# Questionnaire for Official Foreign Travel

United States Attorneys' Offices and the Executive Office for United States Attorneys

Last Revised: April 28, 2016

A separate questionnaire is required for each EOUSA/USAO employee who is traveling.

<table><tr><th colspan="5">Part I. Traveler Information and Scope of Travel</th></tr><tr><td colspan="2">Full Name</td><td colspan="3">Office (e.g., EOUSA, USAO-ALN, etc.)</td></tr><tr><td colspan="2"></td><td colspan="3">USAO-SDNY</td></tr><tr><td colspan="2">Position Title</td><td colspan="3">E-mail Address</td></tr><tr><td colspan="2">AUSA</td><td colspan="3"></td></tr><tr><td colspan="2">Telephone Number</td><td colspan="3">Departure Address (City and State)</td></tr><tr><td colspan="2"></td><td colspan="3">New York, New York</td></tr><tr><td colspan="2">Departure Date (from Home or Office)</td><td colspan="3">Return Date (to Home or Office)</td></tr><tr><td colspan="2">02/03/2020</td><td colspan="3">02/06/2020</td></tr><tr><td>Country of Birth</td><td></td><td>Place of Birth</td><td></td><td></td></tr><tr><td>Foreign Locations</td><td>City</td><td>Province (if applicable)</td><td colspan="2">Country</td></tr><tr><td>Destination 1</td><td>Stockholm</td><td></td><td colspan="2">Sweden</td></tr><tr><td>Destination 2</td><td></td><td></td><td></td><td></td></tr><tr><td>Destination 3</td><td></td><td></td><td></td><td></td></tr><tr><td>Destination 4</td><td></td><td></td><td></td><td></td></tr><tr><td colspan="3">Q1: Are you traveling to more than four destinations? If yes, [ ]
attach an additional sheet listing the additional destinations.</td><td>YES</td><td>[x] NO</td></tr><tr><td colspan="3">Q2: Have you completed your travel reservations? If yes, please
attach a detailed flight itinerary, your lodging information, and
any other transportation reservations. If no, please STOP and
make your travel reservations before proceeding.</td><td>YES</td><td>○ NO</td></tr><tr><td colspan="3">Q3: Have you already obtained OIA's approval? If yes, please
attach OIA's approval e-mail. If you are traveling for civil ○
purposes, you do not need OIA's approval to travel. For others,
submit a completed questionnaire to OIA to obtain approval.</td><td>YES</td><td>[x] NO</td></tr><tr><td colspan="3">Q4: Do you have an official passport that is valid for at least six
months from the date you will arrive in the foreign country?</td><td>YES</td><td>○ NO</td></tr><tr><td colspan="3">Q5: Have you submitted a request for an official passport to ○
EOUSA and is the request currently pending?</td><td>YES</td><td>[x] NO</td></tr><tr><td colspan="3">Q6: Has the Department of State granted you a waiver of the
requirement for an official passport? If yes, please attach the ○
State Department's e-mail granting a waiver.</td><td>YES</td><td>[x] NO</td></tr></table>

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Q7: Do any of your destinations require a visa for travel under an official passport? If applicable, submit the required materials to EOUSA to obtain visas prior to departure.

[ ] YES
[x] NO

Q8: For the passport under which you will be traveling, please provide the following data:

Passport Type (e.g., Tourist, Official): Official
Passport Issuing Country: USA
Passport Number (note pending, if applicable): <empty>
Passport Expiration Date (note pending, if applicable): <empty>

<table><tr><th>Q9: Are you traveling to a high-threat area?</th><th>○ YES</th><th>[x] NO</th></tr><tr><td>Q10: Have you completed HTSOS training in the last five
years? If yes, please attach the training certificate if you are
traveling to a high-threat area.</td><td>YES</td><td>○ NO</td></tr><tr><td>Q11: Have you completed FACT training in the last five years?
If yes, please attach the training certificate, if you are traveling
to a high-threat area.</td><td>○ YES</td><td>[x] NO</td></tr><tr><td>Q12: What is your security clearance level? If you have access
to TS-SCI, you must complete a DOJ-504 and provide it to your
DOSM and receive a security briefing prior to departure.</td><td>Secret

[ ] TS-SCI</td><td>○ Top Secret
[ ] Other</td></tr><tr><td>Q13: Do you plan to take any government-furnished equipment
(including "bring your own device" equipment) out of U.S.
territory? If yes, submit a request to your IT Systems Manager.</td><td>YES</td><td>○ NO</td></tr><tr><td>Q14: Will any travel expenses be paid for, or reimbursed, by a
source external to the EOUSA/USAO community? If yes, seek
advance approval from GCO or RMP, as necessary.</td><td>[ ] YES</td><td>[x] NO</td></tr><tr><td>Q15: Do your travel arrangements include actual lodging
expenses (i.e., lodging expenses in excess of OCONUS rates)?</td><td>○ YES</td><td>[x] NO</td></tr><tr><td>Q16: Do your travel arrangements include premium class travel
(e.g., travel accommodations above coach class)?</td><td>○ YES</td><td>[x] NO</td></tr><tr><td>Q17: Have you already received country clearance from the
State Department through the eCC system? If yes, please attach
the eCC notification that provides country clearance.</td><td>○ YES</td><td>[x] O NO</td></tr><tr><td>Q18: EOUSA requests eCC country clearance for nearly all
EOUSA and USAO travelers. The clearance is required prior to
departure. Shall EOUSA request eCC clearance for you?</td><td>[x] YES</td><td>О NO</td></tr><tr><td>Q19: If you do not have eCC authorization to travel, and you
do not want EOUSA to request eCC clearance for you, what
office is requesting eCC clearance on your behalf? Note that
federal investigative agencies are not authorized to obtain eCC
clearance on behalf of EOUSA or USAO attorneys.</td><td colspan="2"></td></tr></table>

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Part II. General Questions Applicable to All Foreign Travel

Q20: Who is paying for the travel?
USAO- SDNY

Q21: If foreign embassy personnel or consular or diplomatic officials have been consulted regarding travel, please provide their names, titles, organizations and contact information.
N/A

Q22: If U.S. Embassy or consular personnel have been involved, please provide their names, titles, section, and contact information.
N/A

Q23: If assistance from U.S. Embassy or consular personnel is required (e.g., a consul official to administer an oath) or if office space at an Embassy or consulate is required, please specify. If the Embassy is coordinating lodging, please include your credit card information.
N/A

Q24: If the assistance of a stenographer, court reporter, interpreter, or other service provider is required in the foreign country, please provide specific details about when and where services are required. EOUSAs will relay the request to the State Department in the eCC system.
N/A

Q25: Please include any other comments or details that would help the Department of State ensure that difficulties do not arise.
N/A

Q26: I am traveling...
[ ] Abroad to Attend a Conference or Training Event (Complete Part III)
[x] To a Country Other Than Canada on a Judicial Assistance Matter (Complete Part IV)
[ ] To Canada on a Judicial Assistance Matter (Complete Part V)

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Part III. Additional Questions for Conferences and Training Events

Q27: What is the name of the conference event or training program?:<empty>

Q28: What is the purpose of the conference event or training program?:<empty>

Q29: What is the specific venue name and address for the conference event or training program?:<empty>

Q30: Who are the primary points of contact for the conference event or training program? Please include contact information (e.g., organizations, telephone numbers, and email addresses).:<empty>

## Part IV. Additional Questions for Travel to Countries Other Than Canada on Judicial Assistance Matters

Q31: Please provide the names, titles, offices, districts, telephone numbers, and email addresses of the individuals traveling abroad with you for purposes of conducting investigations, interviews, depositions, inspections, etc. Include all federal, state or local U.S. officials who intend to travel, as well as service providers who will be traveling with you (if applicable).

AUSA
AUSA
AUSA
FBI SA

Q32: Please provide the case name, USAO number, and court docket number.
In re Jeffrey Epstein, USAO # 2018R01618

Q33: What is the nature of the case (explain briefly in lay terms)? In what stage is the case?
How sensitive is the case in your estimation?

Investigation is ongoing and very sensitive.

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Q34: What is the purpose of travel? In particular, specify what will be accomplished during travel (e.g., interviewing witnesses, taking depositions, etc.):
Interviewing and debriefing a witness.

Q35: Please list the names and nationalities of persons to be interviewed or deposed, including addresses and telephone numbers if available.:
Jane Doe, Swedish

Q36: Is the prosecution of a foreign national foreseen? If so, provide name and nationality.:
A subject of the investigation is Ghislaine Maxwell, who is believed to be a citizen of the United States, the United Kingdom, and France.

Q37: Is a host country government official to be deposed or interviewed? Please provide name, title, and whether the person has been contacted and has agreed to participate.:
No.

Q38: Have foreign authorities (e.g., INTERPOL, foreign police) cleared the visit and are foreign authorities prepared to cooperate? Please explain in detail and reference the names, titles, and telephone numbers of the foreign contacts.:
Yes.

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Part V. Additional Questions for Travel to Canada on Judicial Assistance Matters

Q39: Please provide the names, titles, offices, districts, telephone numbers, and email addresses of the individuals traveling abroad with you for purposes of conducting investigations, interviews, depositions, inspections, etc. Include all federal, state or local U.S. officials who intend to travel, as well as service providers who will be traveling with you (if applicable):<empty>

Q40: Please provide the case name, USAO number, and court docket number.:<empty>

Q41: Briefly explain the background of the case (including the nature of the case, stage of the case, special sensitivities associated with the case, and how much money is involved).:<empty>

Q42: What is the purpose of travel? In particular, specify what will be accomplished during travel (e.g., interviewing witnesses, taking depositions, etc.). Include the dates and times of the interviewing, investigating or other activities. Why is travel to Canada necessary?:<empty>

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Q43: Names of persons to be interviewed or deposed, including dates of birth, nationality and citizenship, phone numbers, and home or business address for each witness and any other pertinent information that may assist in locating them. If this information is unavailable, DFAIT will not grant clearance.:<empty>

Q44: Provide confirmation that the interviews or depositions are voluntary and provide the contact information for the persons who have contacted the witnesses/suspects (e.g., Royal Canadian Mounted Police).:<empty>

Q45: Provide the name and contact information for any legal representative(s) who may take part in the proceedings, as well as that of their firm/organization.:<empty>

Q46: If the prosecution of a foreign national is foreseen, please provide name and nationality.:<empty>

Q47: If a Canadian government official is to be deposed or interviewed, provide name, title, and whether the person has been contacted and has agreed to participate.:<empty>

Q48: If INTERPOL, Canadian law enforcement, or another Canadian authority has cleared the visit or if Canadian authorities are otherwise prepared to cooperate, explain in detail including names, titles, and telephone numbers of the Canadian contact(s).:<empty>

The completed questionnaire and attachments (e.g., itinerary, training certificate), should be:

• Emailed to OIA to obtain OIA's approval for foreign travel (unless OIA approval has already been
obtained or unless travel is for civil purposes only)

• Emailed to EOUSA (using the USAEO-Foreign Travel Mailbox)

• Included as an attachment to the foreign travel authorization in E2 Solutions.

If you have any questions about foreign travel, please contact the EOUSA RMP Travel Unit by emailing USAEOForeign Travel or by calling (202) 252-5600. If you have any questions about foreign travel, please contact the EOUSA RMP Travel Unit by emailing USAEO- Foreign Travel or by calling (202) 252-5600.

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