FD-794

Version 2.0
Revised 03/11/2021

(Blank form is Unclassificd//P0U0, but may be classified when filled in)

# FEDERAL BUREAU OF INVESTIGATION

## PAYMENT REQUEST

The collection ofinformation on th s form is authorized by 5 U.S.C. 301(FBI authorized to create and retain agency records) and 28 U.S.C. 530C(bX4) (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 inform tion 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-re atcd 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. Justicc/FBI-002, a description of which can be found at hups://go.fbinet.fbiiDOIOGOLTHIPCLU/PrivacyCivil*A20Lihcrties%20Library/Fomis/FBI002.aspx. This information may be disclosed in accordance with the routine uses referenced in this notice.

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 Bureau Name*: (Last, First, Middle Initial)
<empty>
UEID*:
<empty>
Date of Request*:
10/07/21
Division:
New York
Section/RA:
NYO HQ City
Unit/Squad:
C-20
Telephone Number: (include area code)
<empty>
Case Number*:
31E-NY-3027571
Was/will the expense be paid by an alternate employee?
[ ] Yes
[x] No

Is this a one time non-symbol source payment*?
[ ] Yes
[x] No
If an expense was already incurred, was it paid with personal funds?
If yes, please select your preferred method of reimbursement:
[x] 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.

To be completed by FINANCE OFFICE ONLY.
Fund: <empty>
Organization Level 2: <empty>
Program: <empty>
Sub Program: <empty>
SOC: <empty>
Sub SOC: <empty>
Description*: <empty>
Amount*: <empty>

Total Request: <empty>

Add New Row
Remove Row

To he completed by FINANCE OFFICE UNIX.

BBFY: <empty>
EBFY: <empty>
Project: <empty>
User Dimension 4: <empty>
User Dimension 5: <empty>

FD-794

(Blank form is Unclassificdf/F0U0, but may be classified when filled in)

Page of

EFTA00038874

FD-794
Version 2.0
Revised 03/11/2021

(Blank form is Unclassificdf/F0U0, but may be classified when filled in)

# FEDERAL BUREAU OF INVESTIGATION

## PAYMENT REQUEST

## APPROVAL

HQ Only
Signature / Date

Requestor Supervisor:
Next Level Supervisor:

Field Only
Supervisor Initials:
SAC/ASAC/AO/SAS:
Digitally Approved via Sentinel
Procurement Authority:

## FINANCE OFFICE ONLY
SETTLEMENT OF ADVANCE

<table><tr><th colspan="5">Creator  FOS Approver</th></tr><tr><td>Document Number:</td><td>Date:</td><td>Initials:</td><td>Date:</td><td>Initials:</td></tr><tr><td>Commitment: </td><td>P</td><td></td><td></td><td></td></tr><tr><td>Obligation: </td><td></td><td></td><td></td><td></td></tr><tr><td>Advance: </td><td></td><td></td><td></td><td></td></tr><tr><td>Expense: </td><td></td><td></td><td></td><td></td></tr><tr><td>Cash Receipt:</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></tr><tr><td>OTCnet Deposit
Ticket II:</td><td></td><td></td><td></td><td></td></tr></table>

FD-794

(Blank form is Unclassificdf/F0U0, but may be classified when filled in)

Page of

EFTA00038875