Form FEMA Form FF-104-F FEMA Form FF-104-F Force Account Equipment Summary Record

DEPARTMENT OF HOMELAND SECURITY

OMB Control Number: 1660-0017
Expires: November 30, 2025

Federal Emergency Management Agency
FORCE ACCOUNT EQUIPMENT SUMMARY RECORD
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

TYPE OF EQUIPMENT
INDICATE SIZE, CAPACITY, HOURSEPOWER,
MAKE AND MODEL AS APPROPRIATE

DATES AND HOURS USED EACH DAY
EQUIPMENT
CODE
NUMBER

OPERATOR'S
NAME

DATE

COSTS
TOTAL EQUIPMENT
HOURS
RATE

TOTAL
COST

HOURS
HOURS
HOURS
HOURS
HOURS
HOURS
HOURS
HOURS

GRAND TOTAL
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-21-141 (formerly 009-0-127)
(3/22)

TITLE

DATE

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