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-9057 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Unchanged	Available
Form ETA-9154 WOTC Self-Attestation Form (ETA-9154)	Form and Instruction	Modified	Available
Form ETA-9061 in Spanis Individual Characteristics	Form	Unchanged	Available
1205-0371 Justification for Non Substantive Change 3 31 2010.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2010-03-31	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
190816	WOTC Self-Attestation Form (ETA-9154)	Form and Instruction	Modified
184551	Individual Characteristics	Form	Unchanged

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 201003-1205-008
Status: Historical Active	Previous ICR Reference No: 201001-1205-003
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: 04/09/2010
	Date Received in OIRA: 04/02/2010
Terms of Clearance: OMB appreciates DOL's efforts to ensure that the Form ETA-9154 complies with Section 7 of the Privacy Act of 1974, as amended (Pub. L. 93-579). ETA is instructed to review the other forms inventoried under this OMB Control Number to determine if a Privacy Act notice similar to that provided on the Form ETA-9154 is required. ETA will submit the revised forms as a non-substantive no material change request to OMB by no later than May 2010.

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
Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	ETA-9063, ETA-9058, ETA-9057, ETA-9062, ETA-9065, ETA-9059	Conditional Certifications Issued ,   Employer Certification ,   Verification Results: Audit Summary Worksheet, for SWA Internal Unse Only ,   Consolidated Work Opportunity Tax Credit Report #1 ,   Agency Declaration of Verification Results ,   Conditional Certification
WOTC Self-Attestation Form (ETA-9154)	ETA-9154	YOUTH SELF-ATTESTATION FORM Work Opportunity Tax Credit Program

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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: 04/02/2010

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