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 I | |||||||
| 16. Payment will be made by: (Place an ‘X’ in the applicable Box and fill.in if not Jfv10/Finance) 15. Submit Invoices & EFT Information to: | ||||||||
| U.S. Attorney’s Office. SDNY X I Box 15 Bud. et 8 Fiscal Unit or email: |
Form USA-47 (Revised 5-2008) Page 1 of 2¶