Form FEMA Form 90-127 FEMA Form 90-127 Force Account Equipment Summary Record

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
FORCE ACCOUNT EQUIPMENT SUMMARY RECORD

PAGE

PA ID NO.

APLICANT

LOCATION/SITE

OF

PROJECT NO.

DISASTER

CATEGORY

PERIOD COVERING

O.M.B. No. 1660-0017
Expires December 31, 2011

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

COSTS
TOTAL EQUIPMENT TOTAL
HOURS
RATE
COST

DATE

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 09

TITLE

DATE

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.