PUBLIC HEARING REPLY FORM

Those invited to present testimony at the public hearing on The Implementation and Effectiveness of New York's Low-Income Home Energy Assistance Program (HEAP) are requested to complete this reply form as soon as possible and mail it to:

Jill Poklemba
Legislative Analyst
Assembly Committee on Social Services
Room 520 - 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 the additional $100 million for HEAP conducted by the Assembly Committees on Energy, Social Services and Aging on February 14, 2006.

box I plan to submit written testimony at the hearing. I will provide 15 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:

E-MAIL:

TELEPHONE:

FAX TELEPHONE:
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