Document Name Document Type
Form ETA-9062 Work Opportunity Tax Credit (WOTC) Form
ETA-9062 Conditional Certification Work Opportunity Tax Credit ETA Form 9062 - Conditional Certification [clean edit].docx Form
ETA-9062 Conditional Certification Work Opportunity Tax Credit ETA Form 9062 - Conditional Certification [clean edit].docx Form
ETA-9063 Employer Certification Work Opportunity Tax Credit ETA Form 9063 - Employer Certification [clean edit].docx Form
ETA-9063 Employer Certification Work Opportunity Tax Credit ETA Form 9063 - Employer Certification [clean edit].docx Form
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T ETA Form 9061 - Individual Characteristics Form [clean edit].docx Form
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T ETA Form 9061 - Individual Characteristics Form [clean edit].docx Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION ETA Form 9175 - LTUR Self Attestation Form [clean].docx Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION ETA Form 9175 - LTUR Self Attestation Form [clean].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 IC Document
ETA Form 9061 - redline draft.docx ETA-9061- Tracked IC Document
ETA Form 9062 - redline draft.docx ETA 9062 - Tracked IC Document
ETA Form 9062 - redline draft.docx ETA 9062 - Tracked IC Document
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA 9175 - Tracked IC Document
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA 9175 - Tracked IC Document

Information Collection (IC) Details

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IC Title:	Work Opportunity Tax Credit (WOTC)	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-9062	Conditional Certification Work Opportunity Tax Credit	ETA Form 9062 - Conditional Certification [clean edit].docx	Yes	Yes	Fillable Fileable
Form	ETA-9063	Employer Certification Work Opportunity Tax Credit	ETA Form 9063 - Employer Certification [clean edit].docx	Yes	Yes	Fillable Fileable
Form	ETA-9061	Individual Characteristics Form (ICF) Work Opportunity Tax Credit	ETA Form 9061 - Individual Characteristics Form [clean edit].docx	Yes	Yes	Fillable Fileable
Form	ETA-9175	LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF)	ETA Form 9175 - LTUR Self Attestation Form [clean].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

Federal Enterprise Architecture Business Reference Module

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: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,351,967	7,833,595
Annual IC Time Burden (Hours)	7,134,120	4,548,894	2,585,226
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA-9061- Tracked	ETA Form 9061 - redline draft.docx	02/14/2023
ETA 9062 - Tracked	ETA Form 9062 - redline draft.docx	02/14/2023
ETA 9175 - Tracked	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.

Work Opportunity Tax Credit (WOTC)

Work Opportunity Tax Credit

OMB: 1205-0371

IC ID: 43791

View Information Collection (IC)