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.
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.
Work Opportunity Credit Prescreening Notice and Certification Request