Form PR-20 Voucher for Work Performed Under Provisions of the Federal Aid and Federal Highway Acts, as Amended

Form PR-20 or the "Voucher For Work Performed Under Provisions Of The Federal Aid And Federal Highway Acts, As Amended" is a form issued by the U.S. Department of Transportation - Federal Highway Administration.

The form was last revised in April 1, 2014 and is available for digital filing. Download an up-to-date Form PR-20 in PDF-format down below or look it up on the U.S. Department of Transportation - Federal Highway Administration Forms website.

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This collection of information is Mandatory and will be used to reimburse State Departments of Transportation for costs incurred on Federal-aid projects. Public reporting burden is estimated to average
30 minutes per response, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control
number for this collection is 2125-0507. The expiration date for this OMB number is May. 31, 20XX. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: Michael Howell, Information Collection Clearance Officer, Federal Highway Administration, E64-433, 1200 New Jersey Avenue SE, Washington, DC, 20590.
STATE VOUCHER NO.
VOUCHER FOR WORK PERFORMED
U. S. Department
UNDER PROVISIONS OF THE FEDERAL AID
of Transportation
AND FEDERAL HIGHWAY ACTS,
FHWA VOUCHER NO.
AS AMENDED
Federal Highway
Administration
APPROPRIATION
FHWA SCHEDULE NO.
THE UNITED STATES, DR., TO (Insert official or depositary named in project agreement)
PAID BY
ADDRESS
(For use of Paying Office)
STATE
VOUCHER TYPE (Check Appropriate Block)
CURRENT BILLING
FEDERAL AID PROJECT NO.
FROM
VOUCHER PERIOD
OTHER PROGRESS
TO
FINAL VOUCHER(*)
(*) Use Form FHWA-1447 for Final Voucher for a project constructed under certi fication acceptance or secondary road procedures (23 U.S.C. 117).
TOTAL
PRO-RATA OF
TOTAL AMOUNT
LESS
NET
TOTAL ACTUAL COST
PARTICIPATING
PARTICIPATING COST
CLAIMED
PREVIOUS
AMOUNT
COST
CLAIMED
CLAIMED FROM U.S.
FROM U.S.
PAYMENTS
I certify that the cost shown in this voucher have been incurred in accordance with terms of project agreements; applicable State and Federal laws or regulati ons; and
that no claim has previously been submitted for costs claimed.
STATE HIGHWAY AGENCY
DATE
SIGNATURE OF AUTHORIZED OFFICIAL
I certify that supporting records for costs claimed, and the
referenced project (if applicable), have been subjected to required
reviews, approvals and inspections by the Federal Highway
Administration and that the amount approve is justly due.
AMOUNT SUBMITTED
SIGNATURE OF FHWA REPRESENTATIVE
ADJUSTMENTS
AMOUNT APPROVED
DATE APPROVED
FORM PR-20 (Rev. 4-14)
PREVIOUS EDITIONS ARE OBSOLETE
Save Data Only
Clear Form
Save Data & Form
This collection of information is Mandatory and will be used to reimburse State Departments of Transportation for costs incurred on Federal-aid projects. Public reporting burden is estimated to average
30 minutes per response, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control
number for this collection is 2125-0507. The expiration date for this OMB number is May. 31, 20XX. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: Michael Howell, Information Collection Clearance Officer, Federal Highway Administration, E64-433, 1200 New Jersey Avenue SE, Washington, DC, 20590.
STATE VOUCHER NO.
VOUCHER FOR WORK PERFORMED
U. S. Department
UNDER PROVISIONS OF THE FEDERAL AID
of Transportation
AND FEDERAL HIGHWAY ACTS,
FHWA VOUCHER NO.
AS AMENDED
Federal Highway
Administration
APPROPRIATION
FHWA SCHEDULE NO.
THE UNITED STATES, DR., TO (Insert official or depositary named in project agreement)
PAID BY
ADDRESS
(For use of Paying Office)
STATE
VOUCHER TYPE (Check Appropriate Block)
CURRENT BILLING
FEDERAL AID PROJECT NO.
FROM
VOUCHER PERIOD
OTHER PROGRESS
TO
FINAL VOUCHER(*)
(*) Use Form FHWA-1447 for Final Voucher for a project constructed under certi fication acceptance or secondary road procedures (23 U.S.C. 117).
TOTAL
PRO-RATA OF
TOTAL AMOUNT
LESS
NET
TOTAL ACTUAL COST
PARTICIPATING
PARTICIPATING COST
CLAIMED
PREVIOUS
AMOUNT
COST
CLAIMED
CLAIMED FROM U.S.
FROM U.S.
PAYMENTS
I certify that the cost shown in this voucher have been incurred in accordance with terms of project agreements; applicable State and Federal laws or regulati ons; and
that no claim has previously been submitted for costs claimed.
STATE HIGHWAY AGENCY
DATE
SIGNATURE OF AUTHORIZED OFFICIAL
I certify that supporting records for costs claimed, and the
referenced project (if applicable), have been subjected to required
reviews, approvals and inspections by the Federal Highway
Administration and that the amount approve is justly due.
AMOUNT SUBMITTED
SIGNATURE OF FHWA REPRESENTATIVE
ADJUSTMENTS
AMOUNT APPROVED
DATE APPROVED
FORM PR-20 (Rev. 4-14)
PREVIOUS EDITIONS ARE OBSOLETE
Save Data Only
Clear Form
Save Data & Form
STATEMENT OF COSTS INCURRED UNDER PROJECT AGREEMENT
NOTATIONS
UNIT
ITEM
ITEM
UNIT
AMOUNT
QUANTITY
(Payee must not
NO.
PRICE
use this column)
AMOUNT CARRIED FORWARD......

Download Form PR-20 Voucher for Work Performed Under Provisions of the Federal Aid and Federal Highway Acts, as Amended

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