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 | FEDERAL EMERGENCY MANAGEMENT AGENCY |  |  |  |  |  |  |  |  | PAGE ____ | OF ____ | O.M.B. No 3067-0151
 | FORCE ACCOUNT LABOR SUMMARY RECORD |  |  |  |  |  |  |  |  |  |  | Expires October 31, 2008
 | APPLICANT |  |  | PA ID NO. |  |  |  | PROJECT NO. |  |  |  | DISASTER
 | LOCATION/SITE |  |  |  |  |  |  | CATEGORY |  |  |  | PERIOD COVERING
 |  |  |  |  |  |  |  |  |  |  |  |  | TO
 | DESCRIPTION OF WORK PERFORMED
 |  |  | Dates and [NAME] Each Week |  |  |  |  |  |  | Costs
 |  | DATE |  |  |  |  |  |  |  | TOTAL HOURS | HOURLY RATE | BENEFIT RATE/HR | TOTAL HOURLY RATE | TOTAL COSTS |  |  | 2003-09-23 00:00:00 | 2003-09-24 00:00:00 | 2003-09-25 00:00:00 | 2003-09-26 00:00:00 | 2003-09-27 00:00:00 | 2003-09-28 00:00:00 | 2003-09-29 00:00:00
 | NAME |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | REG. |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 8 | 8 | 8 | 8 | 8 | 8 | 8
 | JOB TITLE |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | O.T. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 3 | 8 | 3 | 3 | 3 | 3
 | NAME |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | REG. |  |  |  |  |  |  |  |  |  |  |  |  |  | 3 | 8 | 8 | 8 | 8 | 8 | 8 | 8
 | JOB TITLE |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | O.T. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 3 | 3 | 3 | 3 | 3 | 3
 | NAME |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | REG. |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 8 | 8 | 8 | 8 | 8 | 8 | 8
 | JOB TITLE |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | O.T. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 3 | 3 | 3 | 3 | 3 | 3
 | NAME |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | REG. |  |  |  |  |  |  |  |  |  |  |  |  |  | 5 | 8 | 8 | 8 | 8 | 8 | 8 | 8
 | JOB TITLE |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | O.T. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 3 | 3 | 3 | 3 | 3 | 3
 | NAME |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | REG. |  |  |  |  |  |  |  |  |  |  |  |  |  | 6 | 8 | 8 | 8 | 8 | 8 | 8 | 8
 | JOB TITLE |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | O.T. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 3 | 3 | 3 | 3 | 3 | 3
 | NAME |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | REG. |  |  |  |  |  |  |  |  |  |  |  |  |  | 7 | 8 | 8 | 8 | 8 | 8 | 8 | 8
 | JOB TITLE |  |  |  |  |  |  |  |  | 0 |  |  | 0 | 0
 |  | O.T. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 3 | 3 | 3 | 3 | 3 | 3
 | TOTAL COST FOR FORCE ACCOUNT LABOR REGULAR TIME |  |  |  |  |  |  |  |  |  |  |  |  | 0
 | TOTAL COST FOR FORCE ACCOUNT LABOR OVERTIME |  |  |  |  |  |  |  |  |  |  |  |  | 0
 | 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, OCT
 | PAPERWORK BURDEN DISCLOSURE NOTICE
 | Public reporting burden for this form is estimated to 30 minutes per response.  The burden includes the time for reviewing instruction, 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 a valid OMB control number appears in the upper right corner of this form.  Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0151).  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.