Information Collection

Work Opportunity Tax Credit (WOTC)

IC 43791 under ICR 202604-1205-001 · OMB 1205-0371.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9062 Conditional Certification Work Opportunity Tax Credit Work Opportunity Tax Credit (WOTC)	Form and Instruction
Form ETA-9063 Employer Certification Work Opportunity Tax Credit Work Opportunity Tax Credit (WOTC)	Form and Instruction
Form ETA-9061 Individual Characteristics Form (ICF) Work Opportunity Tax Credit Work Opportunity Tax Credit (WOTC)	Form and Instruction
Form ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF) Work Opportunity Tax Credit (WOTC)	Form
Form ETA-9198 Employer Representative Declaration Work Opportunity Tax Credit (WOTC)	Form and Instruction
Form ETA 9061 ETA Form 9061 - Individual Characteristics Form (Spanish) Work Opportunity Tax Credit (WOTC)	Form
ETA-9062 Conditional Certification Work Opportunity Tax Credit ETA_Form_9062_Conditional_Certification.pdf	Form and Instruction
ETA-9063 Employer Certification Work Opportunity Tax Credit ETA_Form_9063_Employer_Certification.pdf	Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T ETA_Form_9061_Individual_Characteristics_Form.pdf	Form and Instruction
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION ETA_Form_9175_LTUR_Self-Attestation_Form.pdf	Form
ETA-9198 Employer Representative Declaration ETA_Form_9198_Employer_Representative_Declaration_Form.pdf	Form and Instruction
ETA 9061 ETA Form 9061 - Individual Characteristics Form (Spanish ETA_9061_Individual_Characteristics_Form_ES.pdf	Form
ETA Form 9061 - redline draft.docx ETA-9061- 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Work Opportunity Tax Credit (WOTC)

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9062	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9063	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Yes	Yes	Fillable Fileable
Form	ETA-9175	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9198	Yes	Yes	Fillable Fileable
Form	ETA 9061	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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	9,185,562	9,185,562
Annual IC Time Burden (Hours)	7,134,120	7,134,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ETA-9061- Tracked		02/14/2023
ETA 9062 - Tracked		02/14/2023
ETA 9175 - Tracked		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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