Form DC-AF1 "Request for Approval of Attorney's Fees" - Hawaii

What Is Form DC-AF1?

This is a legal form that was released by the Hawaii Department of Labor & Industrial Relations - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2021;
  • The latest edition provided by the Hawaii Department of Labor & Industrial Relations;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DC-AF1 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Labor & Industrial Relations.

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Download Form DC-AF1 "Request for Approval of Attorney's Fees" - Hawaii

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State of Hawaii
Department of Labor and Industrial Relations
Disability Compensation Division
REQUEST FOR APPROVAL OF ATTORNEY’S FEES
Notice is hereby given to the Director of Labor and Industrial Relations that
the undersigned performed services as counsel in the following case.
Attorney: ________________________________________ DCD Case No.: _________________
Claimant: ____________________________ v Employer: _______________________________
Summary of fees and costs requested.
Fees and costs are sought for the foregoing services, and approval thereof is hereby requested
in accordance with Chapter 386, Hawaii Revised Statutes. This request was served upon
____________ on ___________ as required, pursuant to Section 12-10-69, Hawaii
Administrative Rules. Any Party may file a written objection to this request for approval no
later than ten calendar days after service.
Attorney Hourly Rate: $___________
Paralegal Hourly Rate: $____________
Attorney Total Hours: ____________
Paralegal Total Hours: _____________
Fee Requested: $____________
Tax:
$____________
Costs:
$____________
TOTAL Fees and Costs Requested: $____________
WC-17 Box # Requested: __________
Required Attorney Information:
I have approximately ________ years’ experience in workers’ compensation cases.
I have participated in approximately _________ cases before the Disability Compensation
Division over the last 3 years.
Attach a statement itemizing the services provided for claimant, the time spent on each service
(rounded to the nearest one-tenth of an hour), the costs advanced with receipts documenting
those costs, and a brief explanation of the benefits you obtained for your client, case
complexity, novelty, and specific case difficulties to merit the fee request.
I certify that the above information is submitted in good faith and is true and accurate to the
best of my knowledge and belief.
Signature: _____________________________________________ Date: __________________
Mailing Address: ________________________________________________________________
City
State
Zip Code
DC-AF 1 (REV 2/2021)
State of Hawaii
Department of Labor and Industrial Relations
Disability Compensation Division
REQUEST FOR APPROVAL OF ATTORNEY’S FEES
Notice is hereby given to the Director of Labor and Industrial Relations that
the undersigned performed services as counsel in the following case.
Attorney: ________________________________________ DCD Case No.: _________________
Claimant: ____________________________ v Employer: _______________________________
Summary of fees and costs requested.
Fees and costs are sought for the foregoing services, and approval thereof is hereby requested
in accordance with Chapter 386, Hawaii Revised Statutes. This request was served upon
____________ on ___________ as required, pursuant to Section 12-10-69, Hawaii
Administrative Rules. Any Party may file a written objection to this request for approval no
later than ten calendar days after service.
Attorney Hourly Rate: $___________
Paralegal Hourly Rate: $____________
Attorney Total Hours: ____________
Paralegal Total Hours: _____________
Fee Requested: $____________
Tax:
$____________
Costs:
$____________
TOTAL Fees and Costs Requested: $____________
WC-17 Box # Requested: __________
Required Attorney Information:
I have approximately ________ years’ experience in workers’ compensation cases.
I have participated in approximately _________ cases before the Disability Compensation
Division over the last 3 years.
Attach a statement itemizing the services provided for claimant, the time spent on each service
(rounded to the nearest one-tenth of an hour), the costs advanced with receipts documenting
those costs, and a brief explanation of the benefits you obtained for your client, case
complexity, novelty, and specific case difficulties to merit the fee request.
I certify that the above information is submitted in good faith and is true and accurate to the
best of my knowledge and belief.
Signature: _____________________________________________ Date: __________________
Mailing Address: ________________________________________________________________
City
State
Zip Code
DC-AF 1 (REV 2/2021)