Hartford Community Court Legal Services Unit Capital Defense by jD0fQI

VIEWS: 2 PAGES: 6

									                                     ASSIGNED COUNSEL BILLING FORM
pd009 rev. 7/3/12

                                                  PAYEE INFORMATION
Invoice Payable To:                                              Vendor Number: (No more than 8-digits)


Payment Address:                                                 Phone Number:


City:                  State:                                    Zip Code:


Attorney Name:

                                 ASSIGNED COUNSEL CASE INFORMATION
                                                                                           Public Defender Office location:
Client Full Name:

                                                                                                             Select

Date of Appt:



Assignment type:                     Select

Trial:                               Select                      Date of Jury Selection:

                    MOST SERIOUS CRIME CHARGED AND POST CONVICTION CASES
Charge                                                     Description                                        Docket Number
Classification/Case
        Select

                                                             0
                                                      BILLING DETAILS
                                   Purpose                           Specific Time                    Hourly
                          Give brief description of work                                     Unit                     Subtotal
           Date                                                     Designate AM or PM                 Rate
                                    performed
                                                                     Start        End
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                                                                             0.00       $0      $                -
                                    Purpose                    Specific Time                 Hourly
                           Give brief description of work                             Unit                Subtotal
         Date                                                 Designate AM or PM              Rate
                                     performed
                                                              Start         End
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                      0.00    $0      $              -
                                                                                             Hourly       TOTAL
                                                                                      Unit
                                                                                              Rate
                                                                      Total Hours     0.00     $0     $                  -


STATUS OF CURRENT CASE (If disposed, give details below)
Charge                                                                              Date of Disposition




Assigned Counsel Electronic Signature                                   Date

Save and Email this form to: OCPD.Bills.Criminal@jud.ct.gov
VENDOR INVOICE FOR GOODS OR SERVICES                                                                                                                                                               STATE OF CONNECTICUT

RENDERED TO THE STATE OF CONNECTICUT                                                                                                                                                      OFFICE OF THE STATE COMPTROLLER

CO - 17 REV. CCPA 11/16/11                                                                                                                                                              CENTRAL ACCOUNTS PAYABLE DIVISION


                                                                              (2) BUSINESS UNIT NO.                            (3) INVOICE NO.                                            (4) INVOICE AMOUNT
1)   BUSINESS UNIT NAME

                                    PDSM1                                                          98500                                                                                   $                                               -
(5) DOCUMENT DATE                                                             (6) INVOICE DATE             (7) ACCOUNTING DATE                                         (8) RPT. TYPE      (9) VENDOR NUMBER



                                                                                                                                                                                                               0
                             VENDOR / PAYEE: FIELDS 13 THROUGH 22 AND 37 THROUGH 40 ARE MANDATORY FOR PAYMENT
(10) PAYEE INFO:                                                                                                                                                                                              (11) VOUCHER
                                                                                                                                                                                                              NO.
PAYEE:                                                                                                                                                                                                    0
PAYEE:
ADDRESS:                                                                                                                                                           0                                          (12) VOUCHER DATE.

ADDRESS:
CITY:                                                                      0 STATE:                                        0                     ZIP CODE:                                        00000
(13) VENDOR COMMENTS                                                                                                                         0
                                    (14)     GIVE FULL DESCRIPTION OF GOODS AND / OR SERVICES COMPLETED                                            (15) QUANTITY           (16) UNITS            (17) UNIT PRICE                (18) AMOUNT




Total Hours                                                                                                                                                0.00               HRS          $                    -      $                           -



Date Range of Legal Service:

                                              Through



                             Most Serious Crime Charged
                             Classification Or Post-Conviction                          Select
                             Type

                             Trial Status                                               Select




(19)                         (20)                                             (21)                         (22)                (23)              (24)                  (25)               (26)                (27)   (28)         (29)          (30)     (31)


                                                                                                                                                                                                                                                CHART
                                                                                                                                                                                                                                   CHARTFIELD
           AMOUNT                              QUANTITY                                  GL UNIT             BUDGET DATE              FUND         DEPARTMENT                 SID              PROGRAM        ACCO PROJECT/G                    FIELD     BUDGET
                                                                                                                                                                                                                                       1
                                                                                                                                                                                                               UNT   RANT                         2




                                                                                                                                                                       (33) PO.NO.                            (35) COMMODITIES RECEIVE OR SERVICES RENDERED-
                                                                                                                                                                                                              SIGNATURE
(32) AGENCY NAME AND ADDRESS
                                                                                                                                                                                                              JD
                                                                                                                                                                       (34) PO BUSINESS UNIT                  (36) RECEIVING                    (37) DATE(S) OF
John Day                                                                                                                                                                                                      REPORT NO                         RECEIPT(S)

30 Trinity Street
Hartford, CT 06106
Select
                                                                                                                                                        SHIPPING INFORMATION

(38) DATE SHIPPED            (39) FROM – CITY - STATE                                                                          (40) VIA-CARRIER                                                               (41) F. O. B.




DISTRIBUTION: WHITE - CCPA
INSTRUCTIONS – ASSIGNED COUNSEL FOR CRIMINAL SERVICES RENDERED HOURLY BILLING FORM
 Enter the Payee Name (who the check is going to)

   Vendor Number - This is NOT your social security number, it is the vendor # found on CORE/CT Self Service
   Payment Address
   Enter Attorney name
   Enter the client's full name
   Select the Public Defender Location from the Dropdown
   Enter the Date of Appointment
   Select the Assignment Type and Trial Status from the Dropdown
   Enter the Date of Jury Selection if known
   Select the Charge Classification (This will automatically change the rate/hour)
   Enter a Description
 Enter the Docket Number, please put the appropriate prefix (CV, AC, CR, CI,MV, MI, DO, SC). Provide the
year if applicable and the remaining digits of the Docket Number (i.e., CR11-123456)
 For Post-Conviction Cases, Select the Case type and Prefix
 Enter the Docket Number
 Enter the Date of Activity DO NOT COPY AND PASTE FROM ANY OTHER FORMS
 Select an Entry Classification from the drop down.
 Give a brief description of work performed (Cell will grow as you type)
 Enter the time of activity as this example of 12:30 PM. You must put a space between the time and
AM/PM and you must enter AM or PM
   If you are entering time after midnight you must continue to the next line and the next day
   Sign and date the bottom of the form with your approved symbol
   Save and Email the form to: OCPD.Bills.Criminal@jud.ct.gov

ADDITIONAL BILLING INFORMATION
 You do not need to send a separate CO-17 with the hourly invoice because it is included in this file. It is
automatically filled in from the hourly form.
 You must submit your request for payment to the Commission no later than 30 days following the close of
the prior month. Submissions beyond the deadline will result in delayed processing subsequent to the
processing of all timely submitted billing.

 Bills submitted more than six months form the last day of the month in which the work claimed was
performed, except for good cause as determined by the Commission, shall not be accepted

								
To top