Information Collection

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

IC 43791 under ICR 201303-1205-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 9065 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction
TEGL-Non Subs Changes per PL 112-240 3 4 2013.doc	Other-TEGL
ETA 9065 Agency Declaration of Verificatino Results ETA Form 9065 ADVR (3-5-2012).doc	Form and Instruction
ETA 9063 Employer Certification ETA Form 9063 Certification (3-5-2012).doc	Form and Instruction
ETA 9061 Individual Characteristics Form ETA Form 9061 3 4 2013.doc	Form and Instruction
ETA 9062 COnditional Certification ETA Form 9062 3 4 2013.doc	Form and Instruction
ETA 9058 Certification Workload and Characteristics of Certifed I ETA Form 9058 - Report 1 3 4 2013.doc	Form and Instruction
ETA Form 9061 (Exp 6-2015) 3 4 2013.doc ETA 9061	IC Document
ETA Form 9058 - Report 3 12 2013.doc ETA 9058	IC Document
ETA Form 9062 3 12 2013.doc ETA 9062	IC Document

IC Title:

Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) 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
Other-TEGL			TEGL-Non Subs Changes per PL 112-240 3 4 2013.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9058	Certification Workload and Characteristics of Certifed Individuals	ETA Form 9058 - Report 1 3 4 2013.doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9065	Agency Declaration of Verificatino Results	ETA Form 9065 ADVR (3-5-2012).doc	Yes	Yes	Paper Only
Form and Instruction	ETA 9063	Employer Certification	ETA Form 9063 Certification (3-5-2012).doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9062	COnditional Certification	ETA Form 9062 3 4 2013.doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9061	Individual Characteristics Form	ETA Form 9061 3 4 2013.doc	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/ETA-15

FR Citation: 75 FR 6884

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,430,624	1,430,624
Annual IC Time Burden (Hours)	520,745	520,745
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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