U.S. Department of Justice Request,
Authorization and Agreement for Fees and Expenses of Witnesses
PART I - REQUEST
1. Name/Title of Recommending Official
| 1a. Signature
| 2. Date
| 2a. DJ File Number
|
3.
name of Person to be Contatcted
| 4. Telephone
No.
| 5. Case Name, Court and Court Docket
Number
|
Division or District
| Mailing Address (Exec / Admin / Budget Officer)
| Request (circle one)
Original
Supplemental
If Supplemental, enter original FCN
|
9. Type of Expert Witness
________________________________________________________
REASON
FOR REQUEST (Check below and explain in Block 13)
[ ] a.
Expert testimony required on behalf of U.S.
[ ] b. Medical
Examination of Plaintiff / Witness / Defendant in Contemplation of
Testimony on Behalf of U.S.
[ ] c. Examination Under 18 USC
§ 4241, Mental Competency to stand Trial only
[ ] d. Dual
Purpose Psychiatric Examination (Time of Offense & Competency to
Stand Trial) on the motion of _________ ; under Criminal Justice
Act YES [ ] NO [ ]
[ ] e. Unusual Fact Witness Expense |
Name, Address, TIN / SSN, and Phone No.
of Witness
| Anticipated Start and
Ending Dates of Service (enter MO/DA/YR) (in conjunction with Block
12)
a. Examination of Case _____________________
b.
Prep of Testimony _______________________
c. Court Testimony
_______________________
|
12.
Expense Detail (Estimated Expenses--Current FY Only)
a.
Examination of Case:
____ hrs or ____ days x $ ____ = $ ____
b. Preparation of Testimony:
____ hrs or ____ days x $ ____ =
$ ____
c. Court Testimony:
____ hrs or ____ days x $ ____ = $ ____
d. Other Expense:
Subsistence: [ ] Check if Included in Fee
or,
Transportation: [ ] Check if Included in Fee or, | (Other Expenses Cont'd)
Common Carrier at Coach
Class:
$ _______
Taxi To / From Terminal:
$ _______
POV: Miles ~ $0. per Mile =
$ _______ *
*(This cost shall
not exceed cost by common carrier)
e. Miscellaneous Expenses (printing, exhibits, etc.) on actual cost
basis: (Itemize on separate page)
f. Total Estimated Cost:
$ _______
REMINDER: Expert
Witnesses are not entitled to Advance Payments |
13. Explanation and Justification (attach additional
information if space is insufficient)
|
PART II - WITNESS
AUTHORIZATION
|
1. Date
2. Approved / Disapproved
3. Authorized
Amount $ _______
4. Fiscal Control Number
_____
| 5. Accounting Classification
___________
6. Remarks
Approved by
_______________ |
PART III - WITNESS AGREEMENT
|
1. Description of Duties (Explain details of service to
be performed) (Attach additional information if space is
insufficent)
|
2. Witness: Submit Invoice to:
(Name / Address of
Attorney or Admin / Fiscal Office)
| Government Attorney: For Payment in accordance with
internal procedures, send invoice and Original of this form to:
(Check one)
[ ]
or
[ ] DOJ / FDSS /
EXPERT
P.O. Box 50814
Washington, D.C.
20004-0814 |
3. Signature (Government
Attorney)
| Name / Title of Government
Attorney
| Date
|
4. Signature (Expert Witness)
| Name /
Title of Expert Withness
| Date
|
I agree to perform the above services
and appear as a witness on behalf of the government.
| All payments relating to the agreement shall be in
accordance with the Prompt Payment Act.
|
| Previous editions and Form OBD-12 are
obsolete.
FORM OBD-47
AUG. 90 |