EFTA00109057 Dear Sir/Madam: This letter describes the procedure for requesting reimbursement for subpoenaed records. 12 CFR part 219 (subpart A), issued by the Board of Governors of Federal Reserve System under section 1115 of the Right to Financial Privacy Act (12 U.S.C. 3415), sets the rates and conditions for reimbursement of costs directly incurred by financial institutions in assembling or providing customer financial records to a government authority pursuant to the Act. No costs are reimbursable if the records are those of a corporation or a partnership comprised of more than five individuals. If reimbursement is authorized, and the estimated billing to the government will exceed $500, advance permission is necessary from at . If the subpoenaed records indicated on the rider are eligible for reimbursement, please complete section B of the enclosed form OBD-211, which will serve as your invoice, and return it with a copy of the subpoena to the following address: U. S. Attorney's Office - SDNY Accounts Payable Department 86 Chambers Street, 3 rd floor New York, NY 10007 EFTA00109058 Please send your invoice to the above address within 60 days of the submission of the subpoenaed records. If no invoice is received within 120 days, funds will not be available to pay the invoice. Thank you, Accounts Payable Department Enclosure: OBD-211 ## INSTRUCTIONS Form USA-211 ## ATTORNEYS: 1. Fill in blocks 2, 3, 4 (name only), 8, 9, and 10. 2. Mail the subpoena and the USA-211 to the financial institution. (A copy of this "Instructions" sheet and the attached "Important Notice" must be included with each USA-211). In a situation where the financial institution directly returns to you the USA-211 with an invoice and the subpoena/rider , please forward to Budget and sign Box 14, EFTA00109059 15 and the bottom of Box 22 to acknowledge receipt of the requested service. ## FINANCIAL OFFICIAL COMPLETES THE FOLLOWING: 1. Complete block 4 (address). Section B. 2. Complete block 11A and 11B (payments cannot be processed without a Tax ID Number). 3. Either complete or write “See attached invoice” and attach to the USA-211. 4. Sign block 12 and Date block 13. Note carefully the certification in conjunction with the attached "Important Notice". 5. Send the following documents to U.S. Attorney’s Office – SDNY Budget / Fiscal Unit 86 Chambers Street – 3 rd Floor New York, NY 10007 a. Completed USA-211 b. Copy of Subpoena and Rider c. Attach invoice, if applicable IMPORTANT NOTICE Pursuant to the Right to Financial Privacy Act (RFPA), Title 12, United States Code, Section 3415, financial institutions may be reimbursed for necessary costs actually incurred for producing subpoenaed financial records. Reimbursement may only be made in connection with financial records of checking, savings, share, loan or credit card accounts if the accounts belong to individuals or partnerships of five or fewer partners. Reimbursement may only be made to an entity defined as a financial institution under the RFPA. The Federal Reserve Board has established the following guidelines: 1. Search and Processing Costs – May be billed at the following rates of: Clerical/Technical, hourly rate - $22.00 Computer Support Specialist, hourly rate - $30.00* Manager/Supervisory, hourly rate - $30.00 EFTA00109060 *If itemized separately, personnel time for computer searches may be paid at the rates set for specialized computer support only when compliance with the request for information requires that the financial institution use programming or other higher level technical services of specialized computer support in order to reproduce electronically stored information in the format requested by the government authority. ## 2. Reproduction Costs – May be billed at the following rates of: Photocopy, per page - $0.25** Paper copies of microfiche, per frame - $0.25 Duplicate microfiche, per microfiche - $0.50 Storage Media (CD, flash storage device, etc.) – Actual Cost*** **Reimbursement is not permitted on a per-page basis for production of paper documents that had been stored electronically, unless the government specifically requested production of paper documents. ***Storage media may include encryption technologies.** 3. Transportation Costs – If itemized separately, financial institutions may bill for: Reasonably necessary costs directly incurred to transport personnel to locate and retrieve the requested information, and to deliver such material to the place of examination. Reasonable measures taken to insure against a data breach, such as the use of registered mail or courier services as required. No fixed reimbursement will be available for transmittal made by email. However, financial institutions may be reimbursed for personnel costs and other identified costs incurred related to making email transmissions. ## REIMBURSEMENTS CANNOT BE MADE FOR RECORDS RELATING TO ACCOUNTS OF: ## 1. Corporations 2. Large Partnerships (6 or more partners) EFTA00109061 3. Associations 4. Trusts 5. State and local government agencies 6. Other legal entities Unless otherwise requested, all financial record requests should be delivered in an electronic format. Section B, item numbers 11 through 13 of the attached purchase order form must be completed and returned to the United States Attorney’s Office to support reimbursement. To assure prompt payment, please submit an invoice within 60 days. Mail should be directed to the attorney whose name and address appears on the subpoena. Please include the appropriate tax ID number. Note: If invoicing for these services is expected to exceed 120 days, please notify the United States Attorney's Office immediately to ensure funds remain available for payment. FORM USA-211 FEB. 2014 Request for Financial Information Under the Right to Financial Privacy Act (RFPA) (Authorization, Purchase Order and Receiving Report) U. S. Department of Justice Washington, D.C. 20530 1 Tracking Number: 2 Date Order Prepared: 3 USAO Number: Section A - Authorization and Purchase Order 4 Name and Address of Financial Institution: 6 Return Date: 5 Deliver Records To: 7 Remarks: 9 Telephone Number: 8 Name of Requestor: 10 Date of request: No Payment Shall Be Made Unless Expenses Are Itemized Below Or Set Forth On Your Attached Invoice. Section B - Financial Institution Invoice 11C Service(s)/Records Provided: Quantity Cost Per Amount Unit Price Amount Claimed By Financial Institution 13 Date Signed: 12 Signature of Financial Institution Official: Total Section C - Receiving Report 16 Disallowance (See Attached) 17 Net to EFTA00109062
Section
OBJECT
CLASS
2545
2545
2545
2545
2545
2545
Customer Authorization
Administrative Subpoena or Summons
Search Warrant
Judicial Subpoena
Formal Written Request
Grand Jury Subpoena
Special Procedures
3404
3405
Funding Certification & Authorization:
3414
19 Signature of Approving Official:
Accounting Code:
Project Code:
21 Other Accounting/Fund Information:
YREGDOC:
22 Remarks:
This form shall be used when requesting financial records of individuals and partnerships of five or fewer individuals under the RFPA.
Budget Official Signature Funding Available Date
Approving Official Signature Date
Do not proceed with compliance if the total cost will exceed without prior approval. To obtain approval, call the requestor listed in Item 8.
To the best of my knowledge, the financial records received, for which we are being billed, are those of an individual or partnership of five or fewer individuals.
Signature of United States Attorney's Office Representative Date
Program Code:
Call Number (if applicable):
OBL Month (YRMO):
B.
A.
Send Completed USA-211 Form & Invoice To:
3406
EFTA00109063 3407 3408 3413 A. Searching and processing costs (clerical or technical personnel) B. Searching and processing costs (management/supervisory personnel) $22.00 Hour $30.00 Hour C. Searching and processing costs (computer support specialist) $30.00 Hour D. Reproduction Costs (Photocopying) - **Note: Copy charges will be disallowed if E. Reproduction Costs (Paper Copies of Microfiche: provide justification) F. Reproduction Costs (Duplicate Microfiche: provide justification) G. Storage Media Cost (e.g., Compact Disc, DVD, etc., at Actual Cost) H. Transportation Costs (Direct Costs Only) $0.25 Page $0.25 Frame $0.50 Microfiche In Item #12, I certify that the services invoiced above were not performed relative to any corporate accounts and pertain only to accounts of individuals and partnerships of five or fewer individuals. If invoicing for these services is expected to exceed 120 days, please notify the United States Attorney's Office immediately to ensure funds remain available for payment. Please see the attached Important Notice for additional information on invoicing and other requirements for reimbursement. 11A Invoice Number: 11B Tax ID Number: the information is stored electronically, unless the US Attorney's Office requests paper. 20 Funding Source Program Tax ID Number: N/A ## N/A First Premier Bank See attached $ 500.00 Budget / Fiscal Unit 86 Chambers Street, 3rd Floor New York, NY 10007 U.S. Attorney's Office - SDNY EFTA00109064