Work Opportunity Tax Credit

OMB 1205-0371

OMB 1205-0371

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

The latest form for Work Opportunity Tax Credit expires 2023-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material
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No material or nonsubstantive change to a currently approved collection 2024-02-15
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Revision of a currently approved collection 2023-03-13
Approved with change
Revision of a currently approved collection 2020-01-31
Approved without change
Revision of a currently approved collection 2016-11-30
Approved with change
Revision of a currently approved collection 2016-05-10
Approved without change
Extension without change of a currently approved collection 2015-06-30
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-03-14
Approved without change
Revision of a currently approved collection 2012-04-19
Withdrawn and continue
No material or nonsubstantive change to a currently approved collection 2011-12-02
Withdrawn and continue
No material or nonsubstantive change to a currently approved collection 2011-11-29
Approved without change
No material or nonsubstantive change to a currently approved collection 2010-06-10
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No material or nonsubstantive change to a currently approved collection 2010-05-20
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No material or nonsubstantive change to a currently approved collection 2010-05-05
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No material or nonsubstantive change to a currently approved collection 2010-04-02
Approved with change
No material or nonsubstantive change to a currently approved collection 2010-01-08
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No material or nonsubstantive change to a currently approved collection 2009-12-16
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No material or nonsubstantive change to a currently approved collection 2009-10-07
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No material or nonsubstantive change to a currently approved collection 2009-09-28
Approved with change
No material or nonsubstantive change to a currently approved collection 2009-03-20
Approved with change
Revision of a currently approved collection 2008-05-05
Approved without change
Revision of a currently approved collection 2007-08-30
Approved without change
No material or nonsubstantive change to a currently approved collection 2007-02-20
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Extension without change of a currently approved collection 2006-06-22
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Revision of a currently approved collection 2005-06-30
Approved with change
Extension without change of a currently approved collection 2002-08-30
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Extension without change of a currently approved collection 2001-06-29
Approved without change
Extension without change of a currently approved collection 1998-07-24
Approved without change
Extension without change of a currently approved collection 1998-01-08
Withdrawn and continue
Extension without change of a currently approved collection 1997-11-06
Withdrawn and continue
Revision of a currently approved collection 1997-09-17
Approved without change
Revision of a currently approved collection 1997-06-05
Approved without change
New collection (Request for a new OMB Control Number) 1996-09-27
OMB Details

Work Opportunity Tax Credit (WOTC)

Federal Enterprise Architecture: Workforce Management - Training and Employment

Form ETA-9061Individual Characteristics Form (ICF) Work Opportunity Tax CreditFillable FileableForm and instruction
Form ETA-9065Agency Declaration of Verification Results (ADVR) WorksheetFillable FileableForm and instruction
Form ETA-9063Employer Certification Work Opportunity Tax CreditFillable FileableForm and instruction
Form ETA-9062Conditional Certification Work Opportunity Tax CreditFillable FileableForm and instruction
Form ETA-9061Individual Characteristics Form (ICF) Work Opportunity Tax CreditFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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