## UNITED STATES ATTORNEYS Request, Authorization, and Order for Services of Expert Witness, Litigative Consultant, or ADR Neutral

## Contract/Purchase Order No.: Date:

| Part I - Re uest for Services                                                                                                                   |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
|-------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------|----------------------------------------|--------------------------------|----------------------------------------|----------|--------------------------|--------------|--|
| 1. Requesting Official (Name & Title)                                                                                                           |                                                                                                              | 2. Signature of Requesting Official    |                                | 3. Point of Contact (Name and Tel.)    |          | 4. Date of Request       |              |  |
|                                                                                                                                                 |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 |                                                                                                              |                                        | Telephone:                     | 7. Case Name. Court 8 Ct. Docket No.   |          |                          |              |  |
| 5. Proparer (Name & Tel.)                                                                                                                       |                                                                                                              | 6. Originating Office (Name & Address) |                                | 8. DJ File No./USAO No.                |          |                          |              |  |
|                                                                                                                                                 |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 9. Contractor (Namo and Tel.)                                                                                                                   |                                                                                                              |                                        | 10. Contractor Mailing Address | 11. Contractor TIN or SSN (Individual) |          | 12. Contractor Specialty |              |  |
|                                                                                                                                                 |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| Telephone:                                                                                                                                      |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 13. Reason for Request (Place an "X" in the applicable Box in the Left Column)                                                                  |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 13.a. Expert Testimony on Behalf of U.S.                                                                                                        |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 13.b. Deposition Conducted by DOJ Attorney                                                                                                      |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 | 13.c. Medical Examination of Plaintiff/Witness/Defendant in Contemplation of Testimony on Behalf of U.S.     |                                        |                                |                                        |          |                          |              |  |
| 13.d. Examination Under 18 USC 4241. Mental Competency to Stand Trial Only                                                                      |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 | 13.e. Dual Purpose Psychiatric Examination (Time of Offense and Competency to Stand Trial) on the motion of: |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 | 13J. ADR Neutral Services                                                                                    |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 | 13.g. Litigative Consultant Services                                                                         |                                        |                                |                                        |          |                          |              |  |
|                                                                                                                                                 | 13.h. Other (explain below):                                                                                 |                                        |                                |                                        |          |                          |              |  |
| Attach the Statement of Work to this Form                                                                                                       |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 14. Negotiated Contractor Rates. Estimated Expenses. and Performance Dates (Note: Expenses incurred n ust be supported by receipts)             |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| Service/Expanse                                                                                                                                 |                                                                                                              |                                        | Performance Dates (From-To)    | Hour/Day                               | Quantity | Pato                     | Total        |  |
| 14.a. Examine Case                                                                                                                              |                                                                                                              |                                        | -                              | Hour                                   |          |                          | \$ 0.00      |  |
| 14.b. Prepare Testimony                                                                                                                         |                                                                                                              |                                        | -                              | Hour                                   |          |                          | \$ 0.00      |  |
| 14.c. Court Testimony                                                                                                                           |                                                                                                              |                                        | -                              | Hour                                   |          |                          | \$ 0.00      |  |
| 14.d. Deposition                                                                                                                                |                                                                                                              |                                        | -                              | Hour                                   |          |                          | \$ 0.00      |  |
| 14.e. Litigative ConsultanUNeutral                                                                                                              |                                                                                                              |                                        | -                              | Hour                                   |          |                          | \$ 0.00      |  |
| 14.f. Per Diem (if not part of fee)                                                                                                             |                                                                                                              |                                        |                                | Day                                    |          |                          | \$ 0.00      |  |
| 14o. Privately Owned Vehicle (NTE coach rate)                                                                                                   |                                                                                                              |                                        |                                | Mile                                   |          |                          | \$ 0.00      |  |
|                                                                                                                                                 | 14.h. Common Carder Transportation Via GTA                                                                   |                                        |                                |                                        |          |                          |              |  |
| 14.1. Common Carrier Transportation Reimbursed                                                                                                  |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 14.J. Miscellaneous                                                                                                                             |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| 14.k. Total Estimated Expenses                                                                                                                  |                                                                                                              |                                        |                                |                                        |          |                          | \$ 0.00<br>I |  |
| 16. Payment will be made by: (Place an 'X' in the applicable Box and fill.in if not Jfv10/Finance)<br>15. Submit Invoices & EFT Information to: |                                                                                                              |                                        |                                |                                        |          |                          |              |  |
| U.S. Attorney's Office. SDNY<br>X<br>I Box 15<br>Bud. et 8 Fiscal Unit<br>or email:                                                             |                                                                                                              |                                        |                                |                                        |          |                          |              |  |

Form USA-47 (Revised 5-2008) Page 1 of 2