EFTA00163242.pdf

U.S. Department of Justice Office of the Deputy Attorney General Briefing RSVP November 12, 2020- Miami, FL Please fill out the following form and return to the IBriefineRSVP ®usdoi.gov email box by November 2, 2020. lull Name Email Address; Phone Number: Social Security Number: Address 1 Address 2: City. State: Zip: Citizenship: Country of Birth: Date of Birth: Can you attend? Yes I will attend No, I cannot attend Will you need travel arrangements? Yes, I will need 'rive! arrangements : No, l will not need travel arrangements If yes, which mode of transportation do you prefer? Alf . Bus Rail LI Mileage reimbursement (if you are utilizing your own vehicle) Only economy, roundtnp fares and one Checked luggage bag per person will be authorized. You will be responsible for any incidental charges incurred such as ia0lght snacks, Pay.Per-View, Wi-ri, etc. Airport / station of origin: Preferred date and time of departure from origin: Preferred date and time of departure from Miami: Do you require lodging? Only two nights of lodging will be authorized and only hotel room cost and tax will be authorized. You will be required to provkle a credit card for incidental charges upon check In. You will be responsible for any incidental charges Incurred such as snacks, mini bar, Pay-Per-View, phone charges, etc. CI Yes, I will require lodging ZI No, I will not require lodging Do you require ground transportation? 001 will reimburse the costs of parking, ground transportation from home to airport/station, from airport/station to hotel and/or to FBI Building but not for any other local travel. Please keep all receipts. Ye], I will require reimbursement for ground transportation Commented [Ali: Stade wettingwith OWL or AO to confirm ma] box set-up... Author EFTA00163242 : No, I will not require reimbursement for ground transportation Will your attorney participate in the meeting? Please note that Dal will not be able to support any costs related to your attorneys participation. CI Yes, my attorney will participate in the meeting CI No, my attorney will not participate in the meeting If yes, what is the name of your legal representative: You are authorized to bring one support person for your travel, although that person will most likely not be able to enter the FBI building due to COVID-19 protocols. Will you be traveling with a support person? Yes, I will bring one support person . No, I will not bring a support person Information on support person traveling with you of any) Support Person's Name: Relationship: Email Address: Phone Number: Social Security Number (If any(•: Address 1: Address 2: City State: Zip: Citizenship: Country of Binh: •This information is needed in order to enter the FBI Building. Date of Bath: Will your support person need travel arrangements Yes. my support person will need travel arrangements D No, my support person will not need travel arrangements If yes, which mode of transportation do they prefer? Rail LJ Bus Mileage reimbursement (if they are utilizing their own vehicle) Only economy, rounddip fares and one checked luggage bag per person will be authorized. You will be responsible for any incidental charges incurred such as in-flight snacks, Pay-Per-View, WI-FI, etc. Airport / station of origin: Preferred date and time of departure from origin: Preferred date and time of departure from Miami: If bringing a support person, will your support person require separate lodging? Only two nights of lodging will be authorized and only hotel room cost and tax will be authorized. You will be required to providea credit card for incidental charges upon Check In. You will be responsible for any incidental charges incurred such as snacks, mini bar, Pay-Per-View, phone charges, etc. 0 Yes, my support person will require separate lodging No, my support person will not require separate lodging 2 EFTA00163243 If bringing a support person, will your support person require ground transportation? Dal will reimburse the costs of parking, ground transportation from home to airport/station, from airport/station to hotel and/or to FBI Building but not for any other local travel. Please keep all receipts. K Yes, my support person will require reimbursement for ground transportation K No, my support person will not require reimbursement for ground transportation Acknowledgement and Signature (Block 1) By checking and signing below, I acknowledge I have read and understand that only lodging. lodging taxes, mileage, and commercial transportation expenses (airfare, bus, train, and hotel transportation only) will be authorized as outlined above. I understand that the following will not be Included/provided in the authorized expenses: meals, rental vehicle, entertainment, or other Incidental charges. LI Yes, I acknowledge Signature Date: the above statement Acknowledgement and Signature (Block 2) By checking and signing below, I confirm that I will not undertake travel to the meeting if the answer to either of the Covid-19 Questions below is "yes" at the time of travel. I further acknowledge that I have read and understand the COVID-19 protocols in place for this meeting, including the Temperature Screening, and confirm that I will abide by the protocols during the meeting and at all times while inside the FBI building. K Yes, I acknowledge Signature Date: the above statement COVID-19 QUESTIONS: 1. Do I currently have a fever, cough, shortness of breath or difficulty breathing, repeated shaking from chills, muscle pairk sore throat, new loss of taste or smell, or any other flu-like symptoms? 2. In the past 14 days, have I been in close gess than 6 feet) and prolonged (more than 15 minutes) contact with someone with presumptive or confirmed COVID-19 without wearing a face covering or mask? Commented IA2I: Note to attadi the lamp Check Poster Visitor? document but not the more detailed 'Temperature Screening Protocol; which appears more internal? Author EFTA00163244