Information Collection

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

IC 43791 under ICR 200804-1205-001 · OMB 1205-0371.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9058 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	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
ETA-9058 Consolidated Work Opportunity Tax Credit Report #1 ETA From 9058 - Report 1 Certification Wrkload & Characts Cert Individuals (COF 6-25-07).doc	Form and Instruction
ETA-9065 Agency Declaration of Verification Results ETA Form 9065 ADVR (Rev. F6-07).doc	Form and Instruction
ETA-9062 Conditional Certification ETA Form 9062 Conditional Certification (Rev F6-07).doc	Form and Instruction
ETA-9057 Conditional Certifications Issued ETA Form 9057 Conditional Certifications Issued (Rev. F6-07).doc	Form and Instruction
ETA-9063 Employer Certification ETA Form 9063 Certification (Rev F6-07).doc	Form and Instruction

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:

table that charts list of 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 F6-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9065	Agency Declaration of Verification Results	ETA Form 9065 ADVR (Rev. F6-07).doc	Yes	Yes	Fillable Fileable
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-9063	Employer Certification	ETA Form 9063 Certification (Rev F6-07).doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA-9058	Consolidated Work Opportunity Tax Credit Report #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	ETA Form 9057 Conditional Certifications Issued (Rev. F6-07).doc	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,431,028	-990,000	2,421,028
Annual IC Time Burden (Hours)	521,625	-326,700	848,325
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.