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pdfDEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
FORCE ACCOUNT EQUIPMENT SUMMARY RECORD
PA ID NO.
APLICANT
LOCATION/SITE
PAGE
OF
PROJECT NO.
DISASTER
CATEGORY
PERIOD COVERING
O.M.B. No. 1660-0017
Expires October 31, 2008
DESCRIPTION OF WORK PERFORMED
TYPE OF EQUIPMENT
INDICATE SIZE, CAPACITY, HOURSEPOWER,
MAKE AND MODEL AS APPROPRIATE
DATES AND HOURS USED EACH DAY
EQUIPMENT
CODE
NUMBER
OPERATOR'S
NAME
DATE
COSTS
TOTAL EQUIPMENT TOTAL
HOURS
RATE
COST
HOURS
HOURS
HOURS
HOURS
HOURS
HOURS
HOURS
HOURS
GRAND TOTAL
I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.
CERTIFIED
FEMA Form 90-127, FEB 06
TITLE
DATE
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PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 15 minutes 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). Please do not send your
completed form to the above address.
File Type | application/pdf |
File Modified | 2008-08-19 |
File Created | 2008-08-19 |