PUBLIC HEARING REPLY FORM

Persons invited to present testimony at the public hearing on fraud and abuse in the Medicaid program are requested to complete and return this reply form as soon as possible:

Elsie J. Chun
Legislative Associate Assembly Committee on Health
Room 522 - Capitol
Albany, New York 12248
Email: chune@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the following public hearing on fraud and abuse in the Medicaid program to be conducted by the Assembly Committees on Health, Codes, Judiciary and Oversight, Analysis and Investigation on September 19, 2005.

box I plan to make a public statement at the hearing. My statement will be limited to 10 minutes, and I will answer any questions that may arise. I will provide 10 copies of my prepared statement.

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:




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