Individual Characteristics

Work Opportunity 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⚠️ Notice: This information collection may be referencing outdated material.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 Individual Characteristics Form
ETA-9061 Individual Characteristics Form (ICF) ETA Form 9061 - Individual Characteristics Form [clean edit].docx Form
ETA-9061 Individual Characteristics Form (ICF) ETA Form 9061 - Individual Characteristics Form [clean edit].docx Form
ETA-9062 Conditional Certification Form (CC) ETA Form 9062 - Conditional Certification [clean edit].docx Form
ETA-9062 Conditional Certification Form (CC) ETA Form 9062 - Conditional Certification [clean edit].docx Form
ETA-9198 Employer Representative Declaration ETA Form 9198 - Employer Representative Declaration Form .docx Form
ETA-9198 Employer Representative Declaration ETA Form 9198 - Employer Representative Declaration Form .docx Form
ETA-9061 Individual Characteristics Form (Spanish) ETA Form 9061 - Individual Characteristics Form [clean edit] (1).docx Form
ETA-9061 Individual Characteristics Form (Spanish) ETA Form 9061 - Individual Characteristics Form [clean edit] (1).docx Form
ETA Form 9061 - redline draft.docx ETA 9061 - Tracked Changes IC Document
ETA Form 9061 - redline draft.docx ETA 9061 - Tracked Changes IC Document
ETA Form 9062 - redline draft.docx ETA-9062 Tracked Changes IC Document
ETA Form 9062 - redline draft.docx ETA-9062 Tracked Changes 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	Individual Characteristics Form (ICF)	ETA Form 9061 - Individual Characteristics Form [clean edit].docx	Yes	Yes	Fillable Fileable
Form	ETA-9062	Conditional Certification Form (CC)	ETA Form 9062 - Conditional Certification [clean edit].docx	Yes	Yes	Fillable Fileable
Form	ETA-9198	Employer Representative Declaration	ETA Form 9198 - Employer Representative Declaration Form .docx	Yes	Yes	Fillable Fileable
Form	ETA-9061	Individual Characteristics Form (Spanish)	ETA Form 9061 - Individual Characteristics Form [clean edit] (1).docx	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: 9,185,562	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,185,562	3,554,796	5,630,766
Annual IC Time Burden (Hours)	3,031,235	1,173,082	1,858,153
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 9061 - Tracked Changes	ETA Form 9061 - redline draft.docx	02/14/2023
ETA-9062 Tracked Changes	ETA Form 9062 - redline draft.docx	02/14/2023

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