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pdfDEPARTMENT OF HOMELAND SECURITY
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Federal Emergency Management Agency
MATERIALS SUMMARY RECORD
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.
PA ID #.
APPLICANT
LOCATION/SITE
PROJECT #.
DISASTER
CATEGORY
PERIOD COVERING
DESCRIPTION OF WORK PERFORMED
VENDOR
DESCRIPTION
QUAN.
UNIT
PRICE
TOTAL
PRICE
DATE
PURCHASED
DATE
USED
INFO FROM (CHECK ONE)
INVOICE
GRAND TOTAL
CERTIFIED
FEMA Form 009-0-124
TITLE
PREVIOUS EDITION OBSOLETE
DATE
STOCK
| File Type | application/pdf |
| File Title | Special Consideration Questions |
| File Modified | 2014-05-05 |
| File Created | 2014-05-05 |