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 |
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Division or District |
Mailing Address (Exec / Admin / Budget Officer) |
Request (circle one) Original Supplemental If Supplemental, enter original FCN |
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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 |
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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 _______________________ |
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12. Expense Detail (Estimated Expenses--Current FY Only) a. Examination of Case: ____ hrs or ____ days x $ ____ = $ ____ b. Preparation of Testimony: c. Court Testimony: d. Other Expense: |
(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: |
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13. Explanation and Justification (attach additional information if space is insufficient) |
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PART II - WITNESS AUTHORIZATION |
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1. Date 2. Approved / Disapproved 3. Authorized Amount $ _______ 4. Fiscal Control Number _____ |
5. Accounting Classification ___________ 6. Remarks Approved by _______________ |
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PART III - WITNESS AGREEMENT |
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1. Description of Duties (Explain details of service to be performed) (Attach additional information if space is insufficent) |
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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 |
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3. Signature (Government Attorney) |
Name / Title of Government Attorney |
Date |
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4. Signature (Expert Witness) |
Name / Title of Expert Withness |
Date |
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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. |
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Previous editions and Form OBD-12 are obsolete.
FORM OBD-47 |