Qualified Long-term Unemployment Recipient (LTUR)

Work Opportunity Tax Credit

Documents and Forms

Document Name Document Type
Form ETA-9175 Qualified Long-term Unemployment Recipient (LTUR) Form
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.pdf Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM W ETA_Form_9175_LTUR_Self-Attestation_Form.pdf 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.pdf		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	Previously Approved
Annual Number of Responses for this IC	233,160	233,160
Annual IC Time Burden (Hours)	39,637	39,637
Annual IC Cost Burden (Dollars)	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.