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⚠️ Notice: This information collection may be referencing outdated material.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 Certificaiton Workload and Characteristics of Certified ETA From 9058 - Report 1 Certification Wrkload & Characts Cert Individuals (COF 6-25-07).doc Form and Instruction
ETA-9061 Individual Characteristics Form ETA Form 9061- ICF (6 & F7-07).doc Form and Instruction
ETA-9061 Spanish V Individual Characteristics Form, Spanish Version ETA Form 9061- ICF Spanish Version (6 & F7-07).doc Form and Instruction
ETA-9062 Conditinoal Certification ETA Form 9062 Conditional Certification (Rev F6-07).doc Form and Instruction
ETA-9063 Employer Certification, Optional ETA Form 9063 Certification (Rev F6-07).doc Form and Instruction
ETA-9065 Agency Declaration of Verificatino Results, Optional ETA Form 9065 ADVR (Rev. F6-07).doc Form and Instruction
ETA-9057 Conditional Certifications Issued: Summary Worksheet, fo ETA Form 9057 Conditional Certifications Issued (Rev. F6-07).doc Form and Instruction
ETA-9059 Verification Results: Audit Summary Worksheet, for SWA I ETA Form 9059 Verification Results (Rev F7-07).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-9059	Verification Results: Audit Summary Worksheet, for SWA Internal Unse Only	ETA Form 9059 Verification Results (Rev F7-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Individual Characteristics Form	ETA Form 9061- ICF (6 & F7-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061 Spanish Version	Individual Characteristics Form, Spanish Version	ETA Form 9061- ICF Spanish Version (6 & F7-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9065	Agency Declaration of Verificatino Results, Optional	ETA Form 9065 ADVR (Rev. F6-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9062	Conditinoal Certification	ETA Form 9062 Conditional Certification (Rev F6-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9058	Certificaiton Workload and Characteristics of Certified Individuals: Consolidated WOTC Rept No. 1	ETA From 9058 - Report 1 Certification Wrkload & Characts Cert Individuals (COF 6-25-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9057	Conditional Certifications Issued: Summary Worksheet, for SWA Internal Use Onlty	ETA Form 9057 Conditional Certifications Issued (Rev. F6-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9063	Employer Certification, Optional	ETA Form 9063 Certification (Rev F6-07).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: 990,052	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,421,028	0	2,421,028
Annual IC Time Burden (Hours)	848,325	432,957	415,368
Annual IC Cost Burden (Dollars)	0	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.