EFTA00038874

(Blank form is Unclassificd//P0U0, but may be classified when filled in) FD-794 Version 2.0 FEDERAL BUREAU OF INVESTIGATION Revised 03/11/2021 PAYMENT REQUEST The collection ofinformation 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 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. 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 authorized commercial or source-re atcd expenses. Disclosure of the requested information is mandatory; failure to provide the requested information will delay the processing of your request and may result in its denial. This information is maintained in the FBI Central Records System. Justicc/FBI-002, a description of which can be found at hups://go.fbinet.fbiiDOIOGOLTHIPCLU/PrivacyCivil*A20Lihcrties%20Library/Fomis/FBI002.aspx. This information may be disclosed in accordance with the routine uses referenced in this notice. Cost Code•: Forfeiture or Drug Related•? Overall Classification ofForm•: '3540 0 Ycs 0 No 'Unclassified Program/Subprogram• (ifnot listed, rype the 4-5 digital code): I (RIRI) Violent Crimes Against Children, Violent Crimes Against Children I Needhelp? Use the ENIGMA tool online to confirm correct Fir by case classification. INFORMATION ABOUT THE REQUESTING EMPLOYEE Official Bureau Name: (Last, First, Middle Initial) UE1D•: Date of Request•: 10/07/21 1 Division: Section/RA: UnitiSquad: Ncw York 'NYC' HQ City C-20 r: (include area code) Case Number: E-NY-302757I Waslwill the expense be paid by an alternate employee? O Yes 0 No Is this a one time non-symbol source payment•? 0 Yes 0 No If an expense was already incurred. was it paid with personal funds? If yes, please select your preferred method of reimbursement: CD Yes 0 No Justification•: This request is for the reimbursement of expenses incurred by the case team through the purchase of meals fora trial witnesses on 06/23/21. To be completed by FINANCE OFFICE ONLY. Organization Fund: Program: Sub Program: SOC: Sub SOC: Description•: \mount : Level 2: Total Request: Add New Ron Remove Row To he completed by FINANCE OFFICE UNIX. BID 1 FBI 1: Project: User Dimension 4: User Dimension 5: FD-794 Page of (Blank form is Unclassificdf/F0U0, but may be classified when filled in) EFTA00038874 (Blank form is Unclassificdf/F0U0, but may be classified when filled in) FD-794 Version 2.0 FEDERAL BUREAU OF INVESTIGATION Revised 03/11/2021 PAYMENT REQUEST APPROVAL HQ Only Signature! Date Reouestor Supervisor: Next Level Supervisor: Field Only supervisor Initials: SAC/ASAC/AO/SAS: Pigitalla4pproved via Sentinel Procurement Authority: FINANCE OFFICE ONLY SETTLEMENT OF ADVANCE Creator FOS Approver Document Number: Date: Initials: Date: Initials: Commitment: P Obligation: Advance: Expense: Cash Receipt: Cash Receipt - OTCnet (CRO): OTCnet Deposit Ticket II: FD-794 Page of (Blank form is Unclassificdf/F0U0, but may be classified when filled in) EFTA00038875