FORM
45 C.F.R. § 1609.4
(Case number or name of case which has been filed in court or other public forum)
This case is a fee generating case. If the case were undertaken on behalf of an eligible client by an attorney in private practice, there would be reasonable expectation that the case could result in a fee for legal services from an award:
| (1) | to a client __________;or |
| (2) | from public funds ___________; or |
| (3) | from the opposing party ________ 1609.2(a) |
Although, if undertaken by an attorney in private practice, there would be a reasonable expectation that the case could result in a fee for legal services, this is not a fee-generating case because a court appointed the Name of the Program or its employee to provide representation in this case pursuant to a statute or a court rule or practice equally applicable to all attorneys in the jurisdiction _________ . [see below]
| A. | Representation is provided in this
fee-generating case because: |
| (1) the case been rejected by the
local lawyer referral service
Name of referral
service
, or by two private attorneys
Names of attorneys
on
date
___ __________; or |
|
| (2) neither the referral service
Name of referral
service
, nor two private attorneys
Names of attorneys
will consider the case
without payment of a consultation fee ___________
1609.3(a) |
(This section needs to be addressed only if there are no checks in the prior section)
| B. | Representation was provided in this
fee-generating case without first attempting to refer the
case because: |
| (1) the
eligible client is seeking only statutory benefits as
defined by
1609.3(b)(1)_____________;
or |
|
| (2) The director has determined that
referral of the case to the private bar is not possible because: |
| (i) | documented attempts to refer similar cases in the
past generally have been futile _____________; or |
||
| (ii) | emergency circumstances compel immediate action
before referral can be made, but the client has been
advised that, if appropriate and consistent with
professional responsibility, referral will be attempted
at a later time __________; or |
||
| (iii) | recovery of damages is not the principal object of
the recipient's client's case and substantial statutory
attorney's fees are not likely to be available
____________ |
Name of Principal Advocate:_________________ Date completed:________________
This form should be used each time the recipient takes a fee generating case and should capture the reason why the case was taken.
