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pdfDEPARTMENT OF HOMELAND SECURITY
OMB Control Number: 1660-0017
Expires: November 30, 2025
Federal Emergency Management Agency
FORCE ACCOUNT LABOR SUMMARY
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
APPLICANT
PROJECT #
DISASTER
PA ID #
LOCATION/SITE
CATEGORY
PERIOD COVERING
DESCRIPTION OF WORK PERFORMED
DATES AND HOURS WORKED EACH WEEK
NAME
TOTAL
HOURS
DATE
JOB TITLE
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 FF-104-FY-21-137 (formerly 009-0-123)
(3/22)
TITLE
DATE
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| File Type | application/pdf |
| File Title | FEMA Form FF-104-FY-21-137 |
| Subject | FORCE ACCOUNT LABOR SUMMARY |
| Author | FEMA |
| File Modified | 2022-12-01 |
| File Created | 2022-03-14 |