Image Indicates required field Your Contact InformationPrefix:- Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Mx.Rev.Dr.The HonorableRabbiFirst Name: MI: Last Name: Suffix:- None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and FamilyAddressAddressAddress 2City/TownState- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP CodeEmail:Contact Phone Number:Phone Type:- None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD]Phone NumberAlternate Phone Numberphone textWhat are these options?Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone.Organization InformationOrganization Name: Organization Head First Name:Organization Head Last Name:Organization AddressOrganization Street AddressStreet Address ContinuedCityState- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZipAppropriation RequestChoose a Subcommittee:- Select -AgricultureCommerce, Justice, ScienceDefenseEnergy and WaterFinancial ServicesHomeland SecurityInteriorLabor, Health and Human ServicesLegislative BranchMilitary Construction, Veterans AffairsState and Foreign OperationsTransportation, and Housing and Urban DevelopmentRequest Type:- Select -Funding RequestBill LanguageReport LanguageProgram or Language Title: (for Defense requests, include PE number)General InformationHow does this request benefit the district?Describe the problem or issue to be addressed through this request:Describe the project or program, what it will do and why it is necessary: Please include all such partners with whom you will be working or from whom you have requested additional funding for your program or project:Funding InformationRequested Funding Action:- None -Support Total Funding Level ofSupport the Enacted LevelSupport the President's FY23 Budget RequestFY23 Funding Request:FY23 President’s budget amount:Provide requested language and indicate whether it is bill language, report language or both:Provide previously enacted funding levels below, and list all dollar amounts in thousands (i.e. $1,500, not $1.5 million).20222022 PBR2022 HAC2022 SAC:Approps Conf:20212021 PBR2021 HAC2021 SAC:Approps Conf:20202020 PBR2020 HAC2020 SAC:Approps Conf:Provide a brief explanation justifying the request and how it is a good use of taxpayer funds: CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.
