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

ICR 201503-1545-006

OMB: 1545-1500

Federal Form Document

Forms and Documents
ICR Details
1545-1500 201503-1545-006
Historical Active 201111-1545-031
TREAS/IRS
Form 8850 - Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits
Revision of a currently approved collection   No
Regular
Approved without change 11/21/2015
Retrieve Notice of Action (NOA) 04/30/2015
  Inventory as of this Action Requested Previously Approved
11/30/2018 36 Months From Approved 11/30/2015
440,000 0 440,000
3,242,800 0 3,335,200
0 0 0

A job applicant completes and signs, under penalties of perjury, the top portion of the form to indicate that he or she is a member of a targeted group. If the employer has a belief that the applicant is a member of a targeted group, the employer signs the other portion of the form under penalties of perjury and submits it to their state workforce agency (SWA) as part of a written request for certification.

US Code: 26 USC 51 Name of Law: Amount of credit
  
PL: Pub.L. 113 - 295 119 Name of Law: The Tax Increase Prevention Act of 2014
PL: Pub.L. 113 - 295 139 Name of Law: The Tax Increase Prevention Act of 2014

Not associated with rulemaking

  80 FR 7077 02/09/2015
80 FR 24317 04/30/2015
No

  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 440,000 440,000 0 0 0 0
Annual Time Burden (Hours) 3,242,800 3,335,200 -92,400 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There will be a decrease of 92,400 hours in the total burden for this collection due to a reduction of code section referenced in the instruction.

$1,604
No
No
No
No
Yes
Uncollected
Neal Dickman 2026225013

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/30/2015


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