Hill Visit Report Packet

Instructions: Please complete one packet per group (per visit). It is best to complete this form as soon as possible after your appointments and return it to the ACB table in the muster room.

Completion of this form offers us vital feedback and information to aid in accomplishing our legislative goals for 2012. If you run out of space, please use the back. Pick up two business cards from the person you speak with, one for your records and one for the national office. Thank you for your participation!

These forms are also available on the ACB web site atwww.acb.org. Please send print or electronic forms toblemoine@acb.org at the ACB national office ASAP. They can also be processed on line.

1. Name of legislator and state represented (example: Rep. Christopher Van Hollen - Maryland):

2. Name of the congressional staff person you visited:

3. Name of your ACB affiliate (if applicable) and the name(s) ACB participant(s).

__ Check here if you only dropped off materials at a Congressional Office and did not meet with anyone.

Issue: A Bill to Establish Accessible Medication Labeling for Individuals with Vision Loss and Other Disabilities

1. Rate your overall impression of the meeting--was the staff member engaged; did the staff member ask questions?

1 Poor . . 2 Fair . . 3 Neutral . . 4 Well . . 5 Very Well

2. What questions did the staff member ask? Do they need or want further info? What info does he/she want or need? Please specify.

3. __ ACB staff should follow up

4. Any significant intelligence: e.g. "We're going to move that issue this year." "We will definitely support this issue.” “I [my boss] is opposed to ...".

Issue: H.R. 860 A Bill to Amend the Internal Revenue Code of 1986 to Promote Charitable Donations of Qualified Vehicles

1. Rate your overall impression of the meeting--was the staff member engaged; did the staff member ask questions?

1 Poor . . 2 Fair . . 3 Neutral . . 4 Well . . 5 Very Well

2. What questions did the staff member ask? Do they need or want further info? What info does he/she want or need? Please specify.

3. __ ACB staff should follow up

4. Any significant intelligence: e.g. "We're going to move that issue this year." "We will definitely support this issue.” “I [my boss] is opposed to ...".

Additional information – such as comments about blindness, or questions about other issues?