Form FEMA Form 009-0-12 FEMA Form 009-0-12 Force Account Labor Summary Record

Public Assistance Program

FEMA Form 009-0-123

Force Account Labor Summary

OMB: 1660-0017

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DEPARTMENT OF HOMELAND SECURITY

PAGE

Federal Emergency Management Agency
FORCE ACCOUNT LABOR SUMMARY

O.M.B. NO. 1660-0017
Expires July 31, 2016

OF

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average .5 hours per response. The burden estimates includes time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments
regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency,
500 C Street, SW, Washington, DC 20472-3100, Paperwork Reduction Project (1660-0017). NOTE: Do not send your completed questionnaire to this address.
APPLICANT

PA ID #

LOCATION/SITE

PROJECT #

DISASTER

CATEGORY

PERIOD COVERING

DESCRIPTION OF WORK PERFORMED

NAME

DATES AND HOURS WORKED EACH WEEK

JOB TITLE

TOTAL
HOURS

DATE

NAME

COSTS
HOURLY
RATE

BENEFIT
RATE/HR

TOTAL
HOURLY
RATE

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 009-0-123

TITLE

PREVIOUS EDITION OBSOLETE

DATE


File Typeapplication/pdf
File TitleSpecial Consideration Questions
File Modified2014-05-08
File Created2014-05-08

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