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UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF TEXAS
_________________ DIVISION
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V. § Case No.
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CLAIM FOR REIMBURSEMENT OF ATTORNEY FEES AND EXPENSES
I was appointed by the Honorable , United States District
Court Judge, to represent , in the above captioned case.
Final judgment was entered on .
I withdrew from the case on ______________, prior to entry of judgment.
The case was dismissed on _______________, prior to entry of judgment.
In accordance with the provisions of the Plan, I am requesting reimbursement for
fees and expenses as follows:
Fees Claimed:
Expenses Claimed:
Total Amount Claimed: 0.00
I have attached to this Claim a detailed Hourly Fees Worksheet (with a description of
services rendered) or a Report of Expenses Claimed Worksheet, as appropriate, along with all
required receipts.
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I certify the above attorney’s fees and expenses were incurred in the preparation and
presentation of this case; that these attorney’s fees and expenses do not include any costs either
waived or recoverable under the provision of Title 18 or Title 28, United States Code, or which have
been recovered under any other plan; and no attorney’s fees or expenses were awarded pursuant to
a judgment before this court.
____________BBBBB___________________
Attorney Signature
____________________________________
Attorney’s Printed Name
Pending approval from the Non-Appropriated Fund Committee, the above claim for
payment of attorney’s fees is APPROVED in the amount of $ .
Pending approval from the Non-Appropriated Fund Committee, the above claim for
reimbursement of expenses is APPROVED in the amount of $ .
The above claim for reimbursement is DENIED.
Date
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CLAIM FOR REIMBURSEMENT OF ATTORNEY’S FEES AND/OR
REIMBURSEMENT OF EXPENSES FROM THE
NON-APPROPRIATED FUND
Civil Case Number:
Date Court Approved Expenses:
TYPE OF EXPENSE AMOUNT
Depositions and Transcripts:
Investigative or Expert Services
Investigative:
Expert:
Travel Expenses
Mileage at $ per mile: (no. of miles)
Parking:
Lodging:
Fees for Service of Process:
Interpreter Services:
Other
Photocopying:
Photographs:
Telephone Toll Calls:
TOTAL EXPENSES CLAIMED: 0.00
X
Signature Date
Supporting documentation, such as receipts, must be attached to this worksheet.
CIVIL CASE HOURLY FEES WORKSHEET See Next Page for Instructions Reset Page 4
Support for Claim of Reimbursement of Attorney’s Fees from the Non-Appropriated Fund Case Number:
SERVICES PROVIDED
P R E PA R E
P R E PA R E PR E P A R E PREPARE A N D /O R
A N D R E V IE W AND PR E P A R E A N D FOR AND R E V IE W
C A SE R E V IE W ATTEND ATTEND P R E T R IA L IN V E ST IG A T IV E TRAVEL
DATE DESCRIPTION OF SERVICE DOCUM ENTS P L E A D IN G S D E P O SIT IO N S M E D IA T IO N M A T E R IA L S W ORK T IM E OTHER
Page Total 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Grand Total 0.0
INSTRUCTIONS
Date Column
Insert actual date of service. Dates must be in chronological order.
Description Column
Attorney must provide brief, but appropriately detailed description of services noted in “Services Provided” columns per following examples:
Services Provided Column Headings Description Column Example
Prepare and Review Case Documents Interrogatory’s
Request for Production of Documents
Request for Admissions
Discovery
Prepare and Review Pleadings Motion to Compel
Motion for Summary Judgment
Motion for Dismissal
Motion to Transfer Judgment
Motion for Continuance
Prepare For and Attend Depositions
Prepare For and Attend Mediation
Prepare and/or Review Pretrial Materials: Motions in Limine
Witness Lists
Exhibit Lists
Travel Time
Investigative Work: Interviews
Review Private Investigator Reports
Other: Other services not classified above.
Columns
Indicate hours logged on each date, for each service provided, in appropriate column.
Note: Prepare separate worksheets for different CJA hourly rates. Multiply hours by CJA rate effective on date of service. Current and historical
CJA rate information can be found at http://www.txwd.uscourts.gov/cja/default.asp
