Free Corel Office Document - Florida

INTERPRETER CLAIM FOR COMPENSATION AND EXPENSES
Language: Address: Social Security Number/Tax I.D. Number: E-mail Address: Case Docket Number (1) (2) (3) (4) Date (mm/dd/yy) Hours (1) (2) (3) (4) Skill Level: Type of Service: Certified Interpreting to to to to Professionally Skilled Translation @ @ : per hour @ per hour @ @ hours: hours: Total Round-trip miles: Other (specify) days: days: $ $ $ $ $ $ $ $ days: $ $ Language Skilled Style of Case: USA v. USA v. USA v. USA v. Type of Proceeding: Approved for payment by CRD: Phone Number: Fax: Judge/Magistrate/Office Services Provided: Interpreter/Firm Name:

Rate of Payment for ½ day $ Rate of Payment for full day $ Other Rate of Payment $ Overtime Rate: $ Travel Time: $

Mileage $ 0.550 per mile (in excess of 30 miles one-way) Parking @$ per day @ (for travel in excess of 30 miles one-way) per day @ Hotel Rate @ $ M & IE Rate @ $ days: days:

0.00

per day (for overnight travel) @

Total Compensation Claimed :

CERTIFICATION: I hereby certify that no other claims for compensation and/or expenses have been filed, nor has payment been received from any other government source or agency for the services or time represented in this claim. (CHECK ONE) I have not or have worked on this date for (ex. U.S. Probation Office, U.S. Pretrial Services, Public Defender's Office). Note: You may not submit claims for two half-days separately to any of the above, since to do so would result in an overpayment by the U.S. Courts.

Date

Signature of Interpreter FOR COURT USE ONLY

NEW VENDOR INFORMATION: If the interpreter is a new vendor, this section should be completed and a copy of this claim form sent to Sandy Howes. Vendor Type: 1099 Vendor: Fed. Gov. Yes No Non Gov. State Gov. Local Employee Gov.

Print
Revised: 02/02/09