Form 1900-10 US EPA Contractor's Cumulative Claim and Reconciliation

EPA United States Environmental Protection Agency Contractor's Cumulative Claim and Reconciliation					OMB No. 2030 - 0016
1. Contractor's Address (include zip code)					2. Contract No.
3. Total amounts claimed under this contract (less disallowances concurred by the contractor and disallowances not subject to appeal) and approved on Public Vouchers Nos. to (including completion vouchers).
Item					Amount
Direct Labor					$
Direct Material and Supplies					$
Equipment					$
Travel					$
Subcontract Costs					$
Other Direct Costs					$
Consultant Fees					$
Fixed Fee					$
Indirect Costs (Total From Section 4)					$
Total Amount Claimed					$
4. Reconciliation of Indirect Costs Claimed. Record the amount of indirect costs calculated, for each cost center, using negotiated final indirect cost rate(s). Use provisional rate(s) if final rates are not negotiated for any fiscal year period(s). Use the reverse side of this form, if necessary, to display all years and cost centers.
	Cost Center	Cost Center		Cost Center		Cost Center	Cost Center
FY­
Base
Rate
Indirect Costs
FY­
Base
Rate
Indirect Costs
FY­
Base
Rate
Indirect Costs
Totals
No monies or other benefits may be paid unless this report is completed and filed as required in the EPA billing instructions.
I certify that the information provided on this form and attachments thereto are accurate and complete. I acknowledge that any knowingly false or misleading information may be punishable by fine and/or imprisonment under applicable law.
Name and Title (Print or Type)			Signature					Date

Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to average 40 minutes per response, including the time for searching existing data sources, gathering and maintaining data, and completing and reviewing data. Send comments regarding this burden estimate or any other aspect of this collection of information (including suggestions for reducing this burden) to: (1) Manager, Policy and Oversight Service Center (mail code 3802R) U.S. Environmental Protection Agency 1200 Pennsylvania Avenue, NW Washington, DC 20460; and Paperwork Reduction Project (OMB No. 2030-0016) Office of Information and Regulatory Affairs Office of Management and Budget Washington, DC 20503. Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 200503.
	Cost Center	Cost Center	Cost Center	Cost Center	Cost Center
FY
Base
Rate
Indirect Costs
FY­
Base
Rate
Indirect Costs
FY­
Base
Rate
Indirect Costs
FY­
Base
Rate
Indirect Costs
FY­
Base
Rate
Indirect Costs
Totals
No monies or other benefits may be paid unless this report is completed and filed as required in the EPA billing instructions.