|                                                                                | FD-794                                |                                                                                                                                       |               |                                                     |            | (Blank form is Unclassificd/W0U0, but may be classified when filled in)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |                |         |  |  |  |
|--------------------------------------------------------------------------------|---------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------|---------------|-----------------------------------------------------|------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------|---------|--|--|--|
|                                                                                | Version 2.0                           |                                                                                                                                       |               |                                                     |            | FEDERAL BUREAU OF INVESTIGATION                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                | PAYMENT REQUEST<br>Revised 03/11/2021 |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| routine uses referenced in this notice.                                        |                                       |                                                                                                                                       |               |                                                     |            | The collection of information on th s form is authorized by 5 U.S.C. 301 (FBI authorized to create and retain agency records) and 28 U.S.C. 530C(bX4) (FBI authorized to<br>use appropriated funds for conduct of its authorized activities). Your Social Security Number is solicited as authorized by E.O. 9397 (Nov. 30, 1943), as amended by E.O.<br>13478 (Nov. 18, 2008). The inform tion sought will be used by the FBI to process your request for an advance payment of funds or request for reimbursement for<br>authorized commercial or source-re atcd expenses. Disclosure of the requested information is mandatory; failure to provide the requested information will delay the<br>processing of your request and may result in its denial. This information is maintained in the FBI Central Records System. Justice/FBI-002, a description of which can be<br>found at hups://go.(binct.tbi'DO/OGULTEUPCLUIPrivacyCivil*A20Liberliee/020Libraty/FomuNBI002.aspx. This information may be disclosed in accordance with the |                |         |  |  |  |
| Overall Classification of Form*:<br>Cost Code:<br>Forfeiture or Drug Related'? |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| C) No<br>I3540<br>Y"<br>!Unclassified<br>0                                     |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       | Program/Subprogram* (if not listed, type the 4-5 digital code):                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| I                                                                              |                                       | (RIRI) Violent Crimes Against Children, Violent Crimes Against Children                                                               |               |                                                     |            | I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |                |         |  |  |  |
|                                                                                |                                       | Need help? Use the ENIGMA tool online to confirm correct PISP by case classification.                                                 |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| INFORMATION ABOUT THE REQUESTING EMPLOYEE                                      |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| '                                                                              | •                                     |                                                                                                                                       | itial)        |                                                     | VERY':     | Date of Requesr:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |                |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               | Ell                                                 |            | I<br>10/07/21                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |                |         |  |  |  |
| Division:                                                                      |                                       |                                                                                                                                       | Section/RA:   |                                                     |            | UniUSquad:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |                |         |  |  |  |
| New York                                                                       |                                       |                                                                                                                                       | 'NYC) HQ City |                                                     |            | C-20                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |                |         |  |  |  |
|                                                                                | r: (include area code)                |                                                                                                                                       | I             | Case Number*:<br>50D-NY-3027571                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| O<br>0<br>Yes                                                                  | No                                    | Waslwill the expense be paid by an alternate employee?                                                                                |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| Yes *<br>0                                                                     | No                                    | Is this a one time non-symbol source payment*?                                                                                        |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       | If an expense was already incurred. was it paid with personal funds?<br>If yes. please select your preferred method of reimbursement: |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| No<br>0<br>Yes 0                                                               |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| Justification*:                                                                |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       | This request is for the reimbursement of expenses incurred by the case team through the                                               |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       | purchase of meals fora trial witnesses on 06123121.                                                                                   |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       | To be completed by FINANCE OFFICE ONLY.                                                                                               |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| hind:                                                                          | Organization<br>Level 2:              | Program:                                                                                                                              | Sub Program:  | SOC:                                                | Sub SOC:   | Description*:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              | \mount :       |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               |                                                     |            | Investigative Expense                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |                |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Total Request: |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       | Add New Row   |                                                     | Remove Row |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
| BID I':                                                                        |                                       | EBFV:                                                                                                                                 |               | To he completed by FINANCE OFFICE ONLY.<br>Project: |            | User Dimension 4:<br>User Dimension 5:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |                |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
|                                                                                |                                       |                                                                                                                                       |               |                                                     |            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |                |         |  |  |  |
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| FD-794                                                                         |                                       |                                                                                                                                       |               |                                                     |            | (Blank form is Unclassificd/S0U0, but may be classified when filled in)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |                | Page of |  |  |  |

FD-794 Version 2.0 Revised 03/11/2021 (Blank form is Unclassificdf/F0U0, but may be classified when filled in)

### FEDERAL BUREAU OF INVESTIGATION

PAYMENT REQUEST

### APPROVAL

HQ Only

Reouestor Supervisor:

Next Level Supervisor:

Field Only

supervisor Initials:

SAC/ASAC/AO/SAS:

Procurement Authority:

Signature! Date

Pigitalla4pproved via Sentinel

### FINANCE OFFICE ONLY SETTLEMENT OF ADVANCE

|                                 | Creator<br>FOS Approver |           |       |           |  |
|---------------------------------|-------------------------|-----------|-------|-----------|--|
| Document Number:                | Date:                   | Initials: | Date: | Initials: |  |
| Commitment:                     | P                       |           |       |           |  |
| Obligation:                     |                         |           |       |           |  |
| Advance:                        |                         |           |       |           |  |
| Expense:                        |                         |           |       |           |  |
| Cash Receipt:                   |                         |           |       |           |  |
| Cash Receipt -<br>OTCnet (CRO): |                         |           |       |           |  |
| OTCnet Deposit<br>Ticket II:    |                         |           |       |           |  |