Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

Forms and Documents

Document Name	Status
Form 8850 Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits Form	Modified
Summary of changes.pdf Justification for No Material/Nonsubstantive Change	2009-03-28

IC Document Collections

IC ID	Document Title	Status
18507	Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits Form	Modified

ICR Details

OMB Control No: 1545-1500	ICR Reference No: 200903-1545-029
Status: Historical Active	Previous ICR Reference No: 200810-1545-021
Agency/Subagency: TREAS/IRS	Agency Tracking No: ARRA (PL 111-5)
Title: Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/13/2009
	Date Received in OIRA: 03/31/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	12/31/2011	12/31/2011
Responses	440,000	0	400,000
Time Burden (Hours)	2,081,200	0	1,596,000
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 26 USC 51 Name of Law: Amount of credit
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 1221 Name of Law: American Recovery and Reinvestment Act
PL: Pub.L. 110 - 243 4001(b) Name of Law: Food, Conservatio, and Energy Act of 2008
PL: Pub.L. 110 - 343 319 Name of Law: Emergency Economic Stabilization Act of 2008

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 46363	08/08/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 70406	11/20/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits	8850	Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

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ICR Summary of Burden

	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	440,000	400,000	40,000	0	0	0
Annual Time Burden (Hours)	2,081,200	1,596,000	485,200	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Employers use Form 8850 to pre-screen and to make a written request to their state workforce agency (SWA) (unless the employee checks only the Hurricane Katrina employee box) to certify an individual as a member of a targeted group for purposes of qualifying for the work opportunity credit. The following changes were a result of PL 111-5, American Recovery and Reinvestment Act, PL 110-243, Food, Conservation, and Energy Act of 2008, and PL 110-343, Emergency Economic Stabilization Act of 2008: 1] The revision date is changed to March 2009. 2] A line for "county" is added to the address area to help determine residence in a Rural Renewal County. The line for entering a telephone number is moved to the right to accommodate this change. 3] Box 1: the date is changed to August 28, 2009, per P. L. 110-343, Div. C, sec. 319, and P. L. 109-73, section 201(b). 4] Box 3: the text "food stamps" is changed to "Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) " or "SNAP benefits (food stamps) " per P. L. 110-243, sec. 4001(b). 5] Box 3: two new bullets are added for new targeted groups, unemployed veterans and disconnected youth, per section 1221 of P.L. 111-5. 6] In the jurat on page 2, the text “provided the information on” is substituted for the text “completed” at the suggestion of an industry group (National Employment Opportunities Network (NEON)), and the cooperation of CC Matt Howard. 7] The room number in the Paperwork Reduction Act area (for forwarding inquiries to the IRS) is changed to 6526. These changes resulted in a total estimated burden increase of 485,200 hours.

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Annual Cost to Federal Government: $1,604

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/31/2009

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