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FEDERAL EMERGENCY MANAGEMENT AGENCY

FORCE ACCOUNT LABOR SUMMARY RECORD

Page               of

1. APPLICANT

2. PA ID

3. PW #

4. DISASTER NUMBER

5. LOCATION/SITE

6. CATEGORY

7. PERIOD COVERING

                     to

8. DESCRIPTION OF WORK PERFORMED

NAME

DATES AND HOURS WORKED EACH WEEK

COSTS

DATE

 

 

 

 

 

 

 

TOTAL HOURS

HOURLY RATE

BENEFIT RATE/HR

TOTAL HOURLY

TOTAL COSTS

JOB TITLE

NAME

REG.

               

$

/

$

$

JOB TITLE

O.T.

               

$

/

$

$

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 Cost for Force Account Labor Regular Time

$

Total Cost for Force Account Labor Overtime

$

I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

CERTIFIED

TITLE

DATE

FEMA Form 90-123, NOV 98