Juvenile Expert Panel Fee Claim Form {JC-E-639}

SUPERIOR COURT OF CALIFORNIA COUNTY OF SACRAMENTO SITTING AS THE JUVENILE COURT Juvenile Expert Panel Fee Claim Form Court-Appointed Juvenile Delinquency Expert Panel Instructions: Submit claim along with the evaluation report directly to the judicial officer's department that ordered the evaluation. 1. Case Name: 2. Case No.: 4. Department: 5. Date Ordered: Case Information 3. Heard before Judicial Officer: 6. Evaluation Type: A. Dispositional Evaluations (non-CAPS), including Penal Code 288.1 Evaluations, etc. (Welfare & Institutions Code § 741), County expense; B. Child Adolescent Psychiatric Services (CAPS), California Rules of Court, Rule 5.645(a), County expense; or C. Competency, California Rules of Court, Rule 5.645(d), Court expense. I was appointed by the above-named judicial officer to conduct a psychological evaluation and to prepare a written report for the Court pursuant to Section 730 of the Evidence Code. 7. I request a total fee in the amount of: 8. Number of hours claimed: Claim Information and Amount $ You must also provide a separate attached detailed billing statement, with the following information (see sample format on right): a. Date(s) of work performed; b. Description of all work performed; c. Total time for each work activity indicated; and d. Total hours for all worked performed. Note: Requests for fees in excess of $1,000 require prior written approval of the Court. The Expert shall include in the request for approval an explanation as to the basis for additional fees. You must attach any written approvals to your claim. 9. Name: Sample Format: Detailed Billing Statement Date 2/2/15 2/2/15 Worked Performed Evaluation of Minor Preparation of Report Hours 3.5 2.5 6.0 Amount xxx.xx xxx.xx $xxx.xx TOTAL Hours and Amount 10: Vendor No.: 11. Telephone No.: Doctor Information 12. Address: 13. Signature: ___________________________________________________________ Signature of Doctor 15. Court Administration Comments: 14. Date: For Court Use Only 16. Fees are approved in the sum of: $ __________________ _____________________________________________________ Judge of the Superior Court _____________________ Date Form: JC/E-639 Adopted for Mandatory Use (Revised 11/10/2015) Juvenile Expert Panel Fee Claim Form Page 1 American LegalNet, Inc. www.FormsWorkFlow.com