Free CJA 21 Authorization and Voucher for Expert and Other Services (Rev. 5/99) - Wisconsin

INSTR UCT IONS FO R CJA 21 AUTHORIZATION AND VOUCHER FOR EXPERT AND OTHER SERVICES Read these instructions carefully before completing the form. Accuracy and thoroughness will aid in the prompt payment of the claim. Use a typew riter if possible to complete the form ; otherwise, w rite legibly with a ball point pen (preferably black or dark blue ink). If the form is system generated, Items 1 through 10 and 14 will be preprinted on the form. Attach an itemized statement of the services provided and expenses incurred. Give the date and the number of hours claimed for each service provided. Provide the dates for, and a description of expenses incurred. For additional guidance, see the Guidelines for the Administration of the Criminal Justice Act an d Related Statutes (C JA G uidelines), Volum e VII, Guide to Judiciary Po licies and Proced ures, which is available for referen ce in the Clerk's Office. All payments made pursuant to this claim are subject to post-audit. any overpayments are subject to collection, including deduction of amo unts due from future vouchers. Refer to 18 U.S.C. § 3006A(e)(1) and the CJA G uidelines on making Ex Parte applications for services other than counsel. NOTE: Prior authorization from the presiding judicial officer should be obtained for all investigative, expert, or other services w here the cost (excluding re imbu rsement for reason able expenses) will exceed $300. Failure to obtain prior autho rization will result in the disallowance o f any amou nt claim ed for comp ensation in ex cess o f $300, unless the presiding judicial officer, finds that, in the inte rest of justice, timely proc urem ent of necessary se rvices could not aw ait prior au thorization. Compensation may not exceed $1,000, excluding reasonable expenses, unless the excess amount is certified by the presiding judicial officer as necessary to provide fair compensation for services of an unusual character or duration, and the amount exceeding the statutory limit is approved by the chief judge of the court of appeals (or active appeals court judge to whom the chief judge has deleg ated excess com pensation autho rity). If prior authorization is obtained for investigative, expert or other services and later it is determined that the cost of the service will exceed the initial estimate by a significant amount, you should seek, from the presiding judicial officer, further prior autho rization for the additional amount. Item 1. CIR./DIST./DIV. CODE: This four-character location code is the circuit or district and divisional office codes of the court where the proceedin gs for the person rep resented are held. PERSON REPRESENTED: Give the full name of the person whom you were app ointed to represent. DOC KET N UM BERS: Provide the case number or miscellaneous number assigned by the court. Enter the number using the last two digits of the calendar year (YY), the sequential number assigned by the court (NNNN NN), and the defendant number (DDD), as shown on the indictment or charging document. Thus, the format of the docket number is YY -NN NN NN -DD D. Note: If two or more cases are heard or tried together for the person represented, complete a separate voucher for each case in which services are provided (i.e., docket number listed). Prorate the total time among the cases. On the supporting documentation, cross reference all related claims for which costs are prorated. IN C ASE /MA TT ER OF (CA SE N AM E): In criminal cases, en ter U.S. vs. Defendant's Name. If it is a multiple defen dant case, give the case cite as provided on the indictment or information (e.g., U. S. vs. Lea d Defend ant's Name, et al). If the person rep resented is no t a defendant (e.g., m aterial w itness), enter the first nam ed de fendant in the court's recording of the case. If this is a civil case (e.g., habeas corpus), enter the Name of the Petitioner vs. the Name of the Respondent and include the respondent's title. If other than a criminal or civil case (i.e., miscellaneous matters), enter "In the m atter of" followed by the "Name of the Person Represented." PAYMENT CATEGORY: Check the app ropriate box that iden tifies the offense class for the representation in which the expe rt or other services are reque sted. If "O ther" paym ent category is chec ked, specify the catego ry within the sco pe of the CJA. TYPE PERSON REPRESENTED: Check the box that defines the legal status of the person repre sented. REPRESENTATION TYPE: From the list belo w, select the code that describes the typ e of representation: CC A defend ant charged in a crim inal case with an offense(s) that is a felony, m isdem eano r, or petty offense under the U.S. Code, or an assimilated crime under a state code. NT A new trial either directed from the court of appeals on remand or as a result of a mistrial

Item 2. Item s 3-6.

Item 7.

Item 8.

Item 9. Item 10.

MA M otion attacking a se ntence (28 U.S.C . § 2255) MC Motion to correct or reduce sentence (Fed. R. Crim. P. 35) HC Habeas Co rpus, non-ca pital (28 U.S.C . § 2254) BP Bail Presentment W I Material Witness (in custody) W W W itnesses (Gra nd Ju ry, a Court, the Congress, a Fe deral A gency, etc.) PR Probation Revocation PA Parole Revocation SR Supervised Release Hearing EW Extraordinary Writs ( Prohibition, Mandam us) CH M ental Competency Hearings (See Chapter 313 of Title 18 U.S.Code) PT Pretrial Diversion EX Extradition Cases (Foreign) OT Other types (e.g., line ups, consu ltations, prisoner transfer, etc.) TD Appeal of a trial disposition CA Other Types of Appeals AP A ppeal From a M agistrate Case to District Court FOR DEATH PENALTY CASES, USE THE CJA FORM 31 AND THE APPLICABLE TYPE OF REPRESENTATION CODE. Item 11. OFFENSE(S) CHARGED: Cite the U. S. Code, title and section, or other code citation of the offense or offenses (list up to five) with which the person represented is charged. If other than a federal code is cited, state the maximum period of confinement authorized for the offense. If a civil matter, such as a habeas corpus representation or a motion attacking sentence, cite 28 U.S.C. § 2254 or 28 U.S.C. § 2255, respectively. For direct appeals from a trial disposition, cite the major offense (U.S. Code, title and section) at case disposition. ATTO RNEY 'S STATEM ENT, NAM E AND MA ILING ADD RESS: Check the app ropriate box to indica te whether the request is for authorization to obtain services, or approval of services already provided. (Note that prior authorization is required for compensation of all services in excess of $300.) Indicate the estimated cost of the services requested. Note the basis for compensation (e.g., hourly rates, daily rates, fixed fee, etc.). This statement must be signed and dated by counsel for the person represented (or by the person proceeding pro se). Check the appropriate box to designate attorney status as a panel attorney, retained attorney, attorney for a legal organization (bar association, legal aid agency, or community defender organization not receiving a periodic sustaining grant under the CJA), or as a person who qualifies for representation under the CJA but has chosen to proceed pro se. Give the complete legal name of the attorney appointed to represent the person whose name is shown in Item 2. Provide the mailing address and telephone number of the attorney. Item 13. DESCR IPTION OF A ND JUSTIFICA TION FO R SERV ICES: Briefly, describe the nature of the services requested and the reason services are necessa ry to pro vide adequate representation. Procedures for Req uesting Psychiatric and Psychological Services. If this is a request for an examination by a psychiatrist or psychologist, state specifically the purpose of the exam ination. If the exa mina tion is ord ered p ursua nt to a statute, cite the statute (U .S. Co de, title and section). The payment procedures for psychiatric and psychological examinations are outlined below. For further information, refer to paragraph 3.11 of the CJA Guidelines. 1. If this is a court-ordered examination to determine, exclusively, the mental condition as set forth in 18 U.S.C. §§ 4241-4246, DO N OT US E THIS FOR M, regardless of who requested the examination. Examinations conducted pursuant to these statutes are considered "non-defense" purpose examinations. The costs are paid by the Department of Justice, and claims for these examinations should be submitted to the U.S. Attorney. If this is an examination exclusively for a "defense" purpose (where the person represented selects the expert and contro ls disclosure of the report), US E TH IS FO RM . The court order ex ecuted in Item 15 is sufficien t for this pu rpose . If this is a dual purpose examination for a "non-defense" and a "defense" purpose, USE THIS FOR M. For the convenience of the expert, the Administrative Office will pay the expert the total amount approved and

Item 12.

2.

3.

obtain reimbursement from the Department of Justice for one-half of the total amount approved. In order for the Administrative Office to obtain this reimbursement, a separate court order authorizing the examination must be attached to the voucher when it is submitted for payment. This order should indicate (1) who requested the examination, (2) the specific purpose(s) of the examination, (3) to whom the report of the exam ination is directed, and (4) to w hom copies of the report are to be given . This separa te order is in addition to the court order at Item 15, w hich also must be signed and dated by the presiding jud icial officer. 4. If this is a du al purp ose exam ination for two "non -defen se" purposes (e.g ., evaluation of com peten cy to stand trial under 18 U .S.C. § 424 1 and evaluation of sanity a t the time of the offense under 18 U .S.C. § 4242), DO N OT USE TH IS FO RM . Submit the entire claim to the U . S. Attorney for pay men t.

Item 14.

TYPE OF SERVICE PROVIDER: Check the box which identifies the type of service provider requested. If you check the box "Other," be sure to specify the type of service or service provider. If computer assisted legal research (CALR) is checked, refer to paragraph 3.15 of the CJA Guidelines for an explanation of the criteria and procedures for app roval of CA LR as a ne cessa ry service under the CJA . COURT ORDER: This court order must be signed and dated by the presiding judicial officer. An additional court order is not necessary except for certain psychiatric and psychological examinations as explained in the instructions for Item 13, or to authorize payment for services exceeding $300 when prior authorization was not obtained (see Item 23). Indicate whether full or partial repayment of the cost for these services was ordered by the court from the person represented by checking "Yes" or "No ." CLAIM FOR SER VICES AN D EX PENSES: CO M PEN SAT ION (16a): Enter the total amou nt claim ed for p rofessional se rvices rende red. O n an attachm ent to the vo ucher, describe in detail the service s prov ided, including dates of serv ice and the amou nt of time spent (in hours and tenths o f hours). State the basis for the fee claim ed (e.g., hourly rate, daily rate, fixed fee). TR AV EL EX PEN SES (16b): Travel related expenses that are incidental to the representation (e.g., transportation, lodgin g, meals, car rental, parking, bridge, road and tun nel tolls, etc.) must be itemized on a separate sheet, indicating dates the expense w as incu rred. A ttach su pporting do cum entation (receipts, can celed checks, etc.) for all travel expenses. Travel expenses by privately owned automobile, motorcycle, or aircraft should be claimed at the rate in effect for federal employees at the time of travel. For overnight travel, reasonable expenses for lodging and meals will be reimbursed on an actual expense basis; per diem is not allowed. Service providers are limited to the travel and subsistence expenses of federal employees. The clerk of court can advise you of applicable rates and federa l gove rnment travel regulations. OT HE R E XP EN SES (Item 16 c): Itemize all reimbursable out-of-pocket expenses incidental to the services provided. Provide dates and a brief description of the expense. Submit supporting documentation (receipts, canceled chec ks, paid invo ice, etc.) for single item ex penses of $ 50 or more . Do not include g enera l office overhead (e.g., rent, telep hone services, secretarial services) as reim bursa ble expenses. The columns provided "FOR COURT USE ONLY" will reflect any mathematical or technical adjustments to the claim during judicial approval or required additional review of the chief judge of the court of appea ls (or delegate).

Item 15.

Item 16.

Item 17.

PA YE E'S N AM E A ND MAIL ING AD DR ESS , TAXP AY ER IDE NT IFIC AT ION NU M BE R (T IN), CLAIM ANT'S CER TIFICATION AND C LAIM STATU S: Provide the complete name and address of the payee (claimant). The claimant must certify dates covered in the claim for payment by indicating the date range for services rendered. C heck the box to indicate the status of the claim as: (1) final paym ent for the services, (2) an interim payment, or (3) a supplemental payment (an additional claim submitted after a the final payment). If this is an interim payment, indicate the interim payment number. The claimant or payee must sign and date the payment certification statement prior to submitting the claim to the attorney for certification that services were rendered and received. Pro vide the Taxpayer Ide ntification Numbe r (TIN ) to report these earning s to the IR S. CERTIFICATION OF ATTORNEY: This section must be completed by the attorney appointed to provide representation, a retained attorney whose client is unable to afford the cost of service requested, or by a person proceeding pro se under the C JA. APPROVED FOR PAYMENT: The court will review, for reasonableness and compliance with the CJA Guidelines, every claim for compensation of services rendered and any claim for reimbursement of expenses incurred. The presiding judicial officer will indicate the amount approved for payment in each of the payment categories (Item s 19-2 1). These amou nts w ill reflect any mathema tical or technica l adjustm ents m ade to the claim .

Item 18.

Items 19-22.

The "TOTAL AMOUNT APPROVED/CERTIFIED" (Item 22) is the amount approved for payment of the claim, less any am ounts to be w ithheld in accordance w ith an interim payme nt orde r. Upon preliminary ap proval of a claim for more than the $1,000 statutory threshold, not including expenses, the presiding judicial officer will (1) signify approval by circling the word "cert" (for word certified) and indicate the amount approved in Item 22, and (2) forward the claim to the chief judge of the court of appeals (or delegate) for additional review and approval of the exce ss am ount. Item 23. SIGNATURE OF THE PRESIDING JUDICIAL OFFICER: The presiding judicial officer must check the appropriate box to indicate (1) either the cost, excluding expenses, does not exceed $300, or prior authorization was obtained, or (2) approval of cost, excluding expenses, exceeding $300 when prior authorization was not obtained but in the interest of justice the court finds that timely procurement of these services could not await prior authorization. The presiding jud icial officer must sign an d date Item 23, indicating approval/certification of the am ount indicated in Item 22. The cou rt will provide the judg e cod e. If the amount approved for compensation, excluding expenses, is less than or equal to the $1,000 statutory limitation, the claim will be forwarded for pay men t processing. Items 24-27. APPROVED FOR PAYMENT: If the chief judge (or delegate) appro ves the excess co mpe nsation, the judge will indicate the amounts approved in each of the payment categories, Items 24-26, and the total amount approved for payment in Item 27. SIG NA TU RE OF CH IEF JUD GE , CO UR T O F APPE AL S (OR DE LE GA TE ): Before a claim is paid for the excess amount certified, the chief judge of the appeals court (or delegate) must sign and date Item 28, approving payment for compensation that exceeds the statutory threshold. If approval is not granted, compensation will be limited to the statutory maximum for the representation and expenses approved. The JUDGE CODE will be provided by court staff.

Item 28.

OCJA 21 AU THO RIZATIO N AN D VO UCH ER FO R EXP ERT A ND O THER SERV ICES (Rev. 5/99)
1 . C I R. /D I ST ./ D IV . CO D E 3 . M A G. DK T ./D E F . N UMB E R 7 . IN CAS E /MAT T E R O F (Case Nam e) 2. PERSON REPRESENTED 4. DIST. DKT./DEF. NUMB E R 8. PAYMENT CATEGORY V O U CH E R N U M BE R 5 . A PPE A L S D K T ./D E F. N U M BE R 9 . T Y PE PE RSO N RE PRE SE N T E D 6 . O T H E R D K T . N U M B ER 1 0 . RE PRE SE N T A T IO N TY P E (See Instructions)

G Felony G Misdemeanor G Appeal

G Petty Offense G Other

G Adult Defendant G Juvenile Defendant G Other

G Appellant G Appellee

11. OF FEN SE(S ) CH AR GE D (C ite U.S. Co de, Title & S ection) If more than one offense, list (up to five) major offenses charged, according to severity of offense.

REQUEST AND AUTHORIZATION FOR EXPERT SERVICES
1 2 . A T T O R N EY ' S S T A T EM E N T As the attorney for the person represented, who is na med above, I here by affirm that the services requested are necessary for adequa te representation. I hereby request: OR G Authorization to obtain the service. Estimated Compensation and Expenses: Z G Appr oval of service s alread y obtaine d to be p aid for b y the Un ited Stat es purs uant to th e Crim inal Just ice Ac t. (Note: Prior authorization should be obtained for services in excess of $300, excluding expenses) Signature of Attorney Panel Attorney G Retained Attorney G Pro-Se G Legal Organization AT T OR N E Y 'S NA M E (Firs t Na me , M .I., La st N am e, inc ludi ng a ny s uffix) , A N D M A I L I N G A D D RE SS Date

G

Telep hon e Nu mbe r:
1 3 . D E S C R IP T IO N OF AN D JUSTI FICATI ON FOR SERVI CES (See Instructions) 1 4 . T Y PE O F SE RV I CE PRO V I D E R 01 02 03 04 05 06 07 08 09 10 11 13 14

1 5 . C O UR T O R DE R Financial eligibility of the person represented h aving been established to the Court's satisfaction, the authorization requested in Item 12 is hereby granted. Signature of Presiding Judicial Officer or By O rder of the Court Date of Order Nunc Pro T unc Date Repayment or partial repayment ordered from the person represented for this service at time of authorization. G YES G NO

G G G G G G G G G G G G G

Investigator Interpreter/Translator Psychologist Psychiatrist Polygraph Documents Examiner Fingerprint Analyst Accountant CAL R (W estlaw /Lexis, e tc.) Chemist/Toxicologist Ballistics Weapons/F irearms/Explosive Ex pert Pathologist/Medical Examiner

15 16 17 18 19 20 21 22 23 24

G Other Medical G Voice/Audio Analyst G Hair/Fiber Expert G Computer (Hardware/
Software/Systems)

G Paralegal Services G Legal Analyst/Consultant G Jury Consultant G Mitigation Specialist G Duplication Services
(See Instructions)

G Other (Specify)

CLAIM FOR SERVICES AND EXPENSES
16. SERVICES AND EXPENSES (Attach itemization of services with dates)
a. Compensation b. Travel Expenses (lod ging , par king , me als, m ileag e, etc.) c. Other Expenses

FOR COURT USE ONLY
AMOUNT CLAIMED MATH/TECHNICAL ADJUSTED AMOUNT ADDITIONAL REVIEW

GRAND TOTALS (CLAIMED AND ADJUSTED):
1 7. P AY E E'S NA M E (First Nam e, M.I., Last Na me, including any suffix), AND M A I L I N G A D D RE SS

T IN : Telephone CLAIMANT'S CERTIFICATION FOR PERIOD OF SERVICE CLAIM STATUS TO

G Final Payment

G

Interim Payment Num ber

G

Supplemental Payment

I hereby certify that the above claim is for services rendered and is correct, and that I have not sought or received payment (compensation or anything of value) from any other source for these services.

Signature of
18. CER TIFICA TION OF A TTO RNE Y I hereby certify that the services were rendered for this case.

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Signature of

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APPROVED FOR PAYMENT -- COURT USE ONLY
1 9 . T O T A L CO M P E N S A T IO N 20. TRAVEL EXPENSES 2 1 . O T H E R E X PE N SE S 2 2 . T O T A L A M O U N T A PPRO V E D /C ER TIFIED 23. G Either the co st (excluding expenses) of these services does not exceed $300, or prior authorization was obtained. G Prior authorization was not obtained, but in the interest of justice the Court finds that timely procurement of these necessary services could not await prior authorization, even though the co st (excluding expenses) exceeds $300.

Signature of Presiding Judicial Officer
2 4 . T O T A L CO M P E N S A T IO N 25. TRAVEL EXPENSES

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2 6 . O T H E R E X PE N SE S

Judge/Mag. Judge Code
2 7 . T O T A L A M O U N T A PPRO V E D

28. PAYM ENT A PPRO VED IN EXC ESS O F THE STAT UTO RY TH RESH OLD UND ER 18 U.S.C. § 3006A(e)(3)

Signature of Chief Judge, Court of Appeals (or Delegate)

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Judge Code