APPLICANT’S BENEFITS CALCULATION WORKSHEET
APPLICANT’S BENEFITS CALCULATION WORKSHEET
FEMA DISASTER DECLARATION # FEMA-EM-3192-CT
For snow removal assistance, the fringe rate applicable to force account employees is the Overtime % only.
|BENEFIT |REGULAR TIME % |OVERTIME % |
|FICA | |7.65% |
|Retirement (if applicable) | | |
|Health Insurance | | |
|Life Insurance | | |
|Workers Compensation | | |
|Unemployment Insurance | | |
|Annual Leave | | |
|Sick Leave | | |
|Holiday Leave | | |
|TOTAL: | | |
|COMMENTS: | | |
|I certify that the information above was transcribed from payroll records or other documents which are available for audit. |
|Certified by: |
|Title: |
|Date: |
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