Certification Workload and Characteristic of Certified Individuals

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⚠️ Notice: This information collection may be referencing outdated material.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-9058 Certification Workload and Characteristic of Certified Individuals Form
ETA-9058 Certification Workload and Characteristic of Certified I ETA Form 9058 - Clean.rtf Form
ETA-9058 Certification Workload and Characteristic of Certified I ETA Form 9058 - Clean.rtf Form
ETA-9065 Audit Summary Worksheet ETA Form 9065 - Audit Summary Wrksht ADVR [clean edit].docx Form
ETA-9065 Audit Summary Worksheet ETA Form 9065 - Audit Summary Wrksht ADVR [clean edit].docx Form
ETA Form 9058 - redline edits.rtf Form 9058 - Tracked Changes IC Document
ETA Form 9058 - redline edits.rtf Form 9058 - Tracked Changes IC Document

Information Collection (IC) Details

IC Title:	Certification Workload and Characteristic of Certified Individuals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA-9058	Certification Workload and Characteristic of Certified Individuals	ETA Form 9058 - Clean.rtf		Yes	Yes	Fillable Fileable
Form	ETA-9065	Audit Summary Worksheet	ETA Form 9065 - Audit Summary Wrksht ADVR [clean edit].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: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	424	212	4	208
Annual IC Time Burden (Hours)	424	212	4	208
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Form 9058 - Tracked Changes	ETA Form 9058 - redline edits.rtf	02/14/2023

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