Work Opportunity Tax Credit

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 9061 ETA Form 9061 - Individual Characteristics Form (Spanish)	Form	Modified	Available
Form ETA-9198 Employer Representative Declaration	Form and Instruction	Modified	Available
Form ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF)	Form	Modified	Available
Form ETA-9061 Individual Characteristics Form (ICF) Work Opportunity Tax Credit	Form and Instruction	Modified	Available
Form ETA-9063 Employer Certification Work Opportunity Tax Credit	Form and Instruction	Modified	Available
Form ETA-9062 Conditional Certification Work Opportunity Tax Credit	Form and Instruction	Modified	Available
Form ETA-9062 Work Opportunity Tax Credit (WOTC)	Form and Instruction	Modified	Repair queued
Form ETA Form 9058 Certification Workload and Characteristics of Certified Individuals	Form and Instruction	Modified	Available
Form ETA-9065 Audit Summary Worksheet	Form and Instruction	Modified	Available
Form ETA-9065 Certification Workload and Characteristic of Certified Individuals	Form and Instruction	Modified	Repair queued
Form ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program	Form	Modified	Available
Form ETA-9175 Qualified Long-term Unemployment Recipient (LTUR)	Form	Modified	Repair queued
Form ETA-9061 Individual Characteristics Form (Spanish)	Form and Instruction	Modified	Available
Form ETA-9198 Employer Representative Declaration	Form and Instruction	Modified	Available
Form ETA-9062 Conditional Certification Form (CC)	Form and Instruction	Modified	Available
Form ETA-9061 Individual Characteristics Form (ICF)	Form and Instruction	Modified	Available
Form ETA-9061 Individual Characteristics	Form and Instruction	Modified	Repair queued
1205-0371 - Spanish Form 9061 no material change request_.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-08-23	Available
1205-0371 - Spanish Form 9061 no material change request_.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-08-23	Repair queued
1205-0371 - Supporting Statement 3.9.23 - CLEAN .docx	Supporting Statement A	Uploaded 2023-03-10	Available
1205-0371 - Supporting Statement 3.9.23 - CLEAN .docx	Supporting Statement A	Uploaded 2023-03-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43791	Work Opportunity Tax Credit (WOTC)	Form	Modified	ETA Form 9061 - Individual Characteristics Form (Spanish)
43791	Work Opportunity Tax Credit (WOTC)	Form and Instruction	Modified	Employer Representative Declaration
43791	Work Opportunity Tax Credit (WOTC)	Form	Modified	LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF)
43791	Work Opportunity Tax Credit (WOTC)	Form and Instruction	Modified	Individual Characteristics Form (ICF) Work Opportunity Tax Credit
43791	Work Opportunity Tax Credit (WOTC)	Form and Instruction	Modified	Employer Certification Work Opportunity Tax Credit
43791	Work Opportunity Tax Credit (WOTC)	Form and Instruction	Modified	Conditional Certification Work Opportunity Tax Credit
43791	Work Opportunity Tax Credit (WOTC)	Form and Instruction	Modified
239192	Certification Workload and Characteristic of Certified Individuals	Form and Instruction	Modified	Certification Workload and Characteristics of Certified Individuals
239192	Certification Workload and Characteristic of Certified Individuals	Form and Instruction	Modified	Audit Summary Worksheet
239192	Certification Workload and Characteristic of Certified Individuals	Form and Instruction	Modified
221431	Qualified Long-term Unemployment Recipient (LTUR)	Form	Modified	LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program
221431	Qualified Long-term Unemployment Recipient (LTUR)	Form	Modified
184551	Individual Characteristics	Form and Instruction	Modified	Individual Characteristics Form (Spanish)
184551	Individual Characteristics	Form and Instruction	Modified	Employer Representative Declaration
184551	Individual Characteristics	Form and Instruction	Modified	Conditional Certification Form (CC)
184551	Individual Characteristics	Form and Instruction	Modified	Individual Characteristics Form (ICF)
184551	Individual Characteristics	Form and Instruction	Modified

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 202308-1205-002
Status: Active	Previous ICR Reference No: 202302-1205-001
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Work Opportunity Tax Credit
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/28/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/15/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	05/31/2026	05/31/2026
Responses	18,604,708	0	18,604,708
Time Burden (Hours)	10,205,416	0	10,205,416
Cost Burden (Dollars)	0	0	0

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Abstract: The Work Opportunity Tax Credit (WOTC) is a Federal tax credit available to employers for hiring individuals from certain target groups who have consistently faced significant barrier to employment. This submission includes seven WOTC program forms as follows: • ETA Form 9175, Revised November 2016 – Self-Attestation Form (SAF) for the Long-Term Unemployment Recipient • ETA Form 9058 - Report 1, Revised November 2016 - Certification Workload and Characteristics of Certified Individuals • ETA Form 9061, Revised November 2016 - Individual Characteristics Form • ETA Form 9062, Revised April 2016 - Conditional Certification • ETA Form 9063, Revised April 2016 - Employer Certification • ETA Form 9065, Revised April 2016 - Agency Declaration of Verification Results Worksheet

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Authorizing Statute(s): PL: Pub.L. 104 - 188 1201 Name of Law: Small Business Job Protection Act of 1996
   US Code: 26 USC 51 Name of Law: Internal Revenue Code of 1986
   US Code: 26 USC 3111 Name of Law: Internal Revenue Code of 1986
   PL: Pub.L. 116 - 260 113 Name of Law: Consolidated Appropriations Act, 2021
   PL: Pub.L. 101 - 508 11405(c) Name of Law: The Omnibus Budget Reconciliation Act of 1990
   PL: Pub.L. 97 - 34 261(f)(2) Name of Law: Economic Recovery Act of 1981
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 69048	11/17/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 15457	03/13/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Certification Workload and Characteristic of Certified Individuals	ETA-9065, ETA Form 9058	Audit Summary Worksheet ,   Certification Workload and Characteristics of Certified Individuals
Individual Characteristics	ETA-9061, ETA-9062, ETA-9198, ETA-9061	Individual Characteristics Form (ICF) ,   Conditional Certification Form (CC) ,   Employer Representative Declaration ,   Individual Characteristics Form (Spanish)
Qualified Long-term Unemployment Recipient (LTUR)	ETA-9175	LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program
Work Opportunity Tax Credit (WOTC)	ETA-9061, ETA-9062, ETA-9063, ETA-9175, ETA-9198, ETA 9061	Conditional Certification Work Opportunity Tax Credit ,   Employer Certification Work Opportunity Tax Credit ,   Individual Characteristics Form (ICF) Work Opportunity Tax Credit ,   LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF) ,   Employer Representative Declaration ,   ETA Form 9061 - Individual Characteristics Form (Spanish)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	18,604,708	18,604,708	0	0	0	0
Annual Time Burden (Hours)	10,205,416	10,205,416	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $12,962

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/15/2024

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