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:
5. Proparer (Name & Tel.) 6. Originating Office (Name & Address) 7. Case Name. Court 8 Ct. Docket No. 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 I $ 0.00
15. Submit Invoices & EFT Information to: 16. Payment will be made by: (Place an 'X' in the applicable Box and fill.in if not Jfv10/Finance)
U.S. Attorney's Office. SDNY X I Box 15
Bud. et 8 Fiscal Unit
or email:
Form USA-47 (Revised 5-2008)
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EFTA00032652