PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing, An examination of the workers' compensation fee schedules in New York State, are requested to complete this reply form by Wednesday, December 17, 2014 and mail, email, or fax it to:

Jermaine Brookshire, Jr.
Committee Assistant, Assembly Committee on Labor
Room 520 - Capitol
Albany, New York 12248
Email: brookshirej@assembly.state.ny.us
Phone: (518) 455-4311
Fax: (518) 455-7095
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I plan to attend the public hearing, An examination of the workers' compensation fee schedules in New York State, to be conducted by the Assembly Committee on Friday, December 19, 2014.
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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.
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I will address my remarks to the following subjects:


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I do not plan to attend the above hearing.
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I would like to be added to the Committees' mailing list for notices and reports.
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I would like to be removed from the Committees' mailing list.
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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:


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