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Form 90-123 Force Account Labor Summary Record

The document is a force account labor summary record form from FEMA used by applicants for public assistance after a disaster to record labor costs for work performed. It includes fields to list employees, job titles, dates worked, regular and overtime hours and costs claimed.

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angserr.as
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218 views2 pages

Form 90-123 Force Account Labor Summary Record

The document is a force account labor summary record form from FEMA used by applicants for public assistance after a disaster to record labor costs for work performed. It includes fields to list employees, job titles, dates worked, regular and overtime hours and costs claimed.

Uploaded by

angserr.as
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DEPARTMENT OF HOMELAND SECURITY O.M.B. No.

1660-0017
FEDERAL EMERGENCY MANAGEMENT AGENCY PAGE OF
Expires December 31, 2011
FORCE ACCOUNT LABOR SUMMARY RECORD
APPLICANT PA ID NO. PROJECT NO. DISASTER

LOCATION/SITE CATEGORY PERIOD COVERING

DESCRIPTION OF WORK PERFORMED

NAME DATES AND HOURS WORKED EACH WEEK COSTS

TOTAL
JOB TITLE TOTAL HOURLY BENEFIT TOTAL
DATE HOURLY
HOURS RATE RATE/HR COSTS
RATE
NAME
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 TITLE DATE

FEMA Form 90-123, FEB 09


PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 30 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed
data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden
estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC, 20472,
Paperwork Reduction Project (1660-0017). Submission of the form is required to obtain or retain benefits under the Public Assistance Program. Please do not send your completed form to the above address.

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