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

Form 8850--Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.