EFTA00038871.pdf

Type: pdf
Source set: data-set-8

Extracted text

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
Justific…

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