Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit

Forms and Documents

Document Name	Status
Form ETA 9065 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit Form and Instruction	Modified
Form ETA 9154 WOTC Self-Attestation Form (ETA-9154) Form	Removed
Form ETA 9061 Individual Characteristics Form and Instruction	Modified
Supporting Statement 1205-0371 416 12 final.docx Supporting Statement A	2012-04-16
New Forms TEGL Vets leg for PRA Mar 2012.doc Supplementary Document	2012-03-08

IC Document Collections

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

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 201201-1205-001
Status: Historical Active	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 (WOTC) and Welfare-to-Work (WtW) Tax Credit
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/18/2012
	Date Received in OIRA: 04/19/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2015	36 Months From Approved	06/30/2012
Responses	2,420,624	0	2,527,028
Time Burden (Hours)	847,445	0	883,305
Cost Burden (Dollars)	0	0	0

---

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). The current request includes veterans' legislation changes due to requirements in the VOW to Hire Heroes Act of November 2011.

---

Authorizing Statute(s): 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
   PL: Pub.L. 110 - 28 8211 Name of Law: Small Business and Work Opportunity Tax Act
   PL: Pub.L. 112 - 56 261 Name of Law: VOW to Hire Heroes Act of 2011
  

Citations for New Statutory Requirements: PL: Pub.L. 112 - 56 261 Name of Law: VOW to Hire Heroes Act of 2011

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 55946	09/09/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 73682	11/29/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Individual Characteristics	ETA 9061, ETA 9061 Spanish version	Individual Characteristics ,   Individual Characteristics, Spanish version
Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	ETA 9065, ETA 9061, ETA 9063, ETA 9058, ETA 9062	Agency Declaration of Verificatino Results ,   Individual Characteristics Form ,   Employer Certification ,   Conditional Certification ,   Certification Workload
WOTC Self-Attestation Form (ETA-9154)	ETA 9154, Spanish Version, ETA 9154	Youth Self Attestation ,   Youth Self Attestation, Spanish Version

---

ICR Summary 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	2,420,624	2,527,028	0	-106,000	-404	0
Annual Time Burden (Hours)	847,445	883,305	0	-34,985	-875	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes in ROCIS calculations include removal of burden hours associated with the WOTC state plans' requirements. ETA previously required the annual submission of a state plan as a condition for states to receive WOTC funding. However, ETA ended this requirement several years ago and replaced it with a statement of work for the use of WOTC funds by the states. This statement of work is developed by ETA and states do not incur burden hours. In addition, ETA is discontinuing the Youth Self-Attestation Form, ETA Form 9154. This form was used for the ARRA Disconnected Youth WOTC target group, and this category expired on December 31, 2010.

---

Annual Cost to Federal Government: $28,189

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 04/19/2012

---