Work Opportunity Credit Prescreening Notice and Certification Request

ICR 199612-1545-004

OMB: 1545-1500

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1545-1500 199612-1545-004
Historical Active 199609-1545-012
TREAS/IRS
Work Opportunity Credit Prescreening Notice and Certification Request
Extension without change of a currently approved collection   No
Regular
Approved without change 02/03/1997
Retrieve Notice of Action (NOA) 12/06/1996
If the WOTC is extended and the form is revised, the agency will amend the date-of-birth line, pursuant to IRS Announcement 96-116 and to any changes to the WOTC, as appropriate. The agency will also reissue the DOB guidance from Announcement 96-116 with future mailings of form 941 to employers. The agency is not required to display the expiration date.
  Inventory as of this Action Requested Previously Approved
02/29/2000 02/29/2000 02/28/1997
400,000 0 400,000
1,480,000 0 1,480,000
0 0 0

A job applicant completes and signs, under penalties of perjury, the top portion of the form to indicate that he or she is a member of a targeted group. If the employer has a belief that the applicant is a member of a targeted group, the employer signs the other portion of the form under penalties of perjury and submits it to the SESA as part of a written request for certification.

None
None


No

1
IC Title Form No. Form Name
Work Opportunity Credit Prescreening Notice and Certification Request 8850

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 400,000 400,000 0 0 0 0
Annual Time Burden (Hours) 1,480,000 1,480,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/06/1996


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