EFTA00038871

FD-794 Version 2.0 Revised 03/11/2021 (Blank form is Unclassificd/W0U0, but may be classified when filled in) FEDERAL BUREAU OF INVESTIGATION PAYMENT REQUEST The collection of information on th s form is authorized by 5 U.S.C. 301 (FBI authorized to create and retain agency records) and 28 U.S.C. 530C(bX4) (FBI authorized to use appropriated funds for conduct of its authorized activities). Your Social Security Number is solicited as authorized by E.O. 9397 (Nov. 30, 1943), as amended by E.O. 13478 (Nov. 18, 2008). The inform tion sought will be used by the FBI to process your request for an advance payment of funds or request for reimbursement for authorized commercial or source-re atcd expenses. Disclosure of the requested information is mandatory; failure to provide the requested information will delay the processing of your request and may result in its denial. This information is maintained in the FBI Central Records System. Justice/FBI-002, a description of which can be found at hups://go.(binct.tbi'DO/OGULTEUPCLUIPrivacyCivil*A20Liberliee/020Libraty/FomuNBI002.aspx. This information may be disclosed in accordance with the routine uses referenced in this notice. Cost Code: I3540 Forfeiture or Drug Related'? 0 Y" C) No Overall Classification of Form*: !Unclassified Program/Subprogram* (if not listed, type the 4-5 digital code): I(RIRI) Violent Crimes Against Children, Violent Crimes Against Children Need help? Use the ENIGMA tool online to confirm correct PISP by case classification. I INFORMATION ABOUT THE REQUESTING EMPLOYEE ' • itial) Ell VERY': Division: Section/RA: New York r: (include area code) Waslwill the expense be paid by an alternate employee? O Yes 0 No 'NYC) HQ City Case Number*: I50D-NY-3027571 Is this a one time non-symbol source payment*? 0 Yes * No If an expense was already incurred. was it paid with personal funds? If yes. please select your preferred method of reimbursement: 0 Yes 0 No Justification*: I Date of Requesr: 10/07/21 UniUSquad: C-20 This request is for the reimbursement of expenses incurred by the case team through the purchase of meals fora trial witnesses on 06123121. To be completed by FINANCE OFFICE ONLY. hind: Organization Level 2: Program: Sub Program: SOC: Sub SOC: Description*: \mount : Investigative Expense Total Request: Add New Row Remove Row To he completed by FINANCE OFFICE ONLY. BID I': EBFV: Project: User Dimension 4: User Dimension 5: FD-794 (Blank form is Unclassificd/S0U0, but may be classified when filled in) Page of EFTA00038871 FD-794 Version 2.0 Revised 03/11/2021 (Blank form is Unclassificdf/F0U0, but may be classified when filled in) FEDERAL BUREAU OF INVESTIGATION PAYMENT REQUEST APPROVAL HQ Only Reouestor Supervisor: Next Level Supervisor: Field Only supervisor Initials: SAC/ASAC/AO/SAS: Procurement Authority: Signature! Date Pigitalla4pproved via Sentinel FINANCE OFFICE ONLY SETTLEMENT OF ADVANCE Document Number: Commitment: Obligation: Advance: Expense: Cash Receipt: Cash Receipt - OTCnet (CRO): OTCnet Deposit Ticket II: Creator Date: Initials: FOS Approver P Date: Initials: FD-794 (Blank form is Unclassificdf/F0U0, but may be classified when filled in) Page of EFTA00038872