembly Committees on Health, Insurance and Oversight, Analysis and Investigation on October 22nd.
I plan to make a public statement at the hearing. My statement will be limited to 10 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.
I will address my remarks to the following subjects:
I do not plan to attend the above hearing.
I would like to be added to the Committees' mailing list for notices and reports.
I would like to be removed from the Committees' mailing list.
I will require assistance and/or handicapped accessibility information.
Please specify the type of assistance required: