Information Collection

Individual Characteristics

IC 184551 under ICR 201912-1205-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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-9061 Individual Characteristics	Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T Attachment 5A- ETA FORM 9061 (ENGLISH).pdf	Form and Instruction
ETA-9062 Conditional Certification Work Opportunity Tax Credit Attachment 6A- ETA Form 9062, Conditional Certification.pdf	Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T Attachment 5A- ETA FORM 9061 (SPANISH).doc	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9061	Individual Characteristics Form (ICF) Work Opportunity Tax Credit	Attachment 5A- ETA FORM 9061 (ENGLISH).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9062	Conditional Certification Work Opportunity Tax Credit	Attachment 6A- ETA Form 9062, Conditional Certification.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Individual Characteristics Form (ICF) Work Opportunity Tax Credit	Attachment 5A- ETA FORM 9061 (SPANISH).doc	Yes	Yes	Fillable Fileable

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: 5,630,766

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,630,766	3,715,945	1,914,821
Annual IC Time Burden (Hours)	1,858,153	1,226,262	631,891
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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