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pdfDEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
FORCE ACCOUNT LABOR SUMMARY RECORD
APPLICANT
PA ID NO.
LOCATION/SITE
PAGE
O.M.B. No. 1660-0017
Expires October 31, 2008
OF
PROJECT NO.
DISASTER
CATEGORY
PERIOD COVERING
DESCRIPTION OF WORK PERFORMED
NAME
DATES AND HOURS WORKED EACH WEEK
JOB TITLE
TOTAL
HOURS
DATE
NAME
COSTS
HOURLY
RATE
TOTAL
HOURLY
RATE
BENEFIT
RATE/HR
TOTAL
COSTS
REG.
JOB TITLE
O.T.
NAME
REG.
JOB TITLE
O.T.
NAME
REG.
JOB TITLE
O.T.
NAME
REG.
JOB TITLE
O.T.
TOTAL COSTS FOR FORCE ACCOUNT LABOR REGULAR TIME
$
TOTAL COST FOR FORCE ACCOUNT LABOR OVERTIME
$
I CERTIFY THAT THE INFORMATION ABOVE WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.
CERTIFIED
FEMA Form 90-123, FEB 06
TITLE
DATE
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 30 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed
data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden
estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC, 20472,
Paperwork Reduction Project (1660-0017). Submission of the form is required to obtain or retain benefits under the Public Assistance Program. Please do not send your completed form to the above address.
| File Type | application/pdf |
| File Modified | 2008-08-06 |
| File Created | 2008-08-06 |