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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 9058 Certification Workload and Characteristics of Certifed Individuals	Form and Instruction	Modified	Available
Form ETA 9062 COnditional Certification	Form and Instruction	Modified	Available
Form ETA 9061 Individual Characteristics Form	Form and Instruction	Modified	Available
Form ETA 9063 Employer Certification	Form and Instruction	Modified	Available
Form ETA 9065 Agency Declaration of Verificatino Results	Form and Instruction	Modified	Repair queued
Form ETA 9061 Individual Characteristics Form	Form and Instruction	Modified	Available
Form ETA 9061 Spanish v Individual Characteristics, Spanish version	Form	Modified	Available
6-18-15_1205-0371-WOTC_Supporting_Statement_FINAL.docx	Supporting Statement A	Uploaded 2015-06-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Other-TEGL	Modified
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Modified	Certification Workload and Characteristics of Certifed Individuals
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Modified	COnditional Certification
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Modified	Individual Characteristics Form
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Modified	Employer Certification
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Form and Instruction	Modified	Agency Declaration of Verificatino Results
184551	Individual Characteristics	Other-TEGL	Modified
184551	Individual Characteristics	Form and Instruction	Modified	Individual Characteristics Form
184551	Individual Characteristics	Form	Modified	Individual Characteristics, Spanish version

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 201502-1205-006
Status: Historical Active	Previous ICR Reference No: 201303-1205-001
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: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/18/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/30/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2018	36 Months From Approved	08/31/2015
Responses	2,420,624	0	2,420,624
Time Burden (Hours)	847,445	0	847,445
Cost Burden (Dollars)	0	0	0

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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).

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Authorizing Statute(s): 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
   PL: Pub.L. 109 - 432 105 Name of Law: Tax Relief and Health Care Act of 2006
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 11231	03/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 36355	06/24/2015
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

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

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ICR Summary of Burden

table that charts list 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	2,420,624	0	0	0	0
Annual Time Burden (Hours)	847,445	847,445	0	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $11,024

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

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Common Form ICR:  No

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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: 06/30/2015

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