Free CJA 20 - Appointment of and Authority to Pay Court Appointed Counsel - Federal

OCJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT APPOINTED COUNSEL (Rev. 12/03) 1. CIR./DIST./ DIV. CODE 2. PERSON REPRESENTED
3. MAG. DKT./DEF. NUMBER 7. IN CASE/MATTER OF (Case Name) 4. DIST. DKT./DEF. NUMBER 8. PAYMENT CATEGORY

VOUCHER NUMBER 6. OTHER DKT. NUMBER 10. REPRESENTATION TYPE (See Instructions)

5. APPEALS DKT./DEF. NUMBER 9. TYPE PERSON REPRESENTED

G Felony G Misdemeanor G Appeal

G Petty Offense G Other

G Adult Defendant G Juvenile Defendant G Other

G Appellant G Appellee

11. OFFENSE(S) CHARGED (Cite U.S. Code, Title & Section) If more than one offense, list (up to five) major offenses charged, according to severity of offense.

12. ATTORNEY'S NAME (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS

13. COURT ORDER

G O Appointing Counsel G F Subs For Federal Defender G P Subs For Panel Attorney

G C Co-Counsel G R Subs For Retained Attorney G Y Standby Counsel

Telephone Number : 14. NAME AND MAILING ADDRESS OF LAW FIRM (Only provide per instructions)

Prior Attorney's Name: Appointment Dates: G Because the above-named person represented has testified under oath or has otherwise satisfied this Court that he or she (1) is financially unable to employ counsel and (2) does not wish to waive counsel, and because the interests of justice so require, the attorney whose name appears in Item 12 is appointed to represent this person in this case, OR G Other (See Instructions) Signature of Presiding Judge or By Order of the Court

Date of Order Nunc Pro Tunc Date Repayment or partial repayment ordered from the person represented for this service at time appointment. G YES G NO

CLAIM FOR SERVICES AND EXPENSES
CATEGORIES (Attach itemization of services with dates) 15. a. b. c. d. e. f. g. h. a. b. c. d. e. Arraignment and/or Plea Bail and Detention Hearings Motion Hearings Trial Sentencing Hearings Revocation Hearings Appeals Court Other (Specify on additional sheets) ) TOTALS: Interviews and Conferences Obtaining and reviewing records Legal research and brief writing Travel time Investigative and other work (Specify on additional sheets) ) TOTALS: HOURS CLAIMED TOTAL AMOUNT CLAIMED

FOR COURT USE ONLY
MATH/TECH. ADJUSTED HOURS MATH/TECH. ADJUSTED AMOUNT ADDITIONAL REVIEW

In Court 16. Out of Court 17. 18.

(RATE PER HOUR = $

(RATE PER HOUR = $

Travel Expenses (lodging, parking, meals, mileage, etc.) Other Expenses (other than expert, transcripts, etc.) 20. APPOINTMENT TERMINATION DATE IF OTHER THAN CASE COMPLETION 21. CASE DISPOSITION

GRAND TOTALS (CLAIMED AND ADJUSTED):
19. CERTIFICATION OF ATTORNEY/PAYEE FOR THE PERIOD OF SERVICE FROM: 22. CLAIM STATUS TO:

G Final Payment

G Interim Payment Number

G Supplemental Payment

Have you previously applied to the court for compensation and/or reimbursement for this G YES G NO If yes, were you paid? G YES G NO Other than from the Court, have you, or to your knowledge has anyone else, received payment (compensation or anything of value) from any other source in connection with this G NO If yes, give details on additional sheets. representation? G YES I swear or affirm the truth or correctness of the above statements. Signature of Attorney Date

APPROVED FOR PAYMENT -- COURT USE ONLY
23. IN COURT COMP. 24. OUT OF COURT COMP. 25. TRAVEL EXPENSES 26. OTHER EXPENSES DATE 31. TRAVEL EXPENSES 32. OTHER EXPENSES DATE 27. TOTAL AMT. APPR./CERT. 28a. JUDGE CODE 33. TOTAL AMT. APPROVED 34a. JUDGE CODE 28. SIGNATURE OF THE PRESIDING JUDGE 29. IN COURT COMP. 30. OUT OF COURT COMP.

34. SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE) Payment approved in excess of the statutory threshold amount.

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