ETA Form 9058 Certification Workload and Characteristics of Certified

U.S. Department Labor
Employment and Training Administration

OMB Control No. 1205-0371
Expiration Date: May 31, 2026
Certification Workload and Characteristics of Certified Individuals

Work Opportunity Tax Credit - Report No. 1
State:

Quarter
Ending:

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents' obligation to reply to these reporting requirements is mandatory (P.L. 104-188). Public
reporting burden for this collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and
reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the U.S. Department of Labor, Employment
and Training Administration, Division of National Programs, Tools, &Technical Assistance, 200 Constitution Ave., NW, Room C-4510, Washington, D.C. 20210 or email: [email protected] (Paperwork Reduction Project 1205-0371).
PART I. CERTIFICATION WORKLOAD
CERTIFICATION REQUESTS (System Inputs)
CERTIFICATION REQUESTS (System Outputs)

A) Incomplete
Requests

B) Requests Needing Action

C) New Requests

D) Total Requests
to be Processed

E) Certified Requests

F1.

C2) Out of State Requests

I) By WOTC Targeted Group
1. IV-A (TANF) Recipient

(a) No. of CCs
Resulting In
V
Certifications

(b) No. of
Certified
Individuals

1. Management Occupations – 11

2Bb. Disabled Veteran (DV)

2. Business & Financial Operations –
13

3. Ex-Felon

K) By Starting
Hourly Wage

1. Under Federal
Minimum Wage*
2. At Federal

Minimum Wage

14. Building & Grounds Cleaning &
Maintenance – 37

3. $7.25 - $9.99

15. Personal Care & Service - 39
4. $10.00 - $14.99

4. Architecture & Engineering – 17

16. Sales & Related Occupations – 41

5. Life, Physical & Social Sciences – 19

17. Office/Administrative Support – 43

5. $15.00 - $19.99

18. Farming, Fishing & Forestry – 45

6. Community & Social Services – 21

6. $20.00 - more

19. Construction & Extraction – 47
7. Legal Occupations – 23

6b. Ticket Holder (Ticket to Work)

8. Education, Training, & Library – 25

7. TOTAL (For Qtr)

20. Installation/Maintenance /
Repair – 49
21. Production Occupations – 51

8. SSI Recipient

9. Arts, Design, Entertainment, Sports /
Media Occupations – 27

9. Long-Term TANF Recipient

10. Healthcare Practitioner & Technical – 29

10. LTUR

(a) No. of
Certified
Individuals

13. Food Preparation & Serving – 35

3. Computer & Mathematical – 15

6a. Voc. Rehab (VR) Referral

7. SNAP Recipient

H) Requests Needing Action

12. Protective Services – 33

4. Summer Youth Employee
5. Designated Community Resident

G) Incomplete
Requests

F3.

2Bc. DV Unemployed for 6 mos

2Be. V Unemployed for 6 mos

F2.

PART II. CHARACTERISTICS OF CERTIFIED INDIVIDUALS
J) By Occupation
J) By Occupation (Cont.)
(a) No. of
Certified
Name – Code No.
Name – Code No.
Individuals

2Ba. Veteran Receiving SNAP
Benefits (V)

2Bd. V Unemployed for 4 weeks

F) Denied Requests

22. Transportation & Material Moving
Production Occupations – 53
23. Military Specific Occupations – 55

11. Healthcare Support Occupations – 31

24. TOTAL (For Qtr)

11. TOTAL (For Qtr)
12. TOTAL (YTD)
25. Name and Title of Certifying Official:
Page 1 of 5

26. Signature:

27. Date:
ETA Form 9058 (Rev. May 2023)

(a) No. of
Certified
Individuals

U.S. Department of Labor
Employment and Training Administration

Instructions for Preparing “Certification Workload and Characteristics of Certified
Individuals,” ETA Form 9058, Report 1 – Work Opportunity Tax Credit
Introduction. Part I. of this report clarifies and simplifies data reported on certifications issued
and provides state workforce agencies’ (SWAs) workload numbers during each reporting
quarter. Part II. continues to collect data on selected characteristics of certified individuals.
Form Updates. SWAs will report on two new metrics in the EBSS tax credit reporting system:
1) Out-of-state certification requests received during the reporting period (fiscal quarter); and
2) Reason for issuing Denial notifications. See Part I. Certification Workload, Item C, and Item F.
This form also contains updated wage bracket information for reporting on new hire hourly wages.
See Part II., Section K) By Starting Hourly Wage.
Background. The purpose of ETA Form 9058 is to provide SWAs with a standardized ereporting format, which accurately reflects program activity levels and outcomes under the Work
Opportunity Tax Credit (WOTC). It is important for SWAs to maintain programmatic reporting
procedures that account for each certification request (IRS Form 8850) received and its
subsequent outcome (issuance of a certification or denial). A properly completed ETA Form 9058
accurately reflects program use and the level of any programmatic backlog that may exist. To
ensure that the WOTC Program can be evaluated accurately at the national level, it is critical thatall
SWAs report in a standardized manner using the web-based Enterprise Business Service
System (EBSS) Tax Credit Reporting System (TCRS).

Page 2 of 5

ETA Form 9058 (Rev. May 2023)

U.S. Department of Labor
Employment and Training Administration

INSTRUCTIONS FOR COMPLETING THIS FORM:
State. Enter the name of the state of the state workforce agency (SWA) submitting WOTC Report – 1, ETA Form 9058.
Quarter Ending. Enter ending date of the fiscal year reporting quarter for the applicable program data (i.e. QE 9/30/23).
Part I. “Certification Workload.” SWAs must identify the reporting status for each certification request (IRS Form
8850) included in the SWA’s total workload. This includes any requests (IRS Form 8850s) that the SWA interacted
with during the applicable quarter ending. Use the reporting status options for requests, as definedbelow:
(A)

Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received by theSWA
prior to the beginning of the current report period, but for which no applicant eligibility determination action
(excluding the initial review) was taken. Note: This value is auto-populated with the value entered for Part I, Item
(G) of the previous quarter ending’s report on ETA Form 9058.

(B)

Number of Requests Needing Action. Enter the total number of requests (IRS Form 8850s) received bythe
SWA prior to the beginning of the current report period, but for which no review nor eligibility determination was
rendered. Note: This total is auto-populated with the value entered for Part I,Item (B) of the previous quarter ending’s
report on ETA Form 9058.

(C)

Number of New Requests. Enter the total number of new requests (IRS Form 8850s) received by the SWA
during the current reporting quarter. Note: Some SWAs may receive targeted group eligibility verification
requests from other SWAs for individuals who reside (and possibly receive public welfare benefits) in their
state, although the employer’s business is located in another state (per information provided on IRS Form
8850). These requests are referred to as “Out of State” (OOS) certification requests. SWAs should record
the number of “out-of-state” certification requests received in Part I, Item (C2). This number should be
included in the value entered for Item C) New Requests. It is Important for SWAs to report all certification
requests (IRS Form 8850s) received. Therefore, any requests that were received outside of the current reporting
quarter, which have not been previously recorded/ reported on a prior ETA Form 9058, should be included in the
count for ‘Number of New Requests’ for the applicable quarter ending report for when the certification request
is initially reviewed by the SWA. This total (new requests and previously uncounted requests) should be
entered into Part I, Item (C) of ETA Form 9058.

(D)

Total Requests to be Processed. Enter the sum of Items (A) + (B) + (C). This total represents the
number of requests (IRS Form 8850s) which are available to be processed as of the quarter ending
date. Note: This total is auto-tabulated based on the completion formula: Item (A +B + C) = Item D.
This value is to be entered under Part I, Item (D) of ETA Form 9058.

(E)

Number of Requests Certified. Enter the total number of Employer Certifications (ETA Form 9063) issued by the SWA
during the current report period. Note: This value must match the value entered for Part II, Items I)11, J)24, and K)7.

(F)

Number of Requests Denied. Enter the total number of requests (IRS Form 8850s) Denied by the SWA
during thecurrent report period. Provide the number of Denials for the F1 thru F3 categories defined
below. Note: A Denial is a request (IRS Form 8850) determined to be ineligible for the WOTC by the SWA.
F1. Enter the total number of Denials issued due to “failure to meet IRS Form 8850 timely-submission
requirement.” This number should be reflected in the total value entered for Item F) Denied Requests.
F2. Enter the total number of Denials issued due to “applicant does not meet targeted group(s)
eligibility requirements.” This number should be reflected in the total value entered for Item F) Denied
Requests.
F3. Enter the total number of Denials issued due to “ineligible rehires” (applicant previously worked for
the employer seeking WOTC certification). This number should be reflected in the total value entered
for Item F) Denied Requests.

(G) Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received and

reviewed by the SWA during the current report period, but for which the SWA could neither certify nor
deny by the end of the report period, due to such things as, but not limited to: missing supporting
documentation (for which the SWA has made a formal request to the employer to obtain); missing or
incomplete ETA Form 9061/9062; SWA processing delays due to automated system malfunctions, etc.
Note: This value will auto-populate as the value entered in Part I, Item (A) of the subsequent quarter
ending report, ETA Form 9058.

(H)

Number of Requests Needing Action. Enter the number of requests (IRS Form 8850s) received by the SWA
during the current report period, but for which no review and/or processing action has yet been taken to
determine applicant eligibility. This total represents the SWA’s existing “backlog” of pending requests and is
auto-tabulated based on the following completion formula: Item H = Item D – (Item E + F + G). Note: This
value will auto-populate as the value entered in Part I, Item (B) of the subsequent quarter ending report, ETA
Form 9058.

U.S. Department of Labor
Employment and Training Administration
Part I. Completion Formulas:
Item (A +B + C) = Item D; same as: Items (A+B+C) = Item D
Item D – (E + F + G) = Item H; same as: Items (D-E-F-G) = Item H

Part II. "Characteristics of Certified Individuals." SWAs must identify the individual characteristics (of the new
hire/ applicant) for each Certification issued by the SWA during the current report period. Note: Part II is divided
into three subsections: Section (I), Section (J), and Section (K). Section (I) reflects the number of requests (IRS
Form 8850s) certified by the SWA during the current report period by WOTC targeted group. Section (J)
reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by
(applicant) occupation. Section (K) reflects the number of requests (IRS Form 8850s) certified by the SWA
during the current report period by (applicant) starting hourly wage.
Section (I).
Section I, Column (a). Enter the total number of Certifications issued by the SWA, by targeted group, duringthe current
report period, which resulted from the issuance of a conditional certification i.e., ETA Form 9062.
Section I, Column (b). Enter the total number of Certifications issued by the SWA, by targetedgroup, during the
current report period.
Section I, Line #1. Enter the total number of Certifications issued by the SWA during the currentreport period, for the
Qualified IV-A (TANF) Recipients.
Section I, Line #2Ba. Enter the total number of Certifications issued by the SWA during thecurrent report period,
for Veterans receiving SNAP benefits.
Section I, Line #2Bb. Enter the total number of Certifications issued by the SWA during the currentreport period, for
Disabled Veterans receiving compensation for a service-connected disability.
Section I, Line #2Bc. Enter the total number of Certifications issued by the SWA during the currentreport period, for
Disabled Veterans unemployed for 6 months.
Section I, Line #2Bd. Enter the total number of Certifications issued by the SWA during the currentreport period, for
Veterans unemployed for at least 4 weeks but less than 6 months.
Section I, Line #2Be. Enter the total number of Certifications issued by the SWA during thecurrent report period,
for Veterans unemployed for at least 6 months.
Section I, Line #3. Enter the total number of Certifications issued by the SWA during the current reportperiod for Ex-felons.
Section I, Line #4. Enter the total number of Certifications issued by the SWA during the currentreport period for
Summer Youth Employees.
Section I, Line #5. Enter the total number of Certifications issued by the SWA during the current report period for
Designated Community Residents (DCRs).
Section I, Line #6a. Enter the total number of Certifications issued by the SWA during the currentreport period for
Vocational Rehabilitation (VR) Referrals.
Section I, Line #6b. Enter the total number of Certifications issued by the SWA during the currentreport period for
“Ticket Holders” (authorized under the Social Security Administration’s ‘Ticket to Work’ Program).
Section I, Line #7. Enter the total number of Certifications issued by the SWA during the currentreport period for SNAP
(formerly knownasFood Stamps) recipients.
Section I, Line #8. Enter the total number of Certifications issued by the SWA during the current reportperiod, for SSI
recipients.
Section I, Line #9. Enter the total number of Certifications issued by the SWA during the current reportperiod for Longterm Family Assistance (TANF) Recipients.
Section I, Line #10. Enter the total number of Certifications issued by the SWA during the current reportperiod, for Longterm Unemployment Recipients (LTURs).
Section I, Line #11. Enter the sums of columns (a) and (b) for the current reporting quarter as TOTAL (ForQtr.).
Note: The quarterly totals for Column I. “By WOTC Targeted Group” (Line#11); Column J. “By Occupation”
(Line#27); and Column K. “ By Starting Ho u r ly Wage ” ( Li ne#7), must all equal the same value. Note: For the
first quarter ending report (ETA Form 9058) of the federal fiscal year (October 1 - December 31), the values for Section I,
Line #11 (For Qtr) and Line #12 (YTD) should be the same. Also, the total (For Qtr.) of Part II,Section I, Line #12, columns
(a) & (b) should equal the total entered in Part I. Item E. “Certified Requests.”

U.S. Department of Labor
Employment and Training Administration

Section I, Line #12. After Quarter 1, for all subsequent quarters, enter the cumulative fiscal Year-to-Date (YTD) totals
of columns (a) and (b). Reminder: For the first quarterly report of the fiscal year (October 1- December 31), the totals of
Section I, Line #11 and Line #12 should be the same value.
U

Section J.
Section J, Column (a). Enter the total number of WOTC Certifications issued by the SWA during the currentreport
period, By Occupation. Note: The total for Section J, Column (a), Line #24 is the sum of the column and must equal the
total for Section I, Columns (a) & (b), Line # 11 TOTAL (For Qtr).
The occupational data reported in Section J, Boxes 1-23, derive from the job titles reported on ETA Forms 9061//9062.
To prepare this report, SWAs must use the O*NET job families of occupations (standard occupation classifications)
and their two-digit corresponding codes, as illustrated in the following table.

24. TOTAL (For Qtr). Enter the total number of certifications issued for the current reporting period (quarter).

O*NET SOC JOB FAMILIES
Occupation Name

Management Occupations
Business & Financial Occupations
Computer & Mathematical Occupations
Architecture & Engineering
Life, Physical & Social Sciences
Community & Social Services
Legal Occupations
Education, Training, & Library
Arts, Design, Entertainment, Sports, and Media Occupations
Healthcare Practitioner & Technical
Healthcare Support Occupations
Protective Service Occupations
Food Preparation & Serving Related
Bldg. & Grounds Cleaning & Maintenance
Personal Care & Service
Sales & Related Occupations
Office & Administrative Support
Farming, Fishing, Forestry
Construction & Extraction
Installation, Maintenance & Repair
Production Occupations
Transportation & Material Moving
Military Specific Occupations

Code
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
51
53
55

Section K.
Section K, Column (a). Enter the total number of Certifications issued by the SWA during the current report period,
“By Starting Hourly Wage.” Note: The TOTAL (For Qtr) for Section K, Column (a) Line #7, is the sum for that
quarter, and must be equal to the total for Section I, Column (b), Line #11, “Number of Certified Individuals.”
* Federal Minimum Wage information .
31TU

U31T

Convert annual earnings to hourly wages as follows:

Unit of Time
Day
W eek
Month

Calculated Hourly Wage
Amount divided by 8
Amount divided by 40
Amount divided by 172

25. Name and Title of Certifying Official. Enter the name and title of the authorized signatory official.
26. Signature. Enter the signature of the authorized signatory official.
27. Date. Enter the date of signature.