Form 1900-10 US EPA Contractor's Cumulative Claim

Contractor Cumulative Claim and Reconciliation (Renewal)

0246form1900-10

Contractor Cumulative Claim and Reconciliation (Renewal)

OMB: 2030-0016

Document [doc]
Download: doc | pdf

EPA United States Environmental Protection Agency

Contractor's Cumulative Claim and Reconciliation


OMB No. 2030 – 0016

Expiration Date: XX/XX/XX

1. Contractor's Address (include zip code)

2. Contract No.

3. Total amounts claimed under this contract (less disallowances concurred by the contractor and disallowances not subject to appeal) and approved on Public Vouchers Nos. to (including completion vouchers).

Item

Amount

Direct Labor

$

Direct Material and Supplies

$

Equipment

$

Travel

$

Subcontract Costs

$

Other Direct Costs

$

Consultant Fees

$

Fixed Fee

$

Indirect Costs (Total From Section 4)

$

Total Amount Claimed

$

4. Reconciliation of Indirect Costs Claimed. Record the amount of indirect costs calculated, for each cost center, using negotiated final indirect cost rate(s). Use provisional rate(s) if final rates are not negotiated for any fiscal year period(s). Use the reverse side of this form, if necessary, to display all years and cost centers.


Cost Center

Cost Center

Cost Center

Cost Center

Cost Center

FY­


Base






Rate






Indirect Costs






FY­


Base






Rate






Indirect Costs






FY­


Base






Rate






Indirect Costs






Totals






No monies or other benefits may be paid unless this report is completed and filed as required in the EPA billing instructions.

I certify that the information provided on this form and attachments thereto are accurate and complete. I acknowledge that any knowingly false or misleading information may be punishable by fine and/or imprisonment under applicable law.

Name and Title (Print or Type)

Signature

Date



Paperwork Reduction Act Notice

The public reporting and recordkeeping burden for this collection of information is estimated to average 6.3 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.



Cost Center

Cost Center

Cost Center

Cost Center

Cost Center

FY


Base






Rate






Indirect Costs






FY­


Base






Rate






Indirect Costs






FY­


Base






Rate






Indirect Costs






FY­


Base






Rate






Indirect Costs






FY­


Base






Rate






Indirect Costs






Totals








No monies or other benefits may be paid unless this report is completed and filed as required in the EPA billing instructions.






File Typeapplication/msword
File TitleEPA United States Environmental Protection Agency
Authorctsuser
Last Modified ByVanBronkhorst, Kelly
File Modified2015-04-07
File Created2015-04-07

© 2024 OMB.report | Privacy Policy