Hearing

Tell Us About Your Company
Americans have a right to an efficient, effective government that works for them. American job creators deserve the opportunity to succeed and grow here in the United States. It's our job to help taxpayers and entrepreneurs secure these rights. But to get our job right we need help from you, our country's proven job creation experts.

Would you be willing to tell us about your experience? Where does Washington help, and where does it hurt? We're listening.
Business Name*
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Industry*
Other Industry
How many employees does your company employ?*

1 to 4 employees5 to 9 employees10 to 19 employees20 to 99 employees100 to 499 employees500 employees or more
Getting in Touch with You

Who is the best point of contact for questions regarding your responses?
Full Name*

First Name Last Name
Position with the Company*
E-mail*
Phone Number*

Area Code Phone Number
If your business has a website, please write the URL.
Your Opportunity to Speak Out
How is government holding your business back? (If you would like to submit your response as an attachment, please use the field below).*
Please attach a Word or PDF document with your response here.
Please indicate the federal government agencies that oversee the regulations identified in your response (check all that apply).*

Consumer Product Safety CommissionEnvironmental Protection AgencyFederal Communications CommissionFood and Drug AdministrationHealth and Human ServicesDepartment of Homeland SecurityDepartment of InteriorDepartment of LaborNational Labor Relations BoardOccupational Safety and Health Review CommissionSecurities and Exchance CommissionDepartment of TransportationU.S. Army Corps of EngineersOther (fill out below)
Other government agency
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* Your business’ response will be used to publicly educate Congress and the American people about the challenges facing U.S. job creators.
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Tell Us About Your Company

Getting in Touch with You

Your Opportunity to Speak Out