Exhibit A Request For Informal Budget Dispute Resolution

EXHIBIT A

REQUEST FOR INFORMAL BUDGET DISPUTE RESOLUTION

Standing Trustee:   Assistant Director ORO:
Name: _______________________________   Name: _______________________________
Address: ____________________________   Address: ____________________________
                     _______________________________                        _______________________________
Telephone: (___) ___-____  Telephone: ( ) ___-____
FAX: (___) ___-____  FAX: (___) ___-____
United States Trustee:  NACTT Chair:
Name: _______________________________  Name: _______________________________
Address: ____________________________  Address: ____________________________
                     _______________________________                        _______________________________
Telephone: (___) ___-____  Telephone: ( ) ___-____
FAX: (___) ___-____  FAX: (___) ___-____
BUDGET ITEM(S) IN DISPUTE: _____________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
THREE (3) NAMES OF ACCEPTABLE PANEL MEMBERS: 1. ___________________________________
_____ The Parties have agreed to a
      one-member Panel.
2. ___________________________________
_____ I DECLINE TO MEDIATE. 3. ___________________________________

I hereby request informal budget dispute resolution pursuant to the United States Trustees' "Informal Budget Dispute Resolution Process" dated _________, 1997. I understand that this procedure is non-binding on either party. I hereby agree that all discussions, papers, and other communications made or submitted solely in connection with the process and any recommendation of the Panel or fact that a recommendation was made cannot be used by either party in any subsequent administrative or legal proceeding, provided however this agreement will not apply to documents, work papers and other evidentiary materials related to the underlying dispute and prepared by the parties in the ordinary course of business and not generated in connection with or in anticipation of the dispute resolution process.
Date:________________



 



______________________________________________________________
(Party's Signature)

CERTIFICATE OF SERVICE

I certify that I have served a copy of the above and foregoing Request on each of the three (3) other above named individuals by FAX this _____ day of __________, 19__.



_______________________________________________________________________
(Requesting Party's Signature)

Updated May 7, 2015

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