Form 5 - Equal Access To Justice Act Form printable pdf download

FORM 5

EQUAL ACCESS TO JUSTICE ACT FORM

APPLICATION

FOR FEES AND OTHER EXPENSES UNDER THE EQUAL ACCESS TO JUSTICE ACT

Title 28 U.S.C. §2412(d), Title II of Public Law 96-481, 94 STAT 2325

1. COURT

2. DATE FILED

3. DOCKET NO.

United States Court of Federal Claims

4. NAME OF APPLICANT (One per form )

5. GOVERNMENT AGENCY INVOLVED IN CLAIM

(Use agency code on reverse side)

6. NATURE OF APPLICATION

7. APPEAL FROM:

A. G Original application under 28 U.S.C. §2412(d)(1)(A)

G DISTRICT COURT

GBANKRUPTCY COURT

G OTHER:____________________________________

after judgment in civil action against U.S.

B. G Appeal of fees and expenses awarded by Lower Court

(If Item 6B is checked go to Item 7.)

7A. DATE FILED IN LOWER

7B. DOCKET NO.

C. G Original application under 28 U.S.C. §2412(d)(3) after

COURT

review of agency decision.

D. G Petition for leave to appeal an administrative agency

fee determination under 5 U.S.C. §504(c)(2).

8. ADMINISTRATIVE AGENCY DOCKET NO.

9. DATE FILED IN ADMINISTRATIVE AGENCY

10. SHOWING OF “PREVAILING PARTY” STATUS (28 U.S.C. §2412(d)(1)(B)):

Is agency order, court order, or other relevant document attached?G YES G NO

11. SHOWING OF ELIGIBILITY (28 U.S.C. §2412(d)(2)(B)):

Is net worth information attached? G YES G NO

12. ENTER ALLEGATION THAT GOVERNMENT POSITION WAS NOT SUBSTANTIALLY JUSTIFIED (28 U.S.C. §2412(d)(1)(B)):

13. FOR EACH AMOUNT CLAIMED, PLEASE ATTACH ITEMIZATION INDICATING SERVICE PROVIDED, DATE, HOURS, AND RATE

(28 U.S.C. §2412(d)(2)(A)):

AMOUNT CLAIMED

A. ATTORNEY FEES..............................................................................................

$_______________________

B. STUDY................................................................................................................

$_______________________

C. ANALYSIS..........................................................................................................

$_______________________

D. ENGINEERING REPORT...................................................................................

$_______________________

E. TEST..................................................................................................................

$_______________________

F. PROJECT...........................................................................................................

$_______________________

G. EXPERT WITNESS FEES.................................................................................

$_______________________

H. OTHER FEES AND EXPENSES - SPECIFY

(1)_______________________________________________________

$_______________________

(2)_______________________________________________________

$_______________________

(3)_______________________________________________________

$_______________________

I. TOTAL FEES AND EXPENSES..........................................................................

$_______________________

14. SIGNATURE

15. DATE

NOTE: THIS FORM SHOULD ACCOMPANY YOUR CLAIM WHEN FILED WITH THE CLERK OF COURT

187

Form 5 - Equal Access To Justice Act Form

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