UNITED STATES ATTORNEYS

Request, Authorization, and Order for Services of Expert Witness, Litigative Consultant, or ADR Neutral

Contract/Purchase Order No.: <empty>
Date: <empty>

Part I – Request for Services

1. Requesting Official (Name & Title):<empty>
2. Signature of Requesting Official:<empty>
3. Point of Contact (Name and Tel.):
Telephone:<empty>
4. Date of Request:<empty>

5. Preparer (Name & Tel.):<empty>
6. Originating Office (Name & Address):<empty>
7. Case Name, Court & Ct. Docket No.:<empty>
8. DJ File No./USAO No.:<empty>

9. Contractor (Name and Tel.):<empty>
Telephone:<empty>
10. Contractor Mailing Address:<empty>
11. Contractor TIN or SSN (individual):<empty>
12. Contractor Specialty:<empty>

13. Reason for Request (Place an "X" in the applicable Box in the Left Column)

[ ] 13.a. Expert Testimony on Behalf of U.S.
[ ] 13.b. Deposition Conducted by DOJ Attorney
[ ] 13.c. Medical Examination of Plaintiff/Witness/Defendant in Contemplation of Testimony on Behalf of U.S.
[ ] 13.d. Examination Under 18 USC 4241, Mental Competency to Stand Trial Only
[ ] 13.e. Dual Purpose Psychiatric Examination (Time of Offense and Competency to Stand Trial) on the motion of:
[ ] 13.f. ADR Neutral Services
[ ] 13.g. Litigative Consultant Services
[ ] 13.h. Other (explain below):

## Attach the Statement of Work to this Form

14. Negotiated Contractor Rates. Estimated Expenses. and Performance Dates (Note: Expenses incurred n ust be supported by receipts)

<table><tr><th>Service/Expense</th><th>Performance Dates (From-To)</th><th>Hour/Day</th><th>Quantity</th><th>Rate</th><th>Total</th></tr><tr><td>14.a. Examine Case</td><td></td><td>Hour</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.b. Prepare Testimony</td><td></td><td>Hour</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.c. Court Testimony</td><td></td><td>Hour</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.d. Deposition</td><td></td><td>Hour</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.e. Litigative Consultant/Neutral</td><td></td><td>Hour</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.f. Per Diem (if not part of fee)</td><td></td><td>Day</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.g. Privately Owned Vehicle (NTE coach rate)</td><td></td><td>Mile</td><td></td><td></td><td>$ 0.00</td></tr><tr><td>14.h. Common Carrier Transportation Via GTA</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>14.i. Common Carrier Transportation Reimbursed</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>14.j. Miscellaneous</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>14.k. Total Estimated Expenses</td><td></td><td></td><td></td><td></td><td>$ 0.00</td></tr><tr><td>15. Submit Invoices &amp; EFT Information to:
U.S. Attorney's Office, SDNY
Budget &amp; Fiscal Unit

or email:</td><td colspan="5">16. Payment will be made by: (Place an "X" in the applicable Box and fill-in if not JMD/Finance)
[x] ✗ Box 15 [ ]</td></tr></table>

Form USA-47 (Revised 5-2008)

Page 1 of 2

EFTA00032652