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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA-9063 Employer Certification	Form and Instruction	Unchanged	Available
Form ETA-9057 Conditional Certifications Issued	Form and Instruction	Unchanged	Available
Form ETA-9062 Conditional Certification	Form and Instruction	Unchanged	Available
Form ETA-9065 Agency Declaration of Verification Results	Form and Instruction	Unchanged	Repair queued
Form ETA-9058 Consolidated Work Opportunity Tax Credit Report #1	Form and Instruction	Unchanged	Available
Form ETA-9059 Verification Results: Audit Summary Worksheet, for SWA Internal Unse Only	Form and Instruction	Unchanged	Available
Form ETA-9154 Youth Self Attestation	Form	Modified	Available
Form ETA Form 9061 Individual Characteristics	Form and Instruction	Unchanged	Available
Form ETA-9061 Individual Characteristics Form	Form and Instruction	Unchanged	Available
Form ETA-9061 in Spanis WOTC Individual Characteristics	Form	Unchanged	Available
Justification, Voluntary Youth Self Attestation Template, 1205-0371.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-12-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Employer Certification
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Conditional Certifications Issued
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Conditional Certification
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Agency Declaration of Verification Results
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Consolidated Work Opportunity Tax Credit Report #1
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Verification Results: Audit Summary Worksheet, for SWA Internal Unse Only
190816	TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 3-09 Change 1	Form	Modified	Youth Self Attestation
190816	TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 3-09 Change 1	Instruction	Modified
184551	Individual Characteristics	Form and Instruction	Unchanged	Individual Characteristics
184551	Individual Characteristics	Form and Instruction	Unchanged	Individual Characteristics Form
184551	Individual Characteristics	Form	Unchanged	WOTC Individual Characteristics

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 200912-1205-003
Status: Historical Active	Previous ICR Reference No: 200910-1205-004
Agency/Subagency: DOL/ETA	Agency Tracking No: 012-05-01-02-02-2025-00.
Title: Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit
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: 12/22/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/16/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	11/30/2011	11/30/2011
Responses	2,527,028	0	2,527,028
Time Burden (Hours)	883,305	0	883,305
Cost Burden (Dollars)	0	0	0

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Abstract: Tax Credit Program Administration: Data and information provided by the states on these forms are used for program planning, evaluation of Program performance and outcomes through states' quarterly report and for oversight/verification activities as mandated by the Omnibus Budget Reconciliation Act of 1990 (P.L. 101-508) Section 11405(c), which extended indefinitely the $5 million set-aside for testing whether individuals certified as members of WOTC targeted groups are eligible for certification (including use of statistical sampling techniques). As long as there is a WOTC appropriation, this is a continuing requirement.

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Authorizing Statute(s): PL: Pub.L. 110 - 28 8211 Name of Law: Small Business and Work Opportunity Tax Act
   PL: Pub.L. 109 - 432 105 Name of Law: Tax Relief and Health Care Act of 2006
   PL: Pub.L. 101 - 508 11405(c) Name of Law: Omnibus Budget Reconciliation Act of 1989
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 28 8211 Name of Law: Small Business and Work Opportunity Tax Act

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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 1648	01/09/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 24315	05/02/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Individual Characteristics	ETA-9061, ETA Form 9061, ETA-9061 in Spanish	WOTC Individual Characteristics ,   Individual Characteristics Form ,   Individual Characteristics
TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 3-09 Change 1	ETA-9154	Youth Self Attestation
Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	ETA-9062, ETA-9065, ETA-9059, ETA-9063, ETA-9058, ETA-9057	Verification Results: Audit Summary Worksheet, for SWA Internal Unse Only ,   Consolidated Work Opportunity Tax Credit Report #1 ,   Agency Declaration of Verification Results ,   Conditional Certification ,   Conditional Certifications Issued ,   Employer Certification

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ICR Summary of Burden

table that charts list 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	2,527,028	2,527,028	0	0	0	0
Annual Time Burden (Hours)	883,305	883,305	0	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: The additional burden associated with the collections is the result of the fact that the American Recovery and Reinvestment Act made the two new WOTC target populations, unemployed veteran and disconnected youth, eligible for employers to receive the tax credit retroactively to January 1, 2009. However, guidance was not issued to the State Workforce Agencies on implementation of these two new target groups until September 1, 2009. Therefore, SWAs will need to request employers to provide the necessary documentation for applications submitted prior September 1, for these two new target groups, thus creating an additional burden.

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Annual Cost to Federal Government: $23,847

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: 12/16/2009

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