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