Information Collection

Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

IC 18507 under ICR 201111-1545-031 · OMB 1545-1500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1500 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 8850 Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits	Form
Form 8850 Inst.pdf	Instruction
Form 8850 Inst. (2011 Draft).pdf	Instruction
Form 8850 Pre-Screening Notice and Certification Request for the W Form 8850.pdf	Form
Form 8850 Pre-Screening Notice and Certification Request for the W Form 8850 (2011 Draft).pdf	Form
(2011) Burden.PDF Burden	IC Document

IC Title:

Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

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	Form 8850	Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits	Form 8850.pdf	Yes	Yes	Fillable Fileable
Instruction			Form 8850 Inst.pdf	Yes	No	Printable Only
Form	Form 8850	Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credit	Form 8850 (2011 Draft).pdf	Yes	Yes	Fillable Fileable
Instruction			Form 8850 Inst. (2011 Draft).pdf	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 440,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	440,000	80,000	-80,000	440,000
Annual IC Time Burden (Hours)	3,335,200	1,860,400	-606,400	2,081,200
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden	(2011) Burden.PDF	12/15/2011

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