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.

 

 


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