cja28h Other Services Summary Budget Worksheet for Non-capital Representations with the Potential for Extraordinary Cost

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CJA 28H (Rev. 10/12)	
Other Services Summary Budget Worksheet 
for Non-capital Representations with the Potential for Extraordinary Cost	
This summary budget worksheet summarizes anticipated “other” services.  The document should be
submitted to the court in representations that “appear likely to become or have become extraordinary in
terms of potential cost” as set forth in section 230.26.10 of the Guidelines for Administering the CJA and
Related Statutes, Volume 7A, Guide to Judiciary Policy.  The accompanying detailed budget worksheet
may be of assistance to counsel in preparing the summary.  The document automatically totals hours and
dollar amounts.
Date:
Case Name:
Case Number:
Type of Service:
Name of Provider:
Hourly Rate:
Other Service
Hours
I. Nature and Purpose of Services
A. Nature:
Purpose:
B. Nature:
Purpose:
C. Nature:
Purpose:
D. Nature:
Purpose:
II. Estimated Hours of Services (including travel time)
Total Hours:

CJA 28H (Rev. 10/12)	  Other Services Summary/Page 2	
Dollars
III.  Travel Expenses
Travel Costs:
IV. Other Miscellaneous Costs and Expenses
Miscellaneous Costs and Expenses:
Approved Case Budget for Other  Services: Dollars
Other Services Time
Hourly Rate: $0.00
Hours: 0.0
Fees Approved (hours multiplied by hourly rate): $0.00
Travel Costs:$0.00
Other Miscellaneous Costs and Expenses: $0.00
Grand Total Budget for Other Services: $0.00