Qualified Long-term Unemployment Recipient (LTUR)

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⚠️ Notice: This information collection may be referencing outdated material.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-9175 Qualified Long-term Unemployment Recipient (LTUR) Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM W ETA Form 9175 - LTUR Self Attestation Form [clean].docx Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM W ETA Form 9175 - LTUR Self Attestation Form [clean].docx Form
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA-9175-Tracked Changes IC Document
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA-9175-Tracked Changes IC Document

Information Collection (IC) Details

IC Title:	Qualified Long-term Unemployment Recipient (LTUR)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA-9175	LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program	ETA Form 9175 - LTUR Self Attestation Form [clean].docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 233,160	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	233,160	341,402	-170,701	62,459
Annual IC Time Burden (Hours)	39,637	58,038	-29,019	10,618
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA-9175-Tracked Changes	ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx	02/14/2023

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