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Attachment 5 <br /> 14 <br /> REPORT OF SERVICES <br /> Name of Project: Month: Year: <br /> Name of Person Performing Services: Describe the services you performed.(If you supervised others,include their names <br /> and positions.) <br /> Address: <br /> Telephone: <br /> How was the hourly rate shown below determined? <br /> Labor value appraisal on reverse side of this form. <br /> Did you receive any compensation for the time you Other,explain: <br /> devoted to this project? <br /> Yes No <br /> If yes,who paid you? <br /> How much were you paid? <br /> Total number of hours worked each day during this month: <br /> Beginning Sunday Monday Tuesday Wednesday Thursday Friday Saturday Totals <br /> Total hours this. <br /> month: #of hours <br /> Hourly rate: $ Per hour <br /> Amount charged to $ <br /> project: <br /> INSTRUCTIONS: <br /> Use this form to document all labor,whether paid or <br /> voluntary,which is claimed against a grant or used <br /> for the matching share of a grant. Complete it on a <br /> timely basis,i.e.,fill it out immediately after the <br /> service is provided. <br /> 65 <br />