Work Opportunity Tax Credit and Welfare-to-Work Tax Credit

Forms and Documents

Document Name	Status
Form ETA-9062 Work Opportunity Tax Credit and Welfare-to-Work Tax Credit Form and Instruction	Modified
Form ETA 9154 WOTC Self-Attestation Form (ETA-9154) Form	Unchanged
Form ETA-9061 Individual Characteristics Form and Instruction	Modified
Justification for Non Sbs Change Request WOTC Nov 2011 leg changes(20111201).doc Justification for No Material/Nonsubstantive Change	2011-12-01
1205-0371 WOTC supporting statements ROCIS version.pdf Supporting Statement A	2011-12-01
1205-0371 Justification for Non-Substantive Change, June 2010.doc Justification for No Material/Nonsubstantive Change	2010-06-09

IC Document Collections

IC ID	Document Title	Status
43791	Work Opportunity Tax Credit and Welfare-to-Work Tax Credit Form and Instruction	Modified
190816	WOTC Self-Attestation Form (ETA-9154) Form	Unchanged
184551	Individual Characteristics Form and Instruction	Modified

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 201111-1205-010
Status: Historical Inactive	Previous ICR Reference No: 201005-1205-011
Agency/Subagency: DOL/ETA	Agency Tracking No: 012-05-01-02-02-2025-00.
Title: Work Opportunity Tax Credit and Welfare-to-Work 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OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 12/28/2011
	Date Received in OIRA: 12/02/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	12/31/2011	06/30/2012
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 Work Opportunity Tax Credit (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. 101 - 508 11405(c) Name of Law: Omnibus Budget Reconciliation Act of 1989
   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
  

Citations for New Statutory Requirements: None

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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

IC Title	Form No.	Form Name
Individual Characteristics	ETA-9061	Individual Characteristics Form
Work Opportunity Tax Credit and Welfare-to-Work Tax Credit	ETA-9058, ETA-9063, ETA-9062	Conditional Certification ,   Certification ,   Certification Workload and Characteristics of Certified Individuals
WOTC Self-Attestation Form (ETA-9154)	ETA 9154, Spanish Version, ETA 9154	Youth Self Attestation ,   Youth Self Attestation, Spanish Version

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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:

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 12/02/2011

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