FD-794
Version 2.0
Revised 03/11/2021

(Blank form is Unclassified//FOUO, but may be classified when filled in)

# FEDERAL BUREAU OF INVESTIGATION
PAYMENT REQUEST

The collection of information on this form is authorized by 5 U.S.C. 301 (FBI authorized to create and retain agency records) and 28 U.S.C. 530C(b)(4) (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 information 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-related 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, Justice/FBI-002, a description of which can be found at https://go.fbinet.fbi/DO/OGC/LTB/PCLU/PrivacyCivil%20Liberties%20Library/Forms/FB1002.aspx. This information may be disclosed in accordance with the routine uses referenced in this notice.

# FEDERAL BUREAU OF INVESTIGATION
PAYMENT REQUEST (cont.)

Cost Code*: 3540
Forfeiture or Drug Related*?:
[ ] Yes
[x] No
Overall Classification of Form*: Unclassified
Program/Subprogram* (if not listed, type the 4-5 digital code): (RIRI) Violent Crimes Against Children, Violent Crimes Against Children

Need help? Use the ENIGMA tool online to confirm correct P/SP by case classification.

## INFORMATION ABOUT THE REQUESTING EMPLOYEE

Official R Fit Middla itial) UEID": Date of Request*:

W 10/07/21

Division: Section/RA: Unit/Squad:

New York NYO HQ City C-20

ber: (include area code) Case Number*:

50D-NY-3027571

Was/will the expense be paid by an alternate employee?

Yes No

# FEDERAL BUREAU OF INVESTIGATION
PAYMENT REQUEST (cont.)

## INFORMATION ABOUT THE REQUESTING EMPLOYEE (cont.)

Is this a one time non-symbol source payment*?
○ Yes No

If an expense was already incurred, was it paid with personal funds? If yes, please select your preferred method of reimbursement: Yes No

Justification*:

This request is for the reimbursement of expenses incurred by the case team through the purchase of meals for a trial witnesses on 06/23/21.

<table><tr><th colspan="6">To be completed by FINANCE OFFICE ONLY.</th><th colspan="2"></th></tr><tr><td>Fund:</td><td>Organization
Level 2:</td><td>Program:</td><td>Sub Program:</td><td>SOC:</td><td>Sub SOC:</td><td>Description*:</td><td>Amount:</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td>Investigative Expense</td><td></td></tr><tr><td colspan="8">Total Request:</td></tr></table>

Add New Row

Remove Row

To be completed by FINANCE OFFICE ONLY.

<table><tr><th>BBFY:</th><th>EBFY:</th><th>Project:</th><th>User Dimension 4:</th><th>User Dimension 5:</th></tr><tr><td></td><td></td><td></td><td></td><td></td></tr></table>

FD-794

(Blank form is Unclassified//FOUO, but may be classified when filled in)

Page of

EFTA00040011

FD-794
Version 2.0
Revised 03/11/2021

(Blank form is Unclassified//FOUO, but may be classified when filled in)

# FEDERAL BUREAU OF INVESTIGATION
PAYMENT REQUEST

APPROVAL

HQ Only
Requestor Supervisor:

Next Level Supervisor:

Signature / Date

Field Only
Supervisor Initials:

SAC/ASAC/AO/SAS:

Procurement Authority:

Digitally Approved via Sentinel

## FINANCE OFFICE ONLY
SETTLEMENT OF ADVANCE

<table><tr><th></th><th></th><th>Creator</th><th></th><th>FOS Approver</th><th></th><th></th></tr><tr><td>Document Number:</td><td>Date:</td><td></td><td>Initials:</td><td></td><td>Date:</td><td>Initials:</td></tr><tr><td>Commitment:</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Obligation:</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Advance:</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Expense:</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Cash Receipt:</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Cash Receipt -
OTCnet (CRO):</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>OTCnet Deposit
Ticket #:</td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>

FD-794

(Blank form is Unclassified//FOUO, but may be classified when filled in)

Page of

EFTA00040012