Request for Approval of a Specific Case Under a Generally Approved Program

TO:                          Supervisor/Section Chief
THROUGH:           Deputy Designated Agency Ethics Official
FROM:                    Employee
SUBJECT:              Request for Approval of a Specific Case Under a Generally Approved Program

This memorandum is to obtain your approval to provide uncompensated legal services. I have accepted a case through [legal services organization], a program which was given general approval by the Component Head on [date]. The nature of the matter(s) I will be working on is as follows:

[describe the type of matter, with specifics as to issues, parties, etc. ]

I have sought the advice of the [component's] ethics official. Upon reviewing the facts of the case and the parties we have identified no conflict with me personally or with my position with the Department. I have reviewed the Department's Pro Bono Policy Statement and the ethics guidance prepared by the Departmental Ethics Office. In the course of this representation I will not act as agent or attorney for any person before any agency, department, or court in any matter in which the United States has a direct and substantial interest. I also will not participate in any criminal or habeas corpus matter, at the federal, state, or local level or in any matter in which the Department of Justice is or represents a party, litigant, investigator or grant-maker.

I will not participate in any matter that involves a subject matter, policy, or program of the [component]. I understand that I may use Government equipment and resources as provided under the Department's rule on personal use of Government property. I will not use my official position in connection with my representation of any person. I understand that I am to perform these services on my own time and that I may not use the time of a subordinate. This work will not interfere with my ability to meet my obligations and responsibilities to the Department of Justice. [If attorney wishes to request administrative time or annual leave for certain activities or an adjustment of schedule in order to handle pro bono work during the work day, this is where to request it or to document his understanding with supervisor.]

If at any time the United States should develop an interest in a matter covered by this request, or if any of the circumstances under which I am granted approval change, I will seek further advice and further approval if necessary.

Request Approved:

 

_______________________________
                  Supervisor
 

TO:                           Component Head
THOUGH:                Designated Agency Ethics Official and Supervisor
FROM:                     Employee
SUBJECT:               Request for Individual Approval of a Pro Bono Case or Legal Services Program

This memorandum is to request your approval to provide uncompensated legal services pursuant to the Department of Justice Supplemental Standard of Conduct, 5 CFR 3801.106 and DOJ Order 1200.1, Part 11. I would like to perform pro bono legal services [either describe the clinic, program, etc. or describe individual case you wish to participate in]. [state whether the clinic, program or attorney has or does not have malpractice insurance]. The nature of the matter(s) I will be working on is as follows:

[describe the type of matter, with specifics as to issues, parties, etc. ]

I have sought the advice of the [component's] ethics official before requesting your approval, and I have reviewed the Department's Pro Bono Policy Statement and the ethics guidance prepared by the Departmental Ethics Office. [Upon reviewing the facts of the case and the parties/Based on the types of matters for which the clinic provides services], we have identified no conflict with me personally or with my position with the Department. In the course of this representation I will not act as agent or attorney for any person before any agency, department, or court in any matter in which the United States has a direct and substantial interest. I also will not participate in any criminal or habeas corpus matter, at the federal, state, or local level or in any matter in which the Department of Justice is or represents a party, litigant, investigator or grant-maker.

I will not participate in any matter that involves a subject matter, policy, or program of the [component's]. I understand that I may use Government equipment and resources as provided under the Department's rule on personal use of Government property. I will not use my official position in connection with my representation of any person. I understand that I am to perform these services on my own time and that I may not use the time of a subordinate. This work will not interfere with my ability to meet my obligations and responsibilities to the Department of Justice. [If attorney wishes to request administrative time for certain activities or an adjustment of schedule it should be discussed with supervisor first and documented here, e.g., "I have discussed with my supervisor the possibility that I will need to conduct some activities in connection with this representation during the work day. I will adjust my work hours or take annual leave as agreed to with my supervisor."]

If at any time the United States should develop an interest in a matter covered by this request, or if any of the circumstances under which I am granted approval change, I will seek further advice and further approval if necessary.

Request Approved:

_______________________________
Component Head