Information Collection

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

IC 43791 under ICR 201111-1205-010 · OMB 1205-0371.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0371 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9062 Work Opportunity Tax Credit and Welfare-to-Work Tax Credit	Form and Instruction
ETA-9062 Conditional Certification ETA_Form_9062_Conditional_Certification_(Priv_Act_Lang_6-8-10)(12-2011 exp.).doc	Form and Instruction
ETA-9063 Certification ETA_Form_9063__Certification_(Priv_Act_Lang__6-8-10)(12-2011 Exp).doc	Form and Instruction
ETA-9058 Certification Workload and Characteristics of Certified ETA_Form_9058_-_Report_1_(HR_674_CO_20111202).doc	Form and Instruction
1205-0371_Nov_2011_amendments_TEGL.doc TEGL for November 2011 Amendments	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9058	Certification Workload and Characteristics of Certified Individuals	ETA_Form_9058_-_Report_1_(HR_674_CO_20111202).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9063	Certification	ETA_Form_9063__Certification_(Priv_Act_Lang__6-8-10)(12-2011 Exp).doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA-9062	Conditional Certification	ETA_Form_9062_Conditional_Certification_(Priv_Act_Lang_6-8-10)(12-2011 exp.).doc	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,431,028	1,431,028
Annual IC Time Burden (Hours)	521,625	521,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TEGL for November 2011 Amendments	1205-0371_Nov_2011_amendments_TEGL.doc	12/02/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.