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63.

Form OBD-47—Request, Authorization and Agreement for Fees and Expenses of Witnesses

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