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					    FEMA APPLICANT FORMS FOR THE FMAG PROGRAM




                        IN EXCEL 97 FORMAT


                    ALL SHEETS ARE PRINTABLE


CLICK THE "TABLE OF CONTENTS" TAB ON THE BOTTOM LEFT CORNER
                          OF SHEET


    Note only the blocks that are in Yellow need to be filled out.
   The white boxes are automatically filled from previous sheets.
                                           FMAGP FORMS / TABLE OF CONTENTS
                                        Title of Form                                                          FEMA Form No.
REQUEST FOR FIRE MANAGEMENT ASSISTANCE SUBGRANT                                                FEMA Form 90-133, Nov 2004
PROJECT WORKSHEET                                                                              FEMA Form 90-91, Sept 2005
PROJECT WORKSHEET INSTRUCTION PAGE (BACK PAGE)                                                 90-91 INSTRUCTION PAGE
PROJECT WORKSHEET - MAP AND SKETCHES                                                           FEMA Form 90-91C, Sept 2005
SPECIAL CONSIDERATION                                                                          FEMA Form 90-120, Sept 2005
APPLICANT RECORD-KEEPING GUIDELINES                                                            RECORD KEEPING GUIDELINES
FORCE ACCOUNT LABOR SUMMARY RECORD                                                             FEMA Form 90-123, Sept 2005
FORCE ACCOUNT LABOR SUMMARY INSTRUCTION SHEET                                                  90-123 INSTRUCTIONS
MATERIAL SUMMARY SHEET                                                                         FEMA Form 90-124, Sept 2005
MATERIAL SUMMARY INSTRUCTION SHEET                                                             90-124 INSTRUCTION SHEET
RENTED EQUIPMENT SUMMARY RECORD                                                                FEMA Form 90-125, Sept 2005
RENTED EQUIPMENT INSTRUCTION SHEET                                                             90-125 INSTRUCTION SHEET
CONTRACT WORK SUMMARY RECORD                                                                   FEMA Form 90-126, Sept 2005
CONTRACT WORK SUMMARY INSTRUCTION SHEET                                                        90-126 INSTRUCTION SHEET
FORCE ACCOUNT EQUIPMENT SUMMARY RECORD                                                         FEMA Form 90-127, Sept 2005
FORCE ACCOUNT EQUIPMENT SUMMARY INSTRUCTION SHEET                                              90-127 INSTRUCTION SHEET
FRINGE BENEFITS CALCULATION WORKSHEET                                                          FEMA Form 90-128, Sept 2005
FRINGE BENEFITS CALCULATION WORKSHEET (This one does the calculation for you)                  90-128 AUTO CALCULATIONS
FRINGE BENEFITS CALCULATION WORKSHEET INSTRUCTION SHEET                                        90-128 BENEFITS INSTRUCTION SHEET
                    The dark blue tabs are the forms to be filled out. The white tabs are the instruction sheets.
                         The green tab is used to calculated the fringe benefits and auto fills form 90-128.




                                                                                         b95c6a25-1476-4571-bd9b-feff096b8b15.xls, Table of Contents
                                        ONLY need to fill out the yellow boxes.
                            FEDERAL EMERGENCY MANAGEMENT AGENCY
              REQUEST FOR FIRE MANAGEMENT ASSISTANCE SUBGRANT
                                                    PAPERWORK BURDEN DISCLOSURE NOTICE

DISCLOSURE OF BURDEN-Public reporting burden for the collection of information entitled “Request for Fire Management Assis
using FEMA Form 90-133 is estimated to average 10 minutes per response, including the time for reviewing instructions, searchin
gathering and maintaining the needed data and financial resources expended by persons, and completing and submitting the form
to complete this collection of information unless a valid OMB control number appears in the upper right hand corner on this form.
regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden, to: Information Colle
Federal Emergency Management Agency, 500 C Street, SW, Washington, D.C. 20472, Paperwork Reduction Project (3067-0290
your completed form to the above address.

1. APPLICANT (Political subdivision or eligible applicant)



3. COUNTY (location of firefighting activities. If located in multiple counties, please indicate)


                                                           APPLICANT PHYSICAL LOCATION
FEMA


2. CITY                                            3. COUNTY                         4. STATE


                                       MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL LOCATION)
1. STREET ADDRESS


2. POST OFFICE BOX                                 3. CITY                           4. STATE


            Primary Contact/Applicant’s Authorized Agent                                                         Alternate Contact
1. NAME                                                                              1. NAME


2. TITLE                                                                             2. TITLE


3. BUSINESS PHONE                                                                    3. BUSINESS PHONE


4. FAX NUMBER                                                                        4. FAX NUMBER


5. HOME PHONE                                                                        5. HOME PHONE


6. CELL PHONE                                                                        6. CELL PHONE


7. E-MAIL ADDRESS                                                                    7. E-MAIL ADDRESS


8. PAGER & PIN NUMBER                                                                8. PAGER & PIN NUMBER


Title 44 CFR Part 204.41 defines Fire Management Assistance eligibility criteria as: (a) The following entities are eligible to apply
for a subgrant under an approved fire management assistance grant: 1) State agencies; 2) Local governments; and 3) Indian Trib
Entities that are not eligible to apply for a subgrant as identified in (a), such as privately owned entities and volunteer firefighting o
reimbursed through a contract or compact with an eligible applicant for eligible cost associated with the fire or fire complex. (c) Eli
upon the finding that the applicant’s resources were requested by the Incident Commander or comparable State official. (d) The a
be the legal responsibility of the applying entity, required as a result of the fire or fire complex for which a fire management assista
approved, and located within the declared area.
FEMA Form 90-133, NOV 02
o fill out the yellow boxes.
                                                              O.M.B. NO. 3067-0290
                                                             Expires November 30 2004
K BURDEN DISCLOSURE NOTICE

 ction of information entitled “Request for Fire Management Assistance Declaration”
 r response, including the time for reviewing instructions, searching existing data sources,
es expended by persons, and completing and submitting the form. You are not required
trol number appears in the upper right hand corner on this form. Send comments
 luding suggestions for reducing the burden, to: Information Collections Management,
ashington, D.C. 20472, Paperwork Reduction Project (3067-0290). NOTE: Do not send


                                                     2. DATE SUBMITTED




CANT PHYSICAL LOCATION




                                                     5. ZIP CODE


 DIFFERENT FROM PHYSICAL LOCATION)




                                                     5. ZIP CODE


                                             Alternate Contact
                 1. NAME


                 2. TITLE


                 3. BUSINESS PHONE


                 4. FAX NUMBER


                 5. HOME PHONE


                 6. CELL PHONE


                 7. E-MAIL ADDRESS


                 8. PAGER & PIN NUMBER


 ligibility criteria as: (a) The following entities are eligible to apply through a State grantee
  ant: 1) State agencies; 2) Local governments; and 3) Indian Tribal Governments. (b)
n (a), such as privately owned entities and volunteer firefighting organizations, may be
  nt for eligible cost associated with the fire or fire complex. (c) Eligibility is contingent
y the Incident Commander or comparable State official. (d) The activities performed must
 ult of the fire or fire complex for which a fire management assistance declaration was
ONLY need to fill out the yellow boxes because the white boxes are auto filled f
                              FEDERAL EMERGENCY MANAGEMENT AGENCY                                                             O.M.B. No. 3067-0
                                       PROJECT WORKSHEET                                                                    Expires September 3
                                                  PAPERWORK BURDEN DISCLOSURE NOTICE

  Public reporting burden for this form is estimated to average 90 minutes per response. The burden estimate includes the time for reviewing instr
  searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not r
  respond to this collection of information unless a valid OMB control number appears in the upper right hand corner of this form. Send comment
  the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Federal Emergency
  Agency, 500 C Street SW, Washington, DC 20472, Paperwork Reduction Project (3067-0151). Submission of the form is required to obtain ben
  the Public Assistance Program. NOTE: Do not send your completed form to the above address.
   DISASTER                         PROJECT NO.                          PA ID NO.                         DATE
   FEMA -XXXX -DR - XX
      DAMAGED FACILITY                                                                                     WORK COMPLETE AS OF
                                                                                                            ________ : ________ %
      APPLICANT                                                                            COUNTY
  0
      LOCATION                                                                                                        LATITUDE

      DAMAGE DESCRIPTION AND DIMENSIONS




      SCOPE OF WORK




      Does the Scope of Work change the pre-disaster conditions at the site?                      Yes        No
      Special Considerations included?           Yes        No                            Hazard Mitigation proposal included?               Yes
      Is there insurance coverage on this facility?           Yes        No
                                                                       PROJECT COST
         ITEM           CODE                           NARRATIVE                           QUANTITY         UNIT        UNIT PRICE




                                                                                                                     TOTAL COST
      PREPARED BY                                                                          TITLE                      SIGNATURE

      APPLICANT REP.                                                                       TITLE                      SIGNATURE
FEMA Form 90-91, OCT 02   REPLACES ALL PREVIOUS EDITIONS.
se the white boxes are auto filled from previous sheet.
                                            O.M.B. No. 3067-0151
                                          Expires September 30, 2005
 DISCLOSURE NOTICE

 ponse. The burden estimate includes the time for reviewing instructions,
nd completing, reviewing, and submitting the form. You are not required to
 ears in the upper right hand corner of this form. Send comments regarding
en to: Information Collections Management, Federal Emergency Management
 ct (3067-0151). Submission of the form is required to obtain benefits under
  the above address.
                                                         CATEGORY


                          WORK COMPLETE AS OF
                           ________ : ________ %
          COUNTY

                                                         LONGITUDE




e?
         Hazard Mitigation proposal included?             Yes      No


 T COST
                                                                COST
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                                                $0.00
                                     SIGNATURE

                                     SIGNATURE
                                                              PROJECT WORKSH
                                                                 INSTRUCTIONS

The Project Worksheet must be completed for each identified damaged project. A p

After completing all Project Worksheets, submit the worksheets to your Public Assi

                                                               Identifying Informat

Disaster: Indicate the disaster declaration number as established by FEMA (i.e. "FE
Project No: Indicate the project designation number you established to track the pr
PA ID No.: Indicate your Public Assistance identification number on this space. T
Date: Indicate the date the worksheet was prepared in MM/DD/YY format.
Category: Indicate the category of the project according to FEMA specified work
Applicant: Name of the government or other legal entity to which the funds will be
County: Name of the county where the damaged facility is located. If located in m
Damage Facility: Identify the facility and describe its basic function and pre-disas

Work Complete as of: Indicate the date the work was assessed in the format of MM
Location: This item can range anywhere from an "address," intersection of…," "1
different locations or different counties please list each location. Include latitude an
Damage Description and Dimensions: Describe the disaster-related damage to th
components affected.
Scope of Work: List work that has been completed, and work to be completed, wh
Does the Scope of Work change the pre-disaster conditions of the site: If the w
conditions (i.e. increases/decreases the size or function of the facility or does not re
yes. If the Scope of Work returns the site to its pre-disaster configuration, capacity

Special Considerations: If the project includes insurable work, and/or is affected b
the Yes or No box so that appropriate action can be initiated to avoid delays in fund
Hazard Mitigation: If the pre-disaster conditions at the site can be changed to pre
opportunities for hazard mitigation exist check (x) no. Appropriate action will be in
Handbook for further information.
Is there insurance coverage on this facility: Federal law requires that FEMA be
damages from insurance or any other source. Check (x) yes if any funding or proce
any source besides FEMA.
                                                                      Project Cost

Item: Indicate the item number on the column (i.e. 1, 2, 3, etc.). Use additional fo
Code: If using the FEMA cost codes, place the appropriate number here.
Narrative: Indicate the work, material or service that best describes the work (i.e.
replacement", etc.).
Quantity/Unit: List the amount of units and the unit of measure (48/cy", "32/lf', "6
Unit Price: Indicate the price per unit.
Cost: This item can be developed from cost to date, contracts, bids, applicant's exp
themselves to work estimates, such as RS Means, or by using cost codes supplied b
Total Cost: Record total cost of the project.

Prepared By: Record the name, title, and signature of the person completing the P
Applicant Rep.: Record the name, title, and signature of Applicant's representative

                                                                Records Requireme

Please review the Applicant Handbook, FEMA 323 for detailed instructions and ex
For all completed work, the applicant must keep the following records:




For all estimated work, keep calculations, quantity estimates, pricing information, e
which funding is being requested.
                                                             PROJECT WORKSHEET
                                                                INSTRUCTIONS

The Project Worksheet must be completed for each identified damaged project. A project may include damages more than one site.

After completing all Project Worksheets, submit the worksheets to your Public Assistance Coordinator.

                                                               Identifying Information

Disaster: Indicate the disaster declaration number as established by FEMA (i.e. "FEMA 1136-DR-TN", etc.).
Project No: Indicate the project designation number you established to track the project in your system (i.e. 1,2,3, etc.).
PA ID No.: Indicate your Public Assistance identification number on this space. This is optional.
Date: Indicate the date the worksheet was prepared in MM/DD/YY format.
Category: Indicate the category of the project according to FEMA specified work categories (i.e.,A,B,C,D,E,F,G). This is optional.
Applicant: Name of the government or other legal entity to which the funds will be awarded.
County: Name of the county where the damaged facility is located. If located in multiple counties, indicate "Multi-County."
Damage Facility: Identify the facility and describe its basic function and pre-disaster condition.

Work Complete as of: Indicate the date the work was assessed in the format of MM/DD/YY and the percentage of work completed to that date.
Location: This item can range anywhere from an "address," intersection of…," "1 mile south of …on…" to "county wide." If damages are in
different locations or different counties please list each location. Include latitude and longitude of the project if known.
Damage Description and Dimensions: Describe the disaster-related damage to the facility, including the cause of the damage and the area or
components affected.
Scope of Work: List work that has been completed, and work to be completed, which, is necessary to repair disaster-related damage.
Does the Scope of Work change the pre-disaster conditions of the site: If the work described under the Scope of Work changes the site
conditions (i.e. increases/decreases the size or function of the facility or does not replace damage components in kind with like materials), check (x)
yes. If the Scope of Work returns the site to its pre-disaster configuration, capacity and dimensions check (x) no.

Special Considerations: If the project includes insurable work, and/or is affected by environmental (NEPA) or historic concerns, check (x) either
the Yes or No box so that appropriate action can be initiated to avoid delays in funding. Refer to Applicant Handbook for further information.
Hazard Mitigation: If the pre-disaster conditions at the site can be changed to prevent or reduce the disaster-related damage, check (x) Yes. If no
opportunities for hazard mitigation exist check (x) no. Appropriate action will be initiated and avoid delays in funding. Refer to Applicant
Handbook for further information.
Is there insurance coverage on this facility: Federal law requires that FEMA be notified of any entitlement for proceeds to repair disaster-related
damages from insurance or any other source. Check (x) yes if any funding or proceeds can be received for the work within the Scope of Work from
any source besides FEMA.
                                                                     Project Cost

Item: Indicate the item number on the column (i.e. 1, 2, 3, etc.). Use additional forms as necessary to include all items.
Code: If using the FEMA cost codes, place the appropriate number here.
Narrative: Indicate the work, material or service that best describes the work (i.e. "force account labor overtime", "42 in. RCP", "sheet rock
replacement", etc.).
Quantity/Unit: List the amount of units and the unit of measure (48/cy", "32/lf', "6/ea", etc.).
Unit Price: Indicate the price per unit.
Cost: This item can be developed from cost to date, contracts, bids, applicant's experience in that particular repair work, books which lend
themselves to work estimates, such as RS Means, or by using cost codes supplied by FEMA.
Total Cost: Record total cost of the project.

Prepared By: Record the name, title, and signature of the person completing the Project Worksheet.
Applicant Rep.: Record the name, title, and signature of Applicant's representative.

                                                                Records Requirements

Please review the Applicant Handbook, FEMA 323 for detailed instructions and examples.
For all completed work, the applicant must keep the following records:
        *Force account labor documentation sheets identifying the employee, hours worked, date and location;
        *Force account equipment documentation sheets identifying specific equipment, operator, usage by hour/mile and cost used;
        *Material documentation sheets identifying the type of material, quantity used and costs;
        *Copies of all contracts for work and any lease/rental equipment costs.
For all estimated work, keep calculations, quantity estimates, pricing information, etc. as part of the records to document the "cost/estimate" for
which funding is being requested.
ONLY need to fill out the yellow boxes because the white box are auto filled from
                           FEDERAL EMERGENCY MANAGEMENT AGENCY                   O.M.B. No. 3067-0151
                                                                               Expires September 30, 200
                          PROJECT WORKSHEET - Maps and Sketches Sheet
 DISASTER                           PROJECT NO.         PA ID NO.       DATE        CATEGORY
 FEMA ___    - DR -   ______                                                                   0
 APPLICANT                           COUNTY
 0
FEMA Form 90-91C, OCT 02
se the white box are auto filled from previous sheets.
                                       0151
                    Expires September 30, 2005

                         CATEGORY

                                    0
                                             ONLY need to fill out the yellow boxes.
                         FEDERAL EMERGENCY MANAGEMENT AGENCY                                                                        O.M.B. No. 3067-0151
                             SPECIAL CONSIDERATION QUESTION                                                                      Expires September 30, 2005

APPLICANT'S NAME                                                            PA ID NO.                                     DATE


PROJECT NAME                                                                LOCATION


                                                      Form must be filled out - for each project.
1.   Does the damaged facility or item of work have insurance and/or is it an insurable risk? (e.g., buildings, equipment, vehicles, etc.)

           Yes           No             Unsure             Comments




2.   Is the damaged facility located within a floodplain or coastal high hazard area/or does it have an impact on a floodplain or wetland?

           Yes           No             Unsure             Comments




3.   Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an Otherwise Protected Area?

           Yes           No             Unsure             Comments




4.   Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g., footprint, material, location, capacity, use or function)


           Yes           No             Unsure             Comments




5.   Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard mitigation proposal?

           Yes           No             Unsure             Comments




6.    Is the damaged facility on the National Register of Historic Places or the state historic listing? Is it older than 50 years? Are there
       other, similar buildings near the site?

           Yes           No             Unsure             Comments




7.   Are there any pristine or undisturbed areas on, or near, the project site? Are there large tracts of forestland?

           Yes           No             Unsure             Comments




8.   Are there any hazardous materials at or adjacent to the damaged facility and/or item of work?

           Yes           No             Unsure             Comments




9.   Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work?

           Yes           No             Unsure             Comments




FEMA Form 90-120, OCT 02
                                                                                                         APPLICANT RECOR

                                                                      GENERAL INFORMATION:
                                                                      It is essential that you accurately document the expenses incurr
                                                                      period.
                                                                      In the event that a federal declaration occurs, accurate documen

                                                                       *
                                                                       *
                                                                       *
                                                                       *
                                                                       *
                                                                       *

                                                                      FORMS AND REPORTS:

                                                                      While there are many ways to organize records, it is important th
                                                                      spreadsheets, invoices, financial reports, etc. Important: FEM
                                                                      use to summarize project costs. If your agency can provide th
                                                                      it is not necessary to use FEMA forms. The FEMA forms are

                                                                      The summary record forms are:
                                                                      1)
                                                                      2)
                                                                      3)
                                                                      4)
                                                                      5)

                                                                      DOCUMENTATION SAMPLES:


                                                                       1)
                                                                       2)
                                                                       3)
                                                                       4)
                                                                       5)
                                                                       6)
                                                                       7)
                                                                       8)



                                                                       1)
                                                                       2)
                                                                       3)

                                                                       4)


                                                                      PROJECT WORKSHEETS:
                                                                      Project Worksheets are written for each category of work. Cost
                                                                      1)
                                                                      2)
                                                                      3)




b95c6a25-1476-4571-bd9b-feff096b8b15.xls, Record-Keeping Guidelines                                   updated 5/18/05
                                    APPLICANT RECORD-KEEPING GUIDELINES

GENERAL INFORMATION:
It is essential that you accurately document the expenses incurred during the Fire Management Assistance Grant Program, incident
period.
In the event that a federal declaration occurs, accurate documentation will help you to:

    Recover all eligible costs.
    Be prepared to provide information for the Project Officer to prepare the FEMA Project Worksheet.
    Have source documents and summaries readily available for validation by the Project Officer.
    Assist the state and FEMA to review project worksheet(s) for approval.
    Provide a brief narrative describing the eligible work performed by the applicant.
    Be ready for future audits or other financial reviews.

FORMS AND REPORTS:

While there are many ways to organize records, it is important the information is readily available and in a useable format; i.e.,
spreadsheets, invoices, financial reports, etc. Important: FEMA has a set of five Summary Record form available an applicant may
use to summarize project costs. If your agency can provide the same or similar summaries from an existing accounting system
it is not necessary to use FEMA forms. The FEMA forms are available in Excel format.

The summary record forms are:
    Force Account Labor Summary Record (90-123) -- To record agency permanent or temporary labor costs.
    Material Summary Record (90-124) -- Used to record the supplies and materials that is used out of stock or purchased.
    Rented Equipment Summary Record (90-125) -- Used to record the costs of rented or leased equipment.
    Contract Work Summary Record (90-126) -- Used to record the costs of work done by contract.
    Force Account Equipment Summary Record (90-127) -- To record applicant-owned equipment costs.

DOCUMENTATION SAMPLES:
    Types of documentation the state and FEMA will review during the site visit:

    A sampling of your permanent or temporary staff timesheets, vendor or contractor invoices, and other documentation.
    A spreadsheet or report to compare timesheets, invoices and other documentation that needs to be reviewed.
    Access to source documents which will remain on file at the agency (time reports, vehicle records, purchase receipts, etc.).
    Definition of personal classification groups for example: permanent, seasonal, career, and temporary personnel.
    Sample copies of pertinent contracts, cooperative agreements, mutual aid or cost-share agreements etc.
    Complete "Applicants Benefit Calculation Worksheet" for each classification.
    Other documentation determined to be needed by the Project Officer.
    A map of the fire area showing agency jurisdiction.

    Documentation required for Donated Resources:

    Provide copies of sign-in and sign-out logs showing dates and hours of service for each person.
    Provide any call or dispatch logs that document donated resources.
    For donated supplies or equipment, provide an invoice or letter from the vendor or other party showing the date of use and
    customary charges for the resource.
    For personnel - a copy of an invoice or letter from an organization that shows the cost for the use of the organizations personnel.


PROJECT WORKSHEETS:
Project Worksheets are written for each category of work. Cost claimed are separated into the following categories:
    B – Emergency Protective Measures
    H – Firefighting Activities
    Z – Grants Management Costs




   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, Record-Keeping Guidelines                                           updated 5/18/05
b95c6a25-1476-4571-bd9b-feff096b8b15.xls, Record-Keeping Guidelines   updated 5/18/05
  ONLY need to fill out the yellow boxes because the white boxes are automatically filled from previous sheets
                          FEDERAL EMERGENCY MANAGEMENT AGENCY                                                              O.M.B. No 3067-0151
                                                                                            PAGE ____ OF ____
                        FORCE ACCOUNT LABOR SUMMARY RECORD                                                            Expires September 30, 2005
 APPLICANT                               PA ID NO.                            PROJECT NO.                        DISASTER
0                                                         0
 LOCATION/SITE                                                                CATEGORY                           PERIOD COVERING
0                                                                                           0                                TO
DESCRIPTION OF WORK PERFORMED



                                               Dates and Hours Worked Each Week                                     Costs
                                                                                                                               TOTAL
                                                                                                TOTAL   HOURLY   BENEFIT
                           DATE                                                                                               HOURLY
                                                                                                HOURS    RATE    RATE/HR
                                                                                                                                RATE
NAME
                                                                                                 0.00                          $0.00
                           REG.
JOB TITLE
                                                                                                 0.00                          $0.00
                           O.T.
NAME
                                                                                                 0.00                          $0.00
                           REG.
JOB TITLE
                                                                                                 0.00                          $0.00
                           O.T.
NAME
                                                                                                 0.00                          $0.00
                           REG.
JOB TITLE
                                                                                                 0.00                          $0.00
                           O.T.
NAME
                                                                                                 0.00                          $0.00
                           REG.
JOB TITLE
                                                                                                 0.00                          $0.00
                           O.T.
NAME
                                                                                                 0.00                          $0.00
                           REG.
JOB TITLE
                                                                                                 0.00                          $0.00
                           O.T.
NAME
                                                                                                 0.00                          $0.00
                           REG.
JOB TITLE
                                                                                                 0.00                          $0.00
                           O.T.
                                     TOTAL COST FOR FORCE ACCOUNT LABOR REGULAR TIME
                                       TOTAL COST FOR FORCE ACCOUNT LABOR OVERTIME
       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
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 reduc
this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Proje
(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.
omatically filled from previous sheets.
                          O.M.B. No 3067-0151
                       Expires September 30, 2005
                  DISASTER

                  PERIOD COVERING




                     Costs

                                             TOTAL
                                             COSTS
                                                            9/23/03   9/24/03   9/25/03   9/26/03   9/27/03   9/28/03   9/29/03

                                                $0.00
                                                        1      8.0       8.0       8.0       8.0       8.0       8.0       8.0

                                                $0.00
                                                               4.0       3.0       8.0       3.0       3.0       3.0       3.0

                                                $0.00
                                                        3      8.0       8.0       8.0       8.0       8.0       8.0       8.0
                                                $0.00
                                                               4.0       3.0       3.0       3.0       3.0       3.0       3.0
                                                $0.00
                                                        4      8.0       8.0       8.0       8.0       8.0       8.0       8.0

                                                $0.00
                                                               4.0       3.0       3.0       3.0       3.0       3.0       3.0
                                                $0.00
                                                        5      8.0       8.0       8.0       8.0       8.0       8.0       8.0

                                                $0.00
                                                               4.0       3.0       3.0       3.0       3.0       3.0       3.0
                                                $0.00
                                                        6      8.0       8.0       8.0       8.0       8.0       8.0       8.0
                                                $0.00
                                                               4.0       3.0       3.0       3.0       3.0       3.0       3.0
                                                $0.00
                                                        7      8.0       8.0       8.0       8.0       8.0       8.0       8.0
                                                $0.00
                                                               4.0       3.0       3.0       3.0       3.0       3.0       3.0
                                                $0.00
                                                $0.00
THER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.
E
r reviewing instruction, searching existing data sources,
equired to respond to this collection of information unless a
acy of the burden estimate and any suggestions for reducing
SW, Washington, DC 20472, Paperwork Reduction Project
am. Please do not send your completed form to the
                                            FORCE ACCOUNT LABOR SUMMARY RECORD
                                                       INSTRUCTIONS

Force account is the term used to define labor performed and equipment owned by the applicant.

•►    Record regular and overtime hours separately.

•►    Record the benefits separately for regular and overtime hours. Most overtime hours include fewer benefits than regular
      hours.

•►    Attach a Fringe Benefit Rate Sheet giving a breakdown of what is included in your benefits, by percentages, e.g.,
      social security----15.2%, worker's compensation----4.3%, insurance----18.5%, etc. You can use an average
      rate if you have different benefit rates for different employees.

Complete the Record as Follows:

 *    Applicant: Enter organization's name.
 *    PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization. Your Public Assistance Coordinator
      can provide you with this number.
 *    Project No.: Enter the number assigned to this project.
 *    Disaster: Enter the declaration number for this disaster. The Public Assistance Coordinator can also provide you with this
 *    Location/Site: This item can range anywhere from an "address," intersection of…/" "1 mile south of …on…" to "county wide." If
      damages are in different locations or different counties please list each location. Include latitude and longitude of the project if known.
 *    Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z). This is optional.
 *    Period Covering: This is auto filled from the "Dates & Hours Worked Each Week / Date."
 *    Description of Work Performed: Describe the type of work performed.
 *    Dates & Hours Used Each Week / Date: Enter the days of the week.
 *    Name: Enter the names of each employee who worked on the project.
 *    Job Title: Enter the title or occupation of each employee who worked on the project.
 *    REG: Enter the regular hours that each employee worked on the project.
 *    O.T.: Enter overtime hours that each employee worked on the project. REMINDER: Only overtime is eligible
      for reimbursement for emergency work. Record both regular and overtime hours, so that personnel
      hours can be compared with equipment use hours, if necessary.
 *    Costs / Total Hours: Calculates the total hours for the week and auto fills "Total Hours" block.
 *    Costs / Hourly Rate: Enter each employee's hourly rate.
 *    Costs / Benefit Rate/Hr: Enter each employee's hourly benefit rate. Their should be different percentages for benefits
      pertaining to regular and overtime wages.
 *    Costs / Total Hourly Rate: Excel will add the employee's hourly rate in the "Hourly Rate" block and the hourly benefits rate in the
      "Benefit Rate/HR" block and auto fills "Total Hourly Rate" block.
 *    Costs / Total Cost: Multiply the entries in the "Total Hrs" and "Total Hourly Rate" blocks and auto fills "Total Costs" block.
 *    Total Cost for Force Account Labor Regular Time: Add the entries in the "Total Costs", "REG" block for each employee and the
      results in the "Total Cost for Force Account Labor Regular Time" block.
 *    Total Cost for Force Account Labor Overtime: Add the entries in the "Total Costs", "O.T." block for each employee and the
      results in the "Total Cost for Force Account Labor Overtime" block.
 *    Certified: Record the name, title, and date of the person certifying the Force Account Labor Summary Record.




                          updated 5/18/05                                                                                                           b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 8
      ONLY need to fill out the yellow boxes because the white boxes are auto filled from previous sheets.
                     FEDERAL EMERGENCY MANAGEMENT AGENCY                                                               O.M.B. No. 3067-0151
                                                                                         Page ____ OF ______
                           MATERIAL SUMMARY SHEET                                                                  Expires September 30, 2005

APPLICANT                    PA ID NO.                                     PROJECT NO.                          DISASTER

0
LOCATION/SITE                                                              CATEGORY                             PERIOD COVERING
0                                                                                                                              TO
DESCRIPTION OF WORK PERFORMED




                                                                                                                                INFO FROM
                                                                                          TOTAL        DATE      DATE
            VENDOR                       DESCRIPTION               QUAN.   UNIT PRICE                                          (CHECK ONE)
                                                                                          PRICE     PURCHASED    USED
                                                                                                                            INVOICE

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00

                                                                                          $0.00
                                                                                          $0.00
                                                   GRAND TOTAL                            $0.00

    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 90-124, OCT 02
                                                           PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 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 suggestion
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.
e the white boxes are auto filled from previous sheets.
                                                      O.M.B. No. 3067-0151
                                                   Expires September 30, 2005

                                               DISASTER



                                               PERIOD COVERING




                                                               INFO FROM
                                                              (CHECK ONE)
                                                                      STOCK




OLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

                                               DATE
RDEN DISCLOSURE NOTICE

  The burden includes the time for reviewing instruction, searching existing data sources,
ubmitting the form. You are not required to respond to this collection of information
 rm. Send comments regarding the accuracy of the burden estimate and any suggestions
ergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork
or retain benefits under the Public Assistance Program. Please do not send your
                                                         THE MATERIAL REC
                                                                 INSTRUC


                  This form is used to record the costs of supplies and materials p
                  damages caused by the disaster.


                  Complete the Record as Follows:

                    *

                    *


                    *

                    *


                    *



                    *


                    *

                    *

                    *

                    *

                    *

                    *

                    *

                    *

                    *

                    *

                    *
                    *



Updated 5/18/05              b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
                                     THE MATERIAL RECORD SUMMARY
                                             INSTRUCTIONS


This form is used to record the costs of supplies and materials purchased in response to the disaster or used to repair
damages caused by the disaster.


Complete the Record as Follows:

       Applicant: Enter organization's name.

       PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization. Your Public
       Assistance Coordinator can provide you with this number.

       Project No.: Enter the number assigned to this project.

       Disaster: Enter the declaration number for this disaster. The Public Assistance Coordinator can also provide you
       with this information.

       Location/Site: This item can range from an "address," "intersection of…," "1 mile south of…on…" to "county
       wide." If damages are in different locations or different counties please list each location. Include latitude and
       longitude of the project if known.

       Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z). This
       is optional.

       Period Covering: Enter the dates that this period covers.

       Description of Work Performed: Describe the type of work that was performed.

       Vendor: Enter the name of the supplier if the material was bought specifically as a result of the disaster.

       Description: Enter a brief description of the supplies or materials used or purchased.

       Quan.: Enter the number purchased.

       Unit Price: Enter the price per unit.

       Total Price: Calculates the "Quan." times the "Unit Price" and auto fills "Total Price" block.

       Date Purchased: Enter the date item was purchased.

       Date Used: Enter the date item was used.

       Info. from (Check One) Invoice or Stock: Place a check (√) in either the "Invoice" or "Stock" block.

       Grand Total: Adds the costs from "Total Price" blocks and auto fills "Grant Total" block.

       Certified: Record the name, title, and date of the person certifying the Material Summary Record.




        Updated 5/18/05                                                             b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 10
       ONLY need to fill out the yellow boxes because the white boxes are auto filled from previous sheets.
                                   FEDERAL EMERGENCY MANAGEMENT AGENCY                                                               O.M.B. No. 3067-0151
                                                                                                       PAGE ____ OF _____
                                       RENTED EQUIPMENT SUMMARY RECORD                                                           Expires September 30, 200
APPLICANT                                                  PA ID NO.               PROJECT NO.                     DISASTER
0                                                                      0
LOCATION/SITE                                                                      CATEGORY                        PERIOD COVERING
0                                                                                                0                                   TO
DESCRIPTION OF WORK PERFORMED


       TYPE OF EQUIPMENT                           RATE PER HOUR
                                       DATES AND
                                                                           TOTAL                                    INVOICE     DATE AND
Indicate size, Capacity, Horsepower,     HOURS              W/OUT                             VENDOR
                                                   W/OPR                   COST                                       NO.      AMOUNT PAID
  Make and Models as Appropriate          USED               OPR


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                           $0.00


                                                                                           GRAND TOTAL                                     $0.00
            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 90-125, OCT 02
                                                           PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 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 unle
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.
se the white boxes are auto filled from previous sheets.
                                                               O.M.B. No. 3067-0151
                                                           Expires September 30, 2005
                                             DISASTER


                                             PERIOD COVERING




                                                                             CHECK NO.




                                                                     $0.00
ROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

                                                        DATE
URDEN DISCLOSURE NOTICE

  The burden includes the time for reviewing instruction, searching existing data sources,
ubmitting the form. You are not required to respond to this collection of information unless
end comments regarding the accuracy of the burden estimate and any suggestions for
ency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork
or retain benefits under the Public Assistance Program. Please do not send your
                                                       RENTED EQUIPMENT SU
                                                                 INSTRUCTI


                  This form is used to record the costs of equipment that rented or
                  repairs to damages caused by the disaster.

                  Complete the Record as Follows:

                     *
                     *


                     *

                     *


                     *



                     *

                     *

                     *


                     *


                     *



                     *


                     *
                     *

                     *


                     *

                     *

                     *



Updated 5/18/05                b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
                                   RENTED EQUIPMENT SUMMARY RECORD
                                             INSTRUCTIONS


This form is used to record the costs of equipment that rented or leased to respond to the disaster or be used in making
repairs to damages caused by the disaster.

Complete the Record as Follows:

        Applicant: Enter your organization's name.

        PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization. Your Public
        Assistance Coordinator can provide you with this number.

        Project No.: Enter the number assigned to this project.

        Disaster: Enter the declaration number for this disaster here. The Public Assistance
        Coordinator can also provide you with this information.

        Location/Site: This item can range from an "address," "intersection of…," "1 mile south of…on…" to "county
        wide." If damages are in different locations or different counties please list each location. Include latitude and
        longitude of the project if known.
        Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z).
        This is optional.

        Period Covering: Enter the dates that this period covers.

        Type of Equipment: Enter a brief description of the equipment that was leased or rented. Indicate if the
        equipment was rented on a daily, weekly, or monthly rate, instead of an hourly rate.

        Date and Hours Used: Enter the dates for each day the project was worked in the top box and the hours the
        equipment was used in the bottom box.

        Rate Per Hour With or Without Operator: Enter the hourly rental or lease cost of the equipment with or
        without operator. NOTE: Determine that the rental rate is fair and reasonable and has not been raised to
        an unacceptable rate because of the disaster.

        Total Cost: Multiplies the entries in the second box under "Dates & Hours Used" and times it by the "Rate Per
        Hour - W/OPR or W/OUT OPR" and auto fills "Total Cost" block.

        Vendor: Enter the name of the vendor.

        Invoice No.: Enter the invoice number.

        Date & Amount Paid: Enter the date of invoice in the top box and the usage cost based on the renter's
        agreement in the bottom box.

        Check No.: Enter the check number.

        Grand Total: Calculates the "Total Cost" blocks and auto fills the "Grand Total" block.

        Certified: Record the name, title, and date of the person certifying the Rent Equipment Summary Record.




        Updated 5/18/05                                                             b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 12
      ONLY need to fill out the yellow boxes because the white boxes are auto filled from previous sheets.
                     FEDERAL EMERGENCY MANAGEMENT AGENCY                                                               O.M.B. No. 3067-0151
                                                                                       PAGE ____ OF _____
                     CONTRACT WORK SUMMARY RECORD                                                                  Expires September 30, 2005
APPLICANT                                   PA ID NO.          PROJECT NO.                           DISASTER
0
LOCATION/SITE                                                  CATEGORY                              PERIOD COVERING
0                                                                                  0                               TO
DESCRIPTION OF WORK PERFORMED




                                                                 BILLING/INVOICE
    DATES WORKED                   CONTRACTOR                                          AMOUNT                   COMMENTS - SCOPE
                                                                     NUMBER




                                              GRAND TOTAL                               $0.00

    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 90-126, OCT 02
                                                           PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 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.
                                                      CONTRACT WORK SUM
                                                               INSTRUCTI

                  This form is used to record the costs of contracts awarded to


                  Complete the Record as Follows:

                    *

                    *


                    *

                    *


                    *



                    *


                    *

                    *

                    *

                    *

                    *

                    *

                    *

                    *

                    *




Updated 5/18/05                b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
                                 CONTRACT WORK SUMMARY RECORD
                                          INSTRUCTIONS

his form is used to record the costs of contracts awarded to respond to the disaster.


Complete the Record as Follows:

      Applicant: Enter organization's name.

      PA ID No.: Enter the computer tracking number that FEMA assigns to applicant organization.
      Your Public Assistance Coordinator can provide you with this number.

      Project No.: Enter the number assigned to this project.

      Disaster: Enter the declaration number for this disaster here. The Public Assistance
      Coordinator can also provide you with this information.

      Location/Site: This item can range from an "address," "intersection of…," "1 mile south of…on…" to "county
      wide." If damages are in different locations or different counties please list each location. Include latitude and
      longitude of the project if known.

      Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H,
      Z). This is optional.

      Period Covering: Enter the dates that this period covers.

      Description of Work Performed: Enter a brief description of the work performed.

      Date Worked: Enter the date on the invoice.

      Contractor: Enter the name of the contractor receiving the contract.

      Billing/Invoice Number: Enter the invoice number.

      Amount: Enter the total dollar figure listed for each invoice.

      Comments - Scope: Enter a brief description of the type of work that was performed on each invoice.

      Grand Total: Calculates the "Amount" blocks and auto fills the "Grand Total" block.
      Certified: Record the name, title, and date of the person certifying the Contract Work Summary Record.




            Updated 5/18/05                                                              b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 14
         ONLY need to fill out the yellow boxes because the white boxes are auto filled from previous sheets.
                            FEDERAL EMERGENCY MANAGEMENT AGENCY                                                                 O.M.B. No. 3067-0151
                           FORCE ACCOUNT EQUIPMENT SUMMARY RECORD                          PAGE       ___ OF   ______      Expires September 30, 2005
APPLICANT                                               PA ID NO.                   PROJECT NO.                         DISASTER

0
LOCATION/SITE                                                                       CATEGORY                            PERIOD COVERING

0                                                                                                     0                                TO
DESCRIPTION OF WORK PERFORMED




                Type of Equipment                                     Dates and Hours Used Each Day                                    Costs
    INDICATE SIZE, CAPACITY,   EQUIPMENT   OPERATOR'S
                                                                                                                        TOTAL     EQUIPMENT       TOTAL
    HORSEPOWER, MAKE AND         CODE         NAME      DATE
                                                                                                                        HOURS       RATE          COST
     MODEL AS APPROPRIATE       NUMBER

                                                        Hours
                                                                                                                          0.0                     $0.00

                                                        Hours
                                                                                                                          0.0                     $0.00

                                                        Hours
                                                                                                                          0.0                     $0.00

                                                        Hours
                                                                                                                          0.0                     $0.00

                                                        Hours
                                                                                                                          0.0                     $0.00

                                                        Hours
                                                                                                                          0.0                     $0.00

                                                        Hours
                                                                                                                          0.0                     $0.00
                                                                            GRAND TOTALS                                  0.0                     $0.00

       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 90-127, OCT 02
                                                                 PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 15 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.
8   22.0   15.0   15.0   15.0   15.0   15.0   15.0


8    8.0   15.0    8.0    8.0    8.0    8.0    8.0


8    8.0    8.0    8.0    8.0    8.0    8.0    8.0


8    8.0    8.0    8.0    8.0    8.0    8.0    8.0


8    8.0    8.0    8.0    8.0    8.0    8.0    8.0


8    8.0    8.0    8.0    8.0    8.0    8.0    8.0


8    8.0    8.0   22.0    8.0    8.0   15.0    8.0
                                                FORCE ACCOUNT EQUIPM
                                                             INSTRUC

                  Force account is the term used to define labor performed and equ

                  Complete the Record as Follows:

                  *

                  *


                  *
                  *


                  *



                  *

                  *
                  *
                  *



                  *
                  *
                  *
                  *

                  *

                  *

                  *

                  *


                  *




Updated 5/18/05               b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 16
                             FORCE ACCOUNT EQUIPMENT SUMMARY RECORD
                                          INSTRUCTIONS

Force account is the term used to define labor performed and equipment owned by the applicant.

Complete the Record as Follows:

    Applicant: Enter organization's name.
    PA ID No.: Enter the computer tracking number that FEMA assigns applicant organization. Your Public Assistance
    Coordinator can provide you with this number.
    Project No.: Enter the number assigned to this project.
    Disaster: Enter the declaration number for this disaster here. The Public Assistance Coordinator can also provide you
    with this information.
    Location/Site: This item can range anywhere from an "address," intersection of…/" "1 mile south of …on…" to "county
    wide." If damages are in different locations or different counties please list each location. Include latitude and longitude
    of the project if known.
    Category: Indicate the category of the project according to FEMA specified work categories (i.e., B, H, Z). This is
    optional.
    Period Covering: It's auto filled from "Dates & Hours Used Each Day / Date" blocks.
    Description of Work Performed: Describe the type of work performed.
    Type of Equipment / Indicate size, capacity, horsepower, make and model as appropriate: Enter a brief description
    of the equipment, including the rated horsepower or capacity of the equipment. Be sure to include this information if you
    also use a trade name or common name to describe the equipment, e.g., Ditch Witch.
    Equipment Code Number: Enter the FEMA cost code for the equipment.
    Operator's Name: Enter the equipment operators name.
    Dates & Hours Used Each Day / Date: Enter the days of the week.
    Hours: Enter the hours the equipment worked. Notes: Standby time for equipment is not eligible.

    Costs / Total Hours: Adds the total hours for the week and auto fills the Total Hours block.
    Costs / Equipment Rate: Enter the hourly rate for the equipment.

    Costs / Total Cost: Multiply the number in the Total Hours block by the number in the Equipment Rate block and auto
    fills the amount in the Total Cost block.
    Grand Totals: Add the numbers in the Total Hours blocks and auto fills into the Grand Total block; Add the numbers in
    the Total Cost blocks and auto fills into the Grand Total block.

    Certified: Record the name, title, and date of the person certifying the Force Account Equipment Summary Record.




        Updated 5/18/05                                                             b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 16
Updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 16
ONLY need to fill in the yellow boxes because the white boxes are auto filled in from
                          FEDERAL EMERGENCY MANAGEMENT AGENCY
                                                                                                              O.M.B. N
                           APPLICANT'S BENEFITS CALCULATION                         PAGE ____ OF ____      Expires Sep
                                      WORKSHEET
       APPLICANT                                                                                         PA ID NO.
       0
       DISASTER                                                                    PROJECT NO.




            FRINGE BENEFITS (by %)                   REGULAR TIME                                   OVERTIME


       HOLIDAYS
                                                         3.8%
       VACATION LEAVE
                                                         5.8%
       SICK LEAVE
                                                         4.6%
       SOCIAL SECURITY
                                                         7.7%                                           7.7%
       MEDICARE


       UNEMPLOYMENT
                                                         1.5%                                           1.5%
       WORKER'S COMP.
                                                         2.0%                                           2.0%
       RETIREMENT
                                                         5.5%                                           5.5%
       HEALTH BENEFITS
                                                        23.3%
       LIFE INS. BENEFITS
                                                         1.2%
       OTHER

           TOTAL in % of annual salary                  55.3%                                        16.6%
       COMMENTS




            I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER DOCUMENTS WHICH ARE

       CERTIFIED BY                                       TITLE                                          DATE
FEMA Form 90-128, OCT 02
                                         PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to 30 minutes per response. The burden includes the time for review
instruction, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, a
the form. You are not required to respond to this collection of information unless a valid OMB control number appears
right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for redu
burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washi
20472, Paperwork Reduction Project (3067-0151). Submission of the form is required to obtain or retain benefits und
Assistance Program. Please do not send your completed form to the above address.
e the white boxes are auto filled in from "Fringe Benefits."
                                               O.M.B. No. 3067-0151
                                            Expires September 30, 2005


                                          PA ID NO.


                      PROJECT NO.




                                       OVERTIME




                                         7.7%



                                         1.5%

                                         2.0%

                                         5.5%




                                        16.6%




ED FROM PAYROLL RECORDS OR OTHER DOCUMENTS WHICH ARE AVAILABLE

                                          DATE
 URDEN DISCLOSURE NOTICE

  utes per response. The burden includes the time for reviewing
  maintaining the needed data, and completing, reviewing, and submitting
n of information unless a valid OMB control number appears in the upper
 curacy of the burden estimate and any suggestions for reducing this
Emergency Management Agency, 500 C Street, SW, Washington, DC
 ssion of the form is required to obtain or retain benefits under the Public
ed form to the above address.
                                                       This is an example.
          ONLY need to fill out the yellow and blue boxes then it will automatically fill out form 90-128.
                                 Fringe Benefit Calculations
                      There are other ways to calculate Fringe Benefits, this is only one.
                                       This is normally done for each employee or each pay grade.
                      Employee Name:

                             Applicant:

                              PA ID No:

                     Disaster Number:

                           Department:

                  All calculations are based on the amount that only the employer pays .
                          Most figures can be obtained from accounting department.
             Blocks that you fill in =

        Work hrs per year (2080 hrs is normal work year )                 #       2,080
        Pay / Hour                                                        $       20.00
        Basic Pay Annualized                                              $     41,600.00
                                                                                                        See note 1
                                                                              Regular Time     %        Overtime          %
        Vacation - days/year            #        15     days                     120.00        5.8          *
        Holidays - days/year            #        10     days                      80.00        3.8          *
        Sick - days/year                #        12     days                      96.00        4.6          *
        Retirement (% of annual salary) )       5.45                               5.45        5.5        5.45           5.5
        Social Security - fixed rate    %       7.65                               7.65        7.7        7.65           7.7
        Unemployment                    %       1.50                               1.50        1.5        1.50           1.5
        Workman’s Comp                  %       2.00                               2.00        2.0        2.00           2.0
        Health Insurance                $     800.00    / mo / employee           23.08       23.1          *
        Life Insurance                  $      40.00    / mo / employee            1.15        1.2          *
        Dental                          $       5.00    / mo / employee            0.14        0.1          *
        Vision                          $       3.00    / mo / employee            0.09        0.1          *
                                                                                                            *
                                          %                                                                 *

                                                              Total Percent =                   55.3                      16.6
                                                 Transfer to Data Sheet for Employee
                                                         Starting at row F35

                                                               Typical ranges                20-60 %                  3-20 %

        I certify that the information above was transcribed from payroll records or other
        documents which are available for audit.
        Certified by: ________________________________________
        Title: ______________________________________________

        Note 1: Vacation, Holidays and Insurance are not figured into overtime benefits.
        401K plans or similar type plans sometimes are not included in Overtime.
        Retirement, Unemployment and Workman's Comp are sometimes included in overtime benefits.




updated 5/18/05                                                                                      b95c6a25-1476-4571-bd9b-feff096b8b15.xls, Fringe Benefits
                                               FRINGE BENEFIT RATE SHEET INSTRUCTIONS

                    Fringe Benefit Calculations

                    Fringe benefits for force account labor is eligible. Except in extremely unusual cases, frin
                    overtime will be significantly less than regular time.
                    The following steps will assist in calculating the percentage of fringe benefits paid on an
                    Note: items and percentages will vary from one entity to another.

                  1) The normal year consists of 2080 hours (52 weeks x 5 workdays/week x 8 hours/day). Th
                    and vacations.
                  2) Determine the employee's basic hourly pay rate (annual salary/2080 hours).
                  3) Fringe benefit percentage for vacation time: Divide the number of hours of annual va
                    employee by 2080 (80 hours (2 weeks)/2080 = 3.85%).
                  4) Fringe benefit percentage for paid holidays: Divide the number of paid holiday hours
                    holidays)/2080 = 3.07%).
                  5) Retirement pay: Because this measure varies widely, use only the percentage of salary m
                  6) Social Security and Unemployment Insurance: Both are standard percentages of salary.
                  7) Insurance: This benefit varies by employee. Divide the amount paid by the city or coun
                     determined in Step 2.
                  8) Workman's Compensation: This benefit also varies by employee. Divide the amount p
                     the basic pay rate determined in Step 2. Use the rate per $100 to determine the correct pe

                    Note: Typically, you should not be charging the same rate for regular time and overtime.
                    (Social Security) is eligible for overtime; however, some entities may charge retirement t

                    Sample Rates

                    Although some rates may differ greatly between organizations due to their particular expe
                    provides some general guidelines that can be used as a reasonableness test to review subm
                    based on experience in developing fringe rates for several state departments, the default r
                    Florida, following Hurricane Andrew (August 1992), and the review of several FEMA cla
                    determined using the gross wage method applicable to the personnel hourly rate (PHR) m
                    method would result in higher rates.

                            Paid Fringe Benefits
                            HCA Matching                                       7.65%
                            Retirement--Regular                               17.00%
                            Retirement--Special Risk                          25.00%
                            Health Insurance                                  12.00%
                            Life & Disability Insurance                        1.00%
                            Worker's Compensation                              3.00%
                            Unemployment Insurance                             0.25%
                            Leave Fringe Benefits
                            Accrued Annual Leave                               7.00%
                            Sick Leave                                         4.00%
                            Administrative Leave                               0.50%
                            Holiday Leave                                      4.00%
                            Compensatory Leave                                 2.00%
                          Rates outside of these ranges are possible, but should be justified during the v

updated 5/18/05                                           b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 19
updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 19
ENEFIT RATE SHEET INSTRUCTIONS




 s eligible. Except in extremely unusual cases, fringe benefits for

 ating the percentage of fringe benefits paid on an employee's salary.
y from one entity to another.

 (52 weeks x 5 workdays/week x 8 hours/day). This does not include holidays

pay rate (annual salary/2080 hours).
n time: Divide the number of hours of annual vacation time provided to the
2080 = 3.85%).
lidays: Divide the number of paid holiday hours by 2080 (64 hours (8

e varies widely, use only the percentage of salary matched by the employer.
urance: Both are standard percentages of salary.
loyee. Divide the amount paid by the city or county by the basic pay rate

efit also varies by employee. Divide the amount paid by the city or county by
 Use the rate per $100 to determine the correct percentage.

rging the same rate for regular time and overtime. Generally, only FICA
e; however, some entities may charge retirement tax on all income.



 between organizations due to their particular experiences, the table below
 an be used as a reasonableness test to review submitted claims. These rates are
ge rates for several state departments, the default rate is that used for the state of
August 1992), and the review of several FEMA claims. The rates presented are
 d applicable to the personnel hourly rate (PHR) method. The net available hours



                                  (or slightly less)
                                  (or less)
                                  (or slightly more)
                                  (or less)
                                  (or less)
                                  (or less)
                                  (or less)

                                  (or less)
                                  (or less)
                                  (or less)
                                  (or less)
                                  (or less)
re possible, but should be justified during the validation process.

              updated 5/18/05                                                            b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 19
updated 5/18/05   b95c6a25-1476-4571-bd9b-feff096b8b15.xls, 19
                                             Cost Code Listing
           The Cost Codes that are in bold and blue are the most commonly used.

Record       COST              Unit
 Type        CODE      UOM     Price                    DESCRIPTION
Regional       852      LS              STATE MANAGEMENT COSTS
Regional      9001      LS              CONTRACT
National      9004      LS              RENTED EQUIPMENT
National      9005      LS              LABOR, O/T W/O BENEFITS
National      9006      LS              LABOR, W/O BENEFITS
Regional      9007      LS     $0.00    LABOR
National      9008      LS     $0.00    EQUIPMENT
National      9009      LS     $0.00    MATERIAL
National      9010      HR     $0.00    LABORER REGULAR TIME
                                        LABORER OVERTIME, INCLUDE PUMP AND REAR
National      9011      HR     $0.00    SPRAY SYSTEM.
                                        EQUIPMENT OPERATOR REGULAR TIME,
National      9012      HR     $0.00    INCLUDE PUMP AND REAR SPRAY SYSTEM.
National      9013      HR     $0.00    EQUIPMENT OPERATOR OVERTIME
National      9014      HR     $0.00    WORKING FOREMAN REGULAR TIME
National      9015      HR     $0.00    WORKING FOREMAN OVERTIME
                                        EXTRA HIRE W/PAYROLL ADDITIVES REGULAR
National      9016      HR     $0.00    TIME

National      9017      HR     $0.00    EXTRA HIRE W/PAYROLL ADDITIVES OVERTIME
National      9018      HR     $0.00    FIREFIGHTERS OVERTIME
National      9019      HR     $0.00    POLICE OVERTIME
National      9020      HR     $0.00    DISPATCHER OVERTIME
National      9021      HR     $0.00    CONTRACT LABOR
Regional      9022      LS              RENTED EQUIPMENT
Regional      9031      LS              CONTRACTOR FEES
Regional      9032      LS              CONSTRUCTION PLAN REVIEW / PERMIT FEES
Regional      9050      LS              DONATED RESOURCES
Regional      9995      LS              SALES TAX
National      8072      MI      $0.41   AUTOMOBILE, POLICE - TO 250 HP
National      8073      HR     $11.00   AUTOMOBILE, POLICE - TO 250 HP
National      8075      MI      $0.29   MOTORCYCLE, POLICE
National      8120      HR    $157.00   BOAT, TOW- TO 870 HP, SIZE: 55'X20'X5'
National      8121      HR    $248.00   BOAT, TOW- TO 1050 HP, SIZE: 60'X21'X5'
National      8122      HR    $369.00   BOAT, TOW- TO 1350 HP, SIZE: 70'X30'X7.5'
National      8123      HR    $559.00   BOAT, TOW- TO 2000 HP, SIZE: 120'X34'X8'
National      8130      HR      $0.85   BOAT, ROW, HEAVY DUTY.
National      8131      HR      $9.30   BOAT, RUNABOUT- TO 50 HP, SIZE: 13'X5'
National      8132      HR     $20.50   BOAT, TENDER- TO 100 HP, SIZE: 14'X7'
National      8133      HR    $128.00   BOAT, PUSH- TO 435 HP, SIZE: 45'X21'X6'
National      8134      HR    $144.00   BOAT, PUSH- TO 525 HP, SIZE: 54'X21'X6'
National      8135      HR    $176.00   BOAT, PUSH- TO 705 HP, SIZE: 58'X24'X7.5'
National      8136      HR    $206.00   BOAT, PUSH- TO 870 HP, SIZE: 64'X25'X8'
National      8140      HR     $23.00   BOAT, TUG- TO 100 HP, LENGTH: 16 FT
National      8141      HR     $35.00   BOAT, TUG- TO 175 HP, LENGTH: 18 FT
National      8142      HR     $44.00   BOAT, TUG- TO 250 HP, LENGTH: 26 FT
National      8143      HR    $109.00   BOAT, TUG- TO 380 HP, LENGTH: 40 FT
National      8144      HR    $153.00   BOAT, TUG- TO 700 HP, LENGTH: 51 FT
National      8250      HR     $26.50   DOZER, CRAWLER- TO 65 HP
National      8251      HR     $34.00   DOZER, CRAWLER- TO 105 HP
National      8252      HR     $46.00   DOZER, CRAWLER- TO 160 HP
National      8253      HR     $67.00   DOZER, CRAWLER- TO 245 HP
National      8254      HR    $104.00   DOZER, CRAWLER- TO 375 HP
National      8255      HR    $171.00   DOZER, CRAWLER- TO 565 HP

                                                   92 of 94                         4/22/2012
                                             Cost Code Listing
           The Cost Codes that are in bold and blue are the most commonly used.

Record       COST              Unit
 Type        CODE      UOM     Price                    DESCRIPTION
National      8256      HR    $298.00   DOZER, CRAWLER- TO 850 HP
National      8260      HR     $44.00   DOZER, WHEEL- TO 260 HP
National      8261      HR     $52.00   DOZER, WHEEL- TO 335 HP, STEEL
National      8262      HR     $66.00   DOZER, WHEEL- TO 445 HP, STEEL
National      8263      HR     $96.00   DOZER, WHEEL- TO 615 HP, STEEL

National      8690      HR    $44.00    TRUCK, FIRE- PUMP CAPACITY: 1000 GPM, STEEL
National      8691      HR    $46.00    TRUCK, FIRE- PUMP CAPACITY: 1250 GPM
                                        TRUCK, FIRE- PUMP CAPACITY: 1500 GPM,
National      8692      HR    $59.00    OUTBOARD.
                                        TRUCK, FIRE- PUMP CAPACITY: 2000 GPM,
National      8693      HR    $64.00    INBOARD WITH 360 DEGREE DRIVE.
                                        TRUCK, FLATBED- TO 150 HP, MAXIMUM GVW:
National      8700      HR    $11.25    15000 LBS, FLAT HULL
                                        TRUCK, FLATBED- TO 180 HP, MAXIMUM GVW:
National      8701      HR    $13.75    25000 LBS, FLAT FULL
                                        TRUCK, FLATBED- TO 215 HP, MAXIMUM GVW:
National      8702      HR    $17.75    30000 LBS, FLAT HULL
                                        TRUCK, FLATBED- TO 250 HP, MAXIMUM GVW:
National      8703      HR    $23.00    45000 LBS, FLAT HULL
                                        TRUCK, FLATBED- TO 300 HP, MAXIMUM GVW:
National      8704      HR    $28.00    50000 LBS
National      8705      HR    $34.00    TRUCK, FLATBED- TO 375 HP
National      8706      HR    $40.00    TRUCK, FLATBED- TO 450 HP
                                        TRUCK, WATER- TO 175 HP, TANK CAPACITY:
National      8780      HR    $20.50    2500 GAL
                                        TRUCK, WATER- TO 250 HP, TANK CAPACITY: 4000
National      8781      HR    $29.00    GAL
National      8790      HR    $22.00    TRUCK, TRACTOR- TO 210 HP
National      8791      HR    $28.50    TRUCK, TRACTOR- TO 265 HP
National      8792      HR    $32.00    TRUCK, TRACTOR- TO 310 HP
National      8793      HR    $35.00    TRUCK, TRACTOR- TO 350 HP
                                        TRUCK, PICKUP- TO 130 HP, WHEN
National      8800      MI     $0.33    TRANSPORTING PEOPLE.
National      8801      HR     $7.40    TRUCK, PICKUP- TO 130 HP
National      8802      HR     $9.30    TRUCK, PICKUP- TO 180 HP
National      8803      HR    $11.75    TRUCK, PICKUP- TO 230 HP
National      8804      HR    $14.75    TRUCK, PICKUP- TO 280 HP
                                        TRUCK, BUCKET, ADD FLATBED TRUCK TO
National      8810      HR              TRUCK MOUNTED AERIAL LIFT.
                                        TRUCK, CLEANING, ADD FLATBED TRUCK TO
National      8811      HR              SEWER CLEANER.
                                        TRUCK, KNUCKLE BOOM, ADD FLATBED TRUCK
National      8812      HR              TO TRUCK MOUNTED CRANE.
                                        TRUCK, LADDER, ADD FLATBED TRUCK TO
National      8813      HR              TRUCK MOUNTED AERIAL LIFT.
                                        TRUCK, LINE, ADD FLATBED TRUCK TO
National      8814      HR              HYDRAULIC DIGGER DERRICK.
National      2010      HR     $0.00    POLICE OVERTIME
                                        FIRE OVERTIME, Same as Codes 2009 and 2010
National      2011      HR     $0.00    except applies to firemen.




                                                   93 of 94                            4/22/2012
                                              Cost Code Listing
           The Cost Codes that are in bold and blue are the most commonly used.

Record       COST              Unit
 Type        CODE      UOM     Price                       DESCRIPTION
                                       TEMPORARY EMPLOYEES, Those employees hired
                                       specifically to perform duties required by the disaster.
                                       Both regular and overtime is eligible. Should include
National      2012      HR     $0.00   very small fringe benefits.
Regional      3001      LS             MOBILIZATION




                                                     94 of 94                                     4/22/2012

				
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