DISTRICT OF NORTHERN MARIANA ISLANDS

SERVICE PROVIDER FUNDING REQUEST

Complete and attach this form to an AUTH in eVoucher BEFORE provider work exceeding a combined $900 is performed.

SECTION I - GENERAL INFORMATION

Attorney Name:

Defendant Name:

Case Title:

Case Number:

Total No. of Defendants:

Designated Complex:	YES NO

Trial date, if any:

Plea date, if any:

Sentencing date, if any:

SECTION II – SERVICE PROVIDER INFORMATION

Service Provider Name:

Address:

Email:

Phone:

Type of Provider:

SECTION III – REQUESTED FUNDING

Presumptive rates for most providers are available on the Ninth Circuit’s CJA Resources Webpage.

Number of hours:

Hourly Rate:

Amount Requested:

Is this the first request for this service provider type: YES NO

If no, total amount previously authorized: and total amount exhausted to date:

Are you requesting interim payments for this service provider: YES NO

Interim payments are permissible to relieve service providers of financial hardship in extended cases. If you are seeking interim payments for this provider, please provide a brief justification:

SECTION IV – JUSTIFICATION

Describe the services to be provided and why they are necessary. If exceeding the statutory maximum, explain why the requested services are “necessary to provide fair compensation for services of an unusual character or duration.” 18 U.S.C §§ 3006A(e)(3); 3599(g)(2). For supplemental requests, describe what was accomplished with the prior authorization(s) and what services will be provided with the additional funds:

Describe the provider’s relevant experience or specialized knowledge and attach a CV/resume/relevant license to the Documents tab of the AUTH:

NUNC PRO TUNC AUTHORIZATION Note: Counsel is responsible for the oversight of service providers and the status of their available funding. Nunc pro tunc requests for services exceeding $900 (in the aggregate) or for services exceeding an existing funding authorization may be denied absent adequate justification for not requesting the funds in a timely manner. Requested Nunc pro tunc date: Explanation for why procurement of necessary services could not await prior authorization:

SUBMISSION INSTRUCTIONS Save this document as a PDF. In eVoucher, create a new AUTH form and select one of the following: “Create New Authorization” if this is an initial funding request for this provider; or “Request Additional Funds” if this is a second or subsequent request for this provider. On the AUTH Basic Info tab, enter the following: Amount Requested from Section III above in “Estimated Amount” field; Number of hours and hourly rate in “Basis of Estimate” field; Brief description of services to be rendered in “Description” field; “Service Type”; and Provider’s name in “Notes” field (unless name unknown). Upload the PDF of this form to the Documents tab. Click “Submit” on the Confirmation tab. Note: If you’ve previously obtained an order from the Court authorizing funding for this service provider, this form is unnecessary. Instead, attach a copy of the Court’s order to the AUTH in eVoucher.