Individual Characteristics

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0371 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9061 Spanish V Individual Characteristics Form
ETA 9061 Spanish V Individual Characteristics Form, Spanish Version ETA Form 9061 Spanish_FINAL 5.9.16.doc Form
ETA 9061 Individual Characteristics Form ETA Form 9061 English_FINAL 5.9.16.doc Form and Instruction
ETA 9062 Conditional Certification ETA Form 9062_FINAL 5.9.16.doc Form and Instruction
ETA Form 9061 Spanish (track changes) 4.15.16.doc Individual Characteristics Form, Spanish Version IC Document
ETA Form 9061 English (track changes) 4.15.16.doc Individual Characteristics Form IC Document
ETA Form 9062 (track changes) 4.15.16.doc ETA 9062 IC Document
Dept. Clearance TEGL WOTC 2015 Reauthorization 4.15.16.docx TEGL IC Document

Information Collection (IC) Details

IC Title:	Individual Characteristics	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	ETA 9061 Spanish Version	Individual Characteristics Form, Spanish Version	ETA Form 9061 Spanish_FINAL 5.9.16.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9061	Individual Characteristics Form	ETA Form 9061 English_FINAL 5.9.16.doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9062	Conditional Certification	ETA Form 9062_FINAL 5.9.16.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: 1,914,821	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,914,821	924,821	990,000
Annual IC Time Burden (Hours)	631,890	305,190	326,700
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Individual Characteristics Form, Spanish Version	ETA Form 9061 Spanish (track changes) 4.15.16.doc	04/20/2016
Individual Characteristics Form	ETA Form 9061 English (track changes) 4.15.16.doc	04/20/2016
ETA 9062	ETA Form 9062 (track changes) 4.15.16.doc	04/25/2016
TEGL	Dept. Clearance TEGL WOTC 2015 Reauthorization 4.15.16.docx	05/09/2016

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