PUBLIC HEARING REPLY FORM
Persons wishing to present testimony at the public hearing on the impact of the 2009-10 State Budget on the programs provided by the Office of Temporary Disability Assistance are requested to complete this reply form as soon as possible and mail, email or fax it to:
Katie Birchenough
Committee Assistant
Assembly Committee on Social Services
Room 522 - Capitol
Albany, New York 12248
E-mail: birchenoughk@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
I plan to attend the following public hearing on Fiscal Implications of 2009-2010 State Budget on
Programs and Services Provided by the Office of Temporary Disability Assistance to be conducted
by the Assembly Committee on Social Services on December 15, 2009.
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 Committee's mailing list for notices and reports.
I would like to be removed from the Committee's mailing list.
I will require assistance and/or handicapped accessibility information.
Please specify the type of assistance required:
NAME:
TITLE:
ORGANIZATION:
ADDRESS:
E-MAIL:
TELEPHONE:
FAX TELEPHONE: