yodated Firn ETA09058 with responses to OMB

Certification Workload and Characteristics of Certified Individuals U.S. Department of Labor

Consolidated Work Opportunity Tax Credit - Report No. 1 Employment and Training Administration

State:

Quarter Ending:

Persons are not required to respond to this collection of information unless it displays a currently valid OM B control number. Respondents' obligation to reply to these reporting requirements is mandatory (P.L. 104-188). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Labor. Division of Adult Services, Room S-4209, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0371).

OMB No. 1205-0371 Expiration Date: November 30, 2011

PART I. CERTIFICATION WORKLOAD

CERTIFICATION REQUESTS (System Inputs)

CERTIFICATION REQUESTS (System Outputs)

A) Incomplete Requests

B) Requests Needing Action

C) New Requests

D) Total Requests to Be Processed

E) Certified Requests

F) Denied Requests

G) Incomplete Requests

H) Requests Needing Action

PART II. CHARACTERISTICS OF CERTIFIED INDIVIDUALS

I) By WOTC Target Group

(a) No. of CCs Resulting in Certifications

(b) No. Certified Individuals

J) By Occupation

(a) No. Certified Individuals

J) By Occupation (Cont.)

(a) No. Certified Individuals

K) By Starting Hourly Wage

(a) No. Certified Individuals

WOTC

Name-Code

WOTC

Name-Code

WOTC

WOTC

1. IV-A Recipient

1. Management Occupations – 11

14. Protective Services – 33

1. Under Federal Minimum Wage

2a. Veteran

2. Business & Financial Operations – 13

15. Food Preparation & Serving Related – 35

2. $6.55 - $7.25

2b. Disabled Veteran

3. Ex-Felon

3. Computer & Mathematical – 15

16. Bldg. & Grounds Cleaning & Maintenance – 37

3. $6.00 - $6.99

4. Designated Community Resident

4. Healthcare Practitioner & Technical – 29

17. Personal Care & Service – 39

4. $7.00 - $7.99

5a. Voc. Rehab Ref.

5. Architecture & Engineering – 17

18. Sales & Related Occupations – 41

5. $8.00 - $8.99

5b. Ticket Holder

6. Life, Physical & Social Sciences – 19

19. Office/Administrative Support – 43

6. $9.00 – Higher

6. Summer Youth

7. Community & Social Services – 21

20. Farming, Fishing & Forestry – 45

7. Total (for Qtr)

7. Food Stamp

8. Legal Occupations – 23

21. Construction & Extraction – 47

8. SSI Recipient

9 Education, Training, & Library – 25

22. Installation, Maintenance & Repair – 49

9. Long –Term IV-A Recipient (I.)

10. Arts, Design, Entertainment, Sports/Media Occupations – 27

23. Production Occupations – 51

10. Unemployed Veteran

11. Healthcare Support Occupations – 31

24. Transportation & Material Moving Production Occupations – 53

11. Disconnected Youth

25. Military Specific Occupations – 55

12. TOTAL (for qtr.)

13. Total (YTD)

26. Name of Responsible Official:

27. Signature:

28. Date:

29. Total (for qtr)

Page 1 of 4 ETA Form 9058 (August 2009)

Instructions for Preparing ETA Form 9058, Report 1 –“Certification Workload and Characteristics of Certified Individuals,” Work Opportunity Tax Credit Report

Introduction.

ETA Form 9058. Part I. of this report clarifies and simplifies data reported on certifications and indicates state workforce agencies’ (SWAs) workload during each reporting quarter. Part II. continues to collect data on selected characteristics of individuals with tax credit certifications. Revisions to this form include the amendments and new provisions introduced by Public Laws 111-5 (the Recovery Act of 2009), 110-28 and 109-432. The “WtW” and “Dual” columns for Sections I, J, and K of Part II. Characteristics of Certified Individuals have been removed since the WtWTC was merged into the WOTC Program. The Long–term TANF Recipient group remains as target group #9. Five changes were made to “Section I) By WOTC Target Group.” Target Group #2. Veteran is now divided into 2a. Veteran and 2b. Disabled Veteran to capture the number of certifications issued to this expanded group. Target group #4. is no longer called High-Risk Youth. This group is now called “Designated Community Resident (DCR).” Two boxes were added as follows: box 10. Unemployed Veterans and box 11 Disconnected Youth to capture the number of certifications issued to these two new target groups

Background.

The purpose of ETA Form 9058 (Rev. April. 2009) is to provide state workforce agencies (SWAs) with a standardized reporting format, which accurately reflects program activity levels and outcomes under the consolidated Work Opportunity Tax Credit (WOTC). It is important for SWAs to maintain programmatic reporting procedures that account for each tax request (IRS Form 8850) received and its subsequent outcome (issuance of a tax certification or a denial notification). A properly completed ETA Form 9058 accurately reflects program use and the level of any programmatic backlog that may exist. To ensure that the WOTC Program can be accurately evaluated at the national level, it is critical that all SWAs report in a standardized manner.

INSTRUCTIONS FOR COMPLETING THIS FORM:

State. Enter the name of the state submitting ETA Form 9058.

Quarter Ending Period. Enter ending date of the quarter for the reported program data.

Part I. "Certification Workload.” SWAs must identify from Part I, Item F on the previous reporting quarter's ETA Form 9058 the number of requests (IRS Form 8850s) determined to be incomplete or Needing Action, as defined below:

1. Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received by the SWA prior to the beginning of the current report period, but for which no applicant eligibility determination action (excluding the 48-hour review) was taken. This total is to be entered into Part I, Item (A) of ETA Form 9058.

2. Number of Requests Needing Action. Enter the total number of requests (IRS Form 8850s) received by the SWA prior to the beginning of the current report, but for which no review and total is to be entered into Part I, Item (B) of recently revised ETA Form 9058.

3. New Requests. Enter the total number of requests (IRS Form 8850s) received by the SWA during the current reporting quarter. Some states may have received requests (IRS Form 8880s) that were not previously recorded and/or reported on any prior quarterly report ETA 9058 for various reasons. It is Important for the SWA to report all requests (IRS Form 8850s) received. Therefore, any request received outside of the current reporting quarter, which has not previously been reported, should be included with the number of requests received during the current reporting period. That total should be entered as the number of "New Requests". This total is to be entered into Part I, Item (C) of ETA Form 9058.

4. Total Requests to Be Processed. Enter the sum of Items A, B & C. This total represents the number of requests (IRS Form 8850s) received by the SWA, which are available to be processed. This total is to be entered under Part I, Item (D) of ETA Form 9058.

5. Requests Certified. Enter the total number of WOTC certifications issued during the current report period.

6. Requests Denied. Enter the total number of requests (IRS Form 8850s) denied by the SWA during the current report period.

Note. A denial is a request (IRS Form 8850) determined by the SWA to be ineligible for the WOTC.

Page 2 of 4 ETA Form 9058 (August 2009)

7. Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received and reviewed by the SWA, but which the SWA could neither approve nor deny due to such things as, but not limited to, the need for additional eligibility documentation for which the SWA has made a formal request to the employer, authorized tax consultant, or other third party entity, ETA Form 9061 not submitted, etc. Note. This number will also be entered in Part 1, Item A. of the subsequent quarterly report ETA Form 9058.

8. Number of Requests Needing Action. Enter the number of requests (IRS Form 8850s) received by the SWA but for which no review and/or action has yet been taken to determine applicant eligibility.

Note. This value will also be entered in Part I, Item B. of the subsequent quarterly report ETA Form 9058. Part I, Item H is the sum of Item D, minus Item E, minus Item F, minus Item G.

Part I. Completion Formula:

Items (A +B + C) = (D - E - F - G) = H

Part II. "Characteristics of Certified Individuals by Tax Credit." This part is divided into three sections (Section I, Section J, and Section K).

Section I reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by WOTC target groups. Section J reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by occupation. Section K reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by starting hourly wage.

Section I.

Section I, Column (a). Enter the total number of certifications, by target group, issued by the SWA during the current report period, which resulted from the issuance of a conditional certification i.e., ETA Form 9062.

Section I, Column (b). Enter the total number of WOTC certifications issued by the SWA during the current report period, by target group.

Section I, Line #2a. Enter the total number of WOTC certifications issued by the SWA during the current report period, for Veterans.

Section I, Line #2b. Enter the total number of WOTC certifications issued by the SWA during the current report period, for “Disabled Veterans” according to P.L. 110-28.

Section I. Line #4. P.L. 110-28 changed the name of the High-Risk Youth to “Designated Community Residents (DCRs).” Enter the total number of WOTC certifications issued by the SWA during the current report period, for DCRs.

Section I, Line #5a. Enter the total number of WOTC certifications issued by the SWA during the current report period, for “ticket holders.” (e.g., SSI, SSDI, or Voc. Rehab).

Section I, Line #10. Enter the total number of WOTC certifications issued by the SWA during the current report period, for “Unemployed Veterans” according to P.L. 111-5

Section I, Line #11. Enter the total number of WOTC certifications issued by the SWA during the current report period, for “Disconnected Youth” according to P.L. 111-5

Section I. Line #12. Enter the sums of columns (a), and (b). Note. The total (fro quarter) of Section I, Line #12, columns (a) & (b) should equal the total entered in Part I. Item E. Requests Certified.

Section I, Line #13. Enter the cumulative federal program Year-to-Date (YTD) totals of columns (a) and (b). Note. The first quarterly report of the federal program year (October 01-December 31), the totals of Section I, Line #10, and Line #11 should be the same.

Section J.

Section J, Column (a). Enter the total number of WOTC Certifications issued by the SWA during the current report period, by occupation. Note: The total for Section J, Column (a), Line #29 is the sum of the column and must equal the total for Section I, Column (a) & (b) Line # 12.

Page 3 of 4 ETA Form 9858 (August 2009)

T he occupational data reported in boxes 1-25 are derived from the job titles reported on ETA Forms 9061 or 9062. To prepare this report, SWAs/DLAs must use, the O*NET, new job families of occupations and their two-digit corresponding codes as illustrated in the following table.

O*NET SOC JOB FAMILIES
Name	Code		Name	Code
Management Occupations		11	Food Preparation & Serving Related		35
Business & Financial Operations		13	Bldg. & Grounds Cleaning & Maintenance		37
Computer& Mathematical Occupations		15	Personal Care & Service		39
Architecture & Engineering		17	Sales & Related Occupations		41
Life, Physical & Social Sciences		19	Office & Administrative Support		43
Community & Social Services		21	Farming, Fishing, & Forestry		45
Legal Occupations		23	Construction & Extraction		47
Education, Training, & Library		25	Installation, Maintenance & Repair		49
Arts, Design, Entertainment, Sports and Media Occupations		27	Production Occupations		51
Healthcare Practitioner & Technical		29	Transportation & Material Moving		53
Healthcare Support Occupations		31	Military Specific Occupations		55
Protective Service Occupations		33

Section K

Section K, Column (a). Enter the total number of WOTC certifications issued by the SWA/DLA during the current report period, by starting hourly wage¹. Note. The total for Section K, Column (a), Line #7 is the sum of the column and must equal the total for Section I, column (b), Line #12.

Convert as follows:

Unit of Time Calculated Hourly Wage

Day Amount divided by 8

Week Amount divided by 40

Month Amount divided by 172

26. Name and Title of Responsible Official. Enter the name and title of the authorized signatory official.

27. Signature. Enter the signature of the authorized signatory official.

28. Date. Enter the date of the authorized signatory official’s signature.

29. Total (for qtr). Enter the total number of WOTC Certifications issued by the SWA during the current

report period, by occupation. . Note. The total for Section J, Column (a), Line #29 is the sum of the

column for this quarter and must equal the total for Section I, column (b), Line #12.

1 According to the Federal Labor Standards Act (FLSA), the federal minimum salary is $6.55 per hour effective July 24, 2008 and $7.25 per hour effective July 24, 2009. Source: Office of Employment Standards Administration, Division of Wage and Hour at the U.S. Department of Labor.

Page 4 of 4 ETA Form 9058 (August 2009)