|Item 1.||CIR./DIST./DIV. CODE: This four-character location code is the circuit or district, and divisional office codes for the court where the proceedings whom the person represented are held.|
|Item 2.||PERSON REPRESENTED: Give the full name of the person whom you were appointed to represent.|
|Items 3-6.||DOCKET NUMBERS: Provide the case 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 (NNNNNN), and the defendant number (DDD), as shown in the indictment or charging document. Thus, the format of the docket number is YY-NNNNNN-DDD. Note: If two or more cases are heard or tried together for the person represented, complete a separate voucher for each case in which representation is provided (i.e., for each docket number listed). Prorate the total time among the cases. On the supporting documentation, cross reference the voucher number of all related claims for which costs are prorated.|
|Item 7.||IN CASE/MATTER OF (CASE NAME): In criminal cases, enter U.S. vs. Defendant's Name. If it is a multiple defendant case, give the case cite as provided on the indictment (e.g., U.S. vs. Lead Defendant's Name, et al). If this is a habeas corpus proceeding, enter the Name of the Petitioner vs. the Name of the Respondent and include the respondent's title.|
|Item 8.||TYPE PERSON REPRESENTED: Check the box that defines the legal status of the person represented.|
|Item 9.||REPRESENTATION TYPE: Check one of the following types of representations:
D1 Habeas corpus (capital) petition pursuant to 28 U.S.C. § 2254, seeking to vacate or set aside a state death sentence and Appeals;
|Item 10.||OFFENSE(S) CHARGED: If the case is a capital prosecution in federal court, cite the U. S. Code, title and section, or other code citation of all charges up to five. List all death-eligible charges first. If the case is a direct appeal of a federal prosecution, list all offenses for which the defendant was convicted.|
|Item 11/13||ATTORNEY'S NAME AND MAILING ADDRESS AND NAME AND MAILING ADDRESS OF LAW FIRM: Complete Item 11 with the legal name and address of the attorney appointed to represent the person whose name is shown in Item 2. If prior to your appointment for representation, you had a pre-existing agreement with a law firm or corporation, including a professional corporation, indicating that CJA earnings belong to the law firm or corporation, rather than to the court-appointed attorney/payee, provide the Name and Mailing address of that law firm or corporation in Item 13. This information will allow earnings to be reported to the Internal Revenue (IRS) on a 1099 Statement as earnings of the law firm or corporation and not as the earnings of the attorney appointed. (Note: Information about a pre-existing agreement, including the Taxpayer Identification Number (TIN) of the law firm or corporation, should be provided to the court staff when the attorney is admitted to the panel or at initial appointment to a case.)|
|Item 12.||COURT ORDER: Check the box that describes the type of counsel
appointed. If appointed as a substitute counsel, give the name of the previous
counsel and the appointment date. If appointed as a "Standby Counsel,"
attach the court order establishing this type of appointment in accordance
with paragraph 2.17 of the
CJA Guidelines. Specific qualifications
are required for all counsel appointed to provide representation in death
penalty cases. See 21 U.S.C. § 848 (q)(5)- (7) and 18 U.S.C. §
3005. The remaining portion of the Item will be completed by the clerk
of court or other court-designated person.
If the court approves interim payments because of the conditions stated in Box "D," the court should check this box. The presiding judicial officer or clerk of court must sign and date this court order to validate the appointment. Check statement "E," if full or partial repayment was ordered by the court from the person represented at the time of the appointment. If services were provided prior to court appointment, the presiding judicial officer can ratify the previous service by indicating a "nunc pro tunc" date that covers the services prior to appointment. No other court order is necessary.
|Item 14.||STAGE OF PROCEEDING: Check the box that corresponds to the stage of proceeding for services claimed in Item 15 even if it is anticipated that the work will be used in connection with a later stage of the proceeding. CHECK ONLY ONE BOX. Submit a separate voucher for each stage of proceeding. NOTE: The stage noted as "Other" under "Other Proceeding" should be used only for a petition for presidential pardon or clemency, or other proceeding that cannot fit within the other described categories.|
|Item 15.||CLAIM FOR SERVICES--CATEGORIES FOR HOURS AND COMPENSATION: On
the applicable lines "a" through "j" enter the actual time spent in hours
and tenths of hours. Total the number of hours in out-of-court categories
"b" - "j" and enter the total in the "HOURS CLAIMED" column where required.
Multiply the total hours for in-court and out-of-court time by the allowable
compensation rate. Enter the amount claimed in the "TOTAL AMOUNT CLAIMED"
column for category "a", and for categories "b" - "j." NOTE: Indicate
"Other Dispositive Motions" only for work related to a motion to dismiss,
motion for summary judgment, or similar motion to end the entire habeas
corpus proceeding. If services included in-court hearings of one hour each
on separate dates, enter two hours on the form and attach a sheet indicating
one hour for each of the two dates.
Any mathematical or technical adjustments to your claim during the judicial approval process or an additional review will be indicated in the columns provided on the form under the heading "FOR COURT USE ONLY."
|Item 16.||TRAVEL EXPENSES: Travel related expenses that are incidental to the representation (e.g., transportation, lodging, meals, car rental, parking, bridge, road and tunnel tolls, etc.) must be itemized on a separate sheet, indicating dates the expense was incurred. Attach supporting documentation (receipts, canceled 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. Counsel should be guided by prevailing limitations for travel and subsistence expenses of federal employees. The clerk of court can advise you on applicable rates and federal government travel regulations.|
|Item 17.||OTHER EXPENSES: Itemize all reimbursable out-of-pocket expenses
incidental to the representation. Provide dates and a brief description
of the expense. Submit supporting documentation (a receipt, canceled check,
etc.) for single item expenses in excess of $50. Reimbursable expenses
may include, in some circumstances, payments to a law student or law clerks
for research and assistance, and the cost of computer assisted legal research
(CALR) when conducted by counsel. See paragraph 2.31 and 3.15 of the
CJA Guidelines for an explanation. Fees and expenses for expert attorney
and other consultants in death penalty cases should be authorized and claimed
on a CJA Form 31. The following are not reimbursable expenses, and should
not be claimed:
1. General office overhead, such as rent, telephone services, and secretarial services.Totals. Enter the "Grand Total" where required by adding the total amount claimed for "in-court," "categories b - j," "Travel Expenses," and "Other Expenses."
|Item 18.||CERTIFICATION OF ATTORNEY/PAYEE FOR PERIOD OF SERVICE: The person appointed by the court must certify dates of service for the representation. Indicate where required, the date range for the services claimed on the voucher.|
|Item 19.||APPOINTMENT TERMINATION DATE, IF OTHER THAN CASE COMPLETION: If the appointment is discontinued by order of the court (i.e., substituted counsel or reasons other than disposition of the defendant's case such as fugitive defendant, appointment of a public defender, or retention of counsel by defendant), give the effective date for termination of appointment.|
|Item 20.||CASE DISPOSITION: Indicate case disposition for the person represented.
Select applicable code from the table below.
|Item 21.||CLAIM STATUS: Indicate, by checking the appropriate box, whether the voucher is (1) the final payment for the services, (2) an interim payment, or (3) a supplemental payment (an additional claim submitted after a final payment is made). If an interim payment, indicate the payment number. Complete the remaining portion of Item 21, and sign and date the affirmation statement before submitting the claim for court approval.|
|Items 22-27a.||APPROVED FOR PAYMENT--COURT USE ONLY: The presiding judicial officer will indicate the amount approved for each major category. These amounts will reflect mathematical or technical adjustments to your claim. The total amount approved for payment of the claim, less any amounts withheld for interim payment, is reflected in the "TOTAL AMOUNT APPROVED." The "SIGNATURE OF THE PRESIDING JUDICIAL OFFICER" is required to effect payment of the claim. The JUDGE CODE will be provided by the court staff.|