Image Appropriation Programmatic and Language Request Form Fiscal Year 2025Indicates 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.The ProgramProgram or Language Title: (for Defense requests, include PE number)Choose 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 LanguageAgency:Account:Describe the project or program, what it will do and why it is necessary: Funding Request Amount:Funding Choice:- Select -Support the enacted levelSupport the Presidents FY24 budget requestGeneral support for the programFunding should be reducedEliminate the programAmount (if applicable):President’s FY2025 Budget Request:Organization InformationOrganization Name: Organization Head First Name:Organization Head Last Name:Organization AddressOrganization Street AddressStreet Address ContinuedCityState- 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 VirginiaWisconsinWyomingZipEmail:Phone NumberMember Office Leading RequestMember:Staff Contact:Email:Earmark Disclosure:Due to Clause 9(e) of Rule XXI in the House Rules, we are banned from requesting earmarks or specific project requests. Any project requests submitted to this office will not be considered. A congressional earmark is defined by Clause 9(e) Rule XXI as such: For the purpose of this clause, the term "congressional earmark" means a provision or report language included primarily at the request of a Member, Delegate, Resident Commissioner, or Senator providing, authorizing or recommending a specific amount of discretionary budget authority, credit authority, or other spending authority for a contract, loan, loan guarantee, grant, loan authority, or other expenditure with or to an entity, or targeted to a specific State, locality or Congressional district, other than through a statutory or administrative formula-driven or competitive award process. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.
