DEP Memorandum on Federal Reimbursement Documentation, September 18, 2001

NYC 9/11 Public Portal Document

FORCE ACCOUNT LABOR RECORD FORM INSTRUCTIONS (using your own workers)

Fill in the entire heading. Ensure name, DSR number, time period and category is accurately completed. Please note: use a separate form/s for each category of work at each worksite. COLUMN a Enter each worker's name and title. b Enter the dates worked on top row. Separate the regular or straight pay from overtime pay and enter the hours in the appropriate row. c Add the hours (regular and overtime) across for the time period specified and enter amounts in the appropriate row. Ensure you total the hours in the column (regular and overtime) and enter the amount at the bottom. d Enter the appropriate hourly rate of pay used for regular and/or overtime. e Multiply the total hours (column c) by the rate (column d) for total pay. This is the total pay the worker received for the time period listed on this record. Ensure you total the column and enter the total for regular pay (RP) and the total for overtime pay (OT) . f Enter the number on the paycheck the employee received.

g --Regular pay (RP) = total regular pay multiplied by the fringe benefit rate. (Enter the fringe amount in the blank). 1 equals this total. --Overtime pay (OT) = the total overtime pay multiplied by the rate. (Enter the fringe amount in the blank). 3 equals this total. ------ Add the amounts of 1 through 4 for the grand total.

Sign the force account labor record. Use additional sheets when necessary. Each record needs to be certified.

The information to complete this form is available from the employee's time cards, supervisor's work logs and from the payroll office.

Refer to the Applicant's Handbook for work eligibility when using your own workers.

NYC-WTC_000152514