Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0371 can be found here:

Documents and Forms

Document Name Document Type
Form ETA-9058 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit Form and Instruction
ETA-9058 Report 1 Certification Workload & Characteristics of Cer ETA From 9058 - Report 1 Certification Workload & Characteristics of Certified Individuals R12-28-06.doc Form and Instruction
ETA-9057 Conditional Certifications ETA Form 9057 Conditional Certifications Issued 2-2-07.doc Form and Instruction
ETA-9059 verfification results ETA Form 9059 Verification Results Rev. 2-02-07.doc Form and Instruction
ETA-9065 Work Opportunity Tax Credit ETA Form 9065 ADVR Rev. 12-28-06.doc Form and Instruction
ETA-9061 Individual Characteristics ETA Form 9061 Individual Characteristics Form rev 12-28-06.doc Form and Instruction
ETA-9062 Conditional Certification ETA Form 9062 Conditional Certification Rev 12-28-06.doc Form and Instruction
ETA-9063 Certification Form ETA Form 9063 Certification Form Rev 2-02-07.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9062	Conditional Certification	ETA Form 9062 Conditional Certification Rev 12-28-06.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9063	Certification Form	ETA Form 9063 Certification Form Rev 2-02-07.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9058	Report 1 Certification Workload & Characteristics of Certified Individuals	ETA From 9058 - Report 1 Certification Workload & Characteristics of Certified Individuals R12-28-06.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9057	Conditional Certifications	ETA Form 9057 Conditional Certifications Issued 2-2-07.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9059	verfification results	ETA Form 9059 Verification Results Rev. 2-02-07.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Individual Characteristics	ETA Form 9061 Individual Characteristics Form rev 12-28-06.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9065	Work Opportunity Tax Credit	ETA Form 9065 ADVR Rev. 12-28-06.doc	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 990,520	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,421,028	2,421,028
Annual IC Time Burden (Hours)	415,368	415,368
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.