CJA 21 AUTHORIZATION AND VOUCHER FOR EXPERT AND OTHER SERVICES (Rev. 5/99)
1. CIR./DIST./ DIV. CODE	2. PERSON REPRESENTED	VOUCHER NUMBER
3. MAG. DKT./DEF. NUMBER	4. DIST. DKT./DEF. NUMBER	5. APPEALS DKT./DEF. NUMBER	6. OTHER DKT. NUMBER
7. IN CASE/MATTER OF (Case Name)	8. PAYMENT CATEGORY	9. TYPE PERSON REPRESENTED	10. REPRESENTATION TYPE
□	Felony	□	Petty Offense	□	Adult Defendant	□	Appellant	(See Instructions)
□	Misdemeanor	□	Other	□	Juvenile Defendant	□	Appellee
□	Appeal	□	Other
11. OFFENSE(S) CHARGED (Cite U.S. Code, Title & Section) If more than one offense, list (up to five) major offenses charged, according to severity of offense.
REQUEST AND AUTHORIZATION FOR EXPERT SERVICES
12. ATTORNEY'S STATEMENT
As the attorney for the person represented, who is named above, I hereby affirm that the services requested are necessary for adequate representation. I hereby request:
□	Authorization to obtain the service. Estimated Compensation and Expenses:	OR
□	Approval of services already obtained to be paid for by the United States pursuant to the Criminal Justice Act. (Note: Prior authorization should be obtained for services in excess of $300, excluding expenses)
Signature of Attorney	Date
□	Panel Attorney	□	Retained Attorney	□	Pro-Se	□	Legal Organization
ATTORNEY'S NAME (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS
Telephone Number:
13. DESCRIPTION OF AND JUSTIFICATION FOR SERVICES (See Instructions)	14. TYPE OF SERVICE PROVIDER
01	□	Investigator	15	□	Other Medical
02	□	Interpreter/Translator	16	□	Voice/Audio Analyst
03	□	Psychologist	17	□	Hair/Fiber Expert
04	□	Psychiatrist	18	□	Computer (Hardware/
15. COURT ORDER	05	□	Polygraph	Software/Systems)
06	□	Documents Examiner	19	□	Paralegal Services
Financial eligibility of the person represented having been established to the Court's satisfaction, the authorization requested in Item 12 is hereby granted.
07	□	Fingerprint Analyst	20	□	Legal Analyst/Consultant
08	□	Accountant	21	□	Jury Consultant
09	□	CALR (Westlaw/Lexis, etc.)	22	□	Mitigation Specialist
Signature of Presiding Judicial Officer or By Order of the Court	10	□	Chemist/Toxicologist	23	□	Duplication Services
11	□	Ballistics	(See Instructions)
Date of Order	Nunc Pro Tunc Date	13	□	Weapons/Firearms/Explosive Expert	24	□	Other (Specify)
Repayment or partial repayment ordered from the person represented for this service at time of authorization.	14	□	Pathologist/Medical Examiner
□	YES	□	NO
CLAIM FOR SERVICES AND EXPENSES	FOR COURT USE ONLY
16.	SERVICES AND EXPENSES

(Attach itemization of services with dates)	AMOUNT CLAIMED	MATH/TECHNICAL

ADJUSTED AMOUNT	ADDITIONAL

REVIEW
a. Compensation
b. Travel Expenses (lodging, parking, meals, mileage, etc.)
c. Other Expenses
GRAND TOTALS (CLAIMED AND ADJUSTED):
17. PAYEE'S NAME (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS

TIN:
Telephone Number:
CLAIMANT'S CERTIFICATION FOR PERIOD OF SERVICE FROM	TO
CLAIM STATUS	□	Final Payment	□	Interim Payment Number	□	Supplemental Payment
I hereby certify that the above claim is for services rendered and is correct, and that I have not sought or received payment (compensation or anything of value) from any other source for these services.
Signature of Claimant/Payee	Date
18. CERTIFICATION OF ATTORNEY I hereby certify that the services were rendered for this case.
Signature of Attorney	Date
APPROVED FOR PAYMENT — COURT USE ONLY
19. TOTAL COMPENSATION	20. TRAVEL EXPENSES	21. OTHER EXPENSES	22. TOTAL AMOUNT APPROVED/CERTIFIED
23.	□	Either the cost (excluding expenses) of these services does not exceed $300, or prior authorization was obtained.
□	Prior authorization was not obtained, but in the interest of justice the Court finds that timely procurement of these necessary services could not await prior authorization, even though the cost (excluding expenses) exceeds $300.
Signature of Presiding Judicial Officer	Date	Judge/Mag. Judge Code
24. TOTAL COMPENSATION	25. TRAVEL EXPENSES	26. OTHER EXPENSES	27. TOTAL AMOUNT APPROVED
28. PAYMENT APPROVED IN EXCESS OF THE STATUTORY THRESHOLD UNDER 18 U.S.C. § 3006A(e)(3)
Signature of Chief Judge, Court of Appeals (or Delegate)	Date	Judge Code