Information Collection

Qualified Long-term Unemployment Recipient (LTUR)

IC 221431 under ICR 202604-1205-001 · OMB 1205-0371.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program 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 Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA-9175-Tracked Changes	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA-9175				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 %

table that charts list of burden
	Requested	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

table that charts IC Documents
Title	Document	Date Uploaded
ETA-9175-Tracked Changes		02/14/2023

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

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