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pdfDEPARTMENT 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 Type | application/pdf |
| File Title | Special Consideration Questions |
| File Modified | 2014-05-08 |
| File Created | 2014-05-08 |