PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing regarding the strengths and weaknesses of New York State's Medicaid Buy-In program are requested to complete this reply form as soon as possible and send it to:

Kimberly Hill
Director
Assembly Task Force on People with Disabilities
Agency Building 4, 13th Floor
Albany, New York 12248
E-mail: hillk@assembly.state.ny.us
Phone: (518) 455-4592
Fax: (518) 455-7099


box I plan to attend the public hearing on New York State's Medicaid Buy-In program on September 15, 2008.

box I plan to testify 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.

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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:

TITLE:

ORGANIZATION:

ADDRESS:

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