INTERPRETER CLAIM FOR COMPENSATION AND EXPENSES Language: Interpreter/Firm Name: Address: Social Security Number/Tax I.D. Number: Phone Number: E-mail Address: Fax: Case Docket Number Style of Case: (1) USA v. (2) USA v. (3) USA v. (4) Judge/Magistrate/Office Services Provided: USA v. Date (mm/dd/yy) Hours Type of Proceeding: (1) to (2) to (3) to (4) Approved for payment by CRD: to Skill Level: Certified Type of Service: Professionally Skilled Interpreting Translation Language Skilled Other (specify) Rate of Payment for ½ day $ @ days: $ Rate of Payment for full day $ @ days: $ Other Rate of Payment $ : @ $ Overtime Rate: $ per hour @ hours: $ Travel Time: per hour @ hours: $ $ Mileage $ 0.550 per mile (in excess of 30 miles one-way) Parking @$ per day @ (for travel in excess of 30 miles one-way) per day @ Hotel Rate @ $ M & IE Rate @ $ Total Round-trip miles: $ days: $ days: $ per day (for overnight travel) @ days: Total Compensation Claimed : $ $ CERTIFICATION: I hereby certify that no other claims for compensation and/or expenses have been filed, nor has payment been received from any other government source or agency for the services or time represented in this claim. (CHECK ONE) I have not or have worked on this date for (ex. U.S. Probation Office, U.S. Pretrial Services, Public Defender’s Office). Note: You may not submit claims for two half-days separately to any of the above, since to do so would result in an overpayment by the U.S. Courts. Date Signature of Interpreter FOR COURT USE ONLY NEW VENDOR INFORMATION: If the interpreter is a new vendor, this section should be completed and a copy of this claim form sent to Sandy Howes. Vendor Type: Fed. Gov. 1099 Vendor: Yes Non Gov. State Gov. Local Employee Gov. No American LegalNet, Inc. www.FormsWorkflow.com Revised: 02/02/09