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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1205-0371
ICR Reference No:
201611-1205-003
Status:
Historical Active
Previous ICR Reference No:
201604-1205-005
Agency/Subagency:
DOL/ETA
Agency Tracking No:
012-05-01-02-02-2025-00.
Title:
Work Opportunity Tax Credit
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/23/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/30/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2020
36 Months From Approved
01/31/2017
Responses
5,840,620
0
5,840,620
Time Burden (Hours)
1,960,777
0
1,960,774
Cost Burden (Dollars)
0
0
0
Abstract:
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 April 2016 - Certification Workload and Characteristics of Certified Individuals • ETA Form 9061, Revised November 2016 - Individual Characteristics Form • ETA Form Spanish 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
Authorizing Statute(s):
PL:
Pub.L. 101 - 508 11405(c)
Name of Law: Omnibus Budget Reconciliation Act of 1989
PL:
Pub.L. 97 - 34 261(f)(2)
Name of Law: Economic Recovery Act of 1981
PL:
Pub.L. 97 - 248 233(e)
Name of Law: Tax Equity and Fiscal Responsibility Act of 1982
PL:
Pub.L. 98 - 369 1041(b)
Name of Law: Tax Equity and Fiscal Responsibility Act of 1982
PL:
Pub.L. 99 - 514 1701(d)
Name of Law: Tax Equity and Fiscal Responsibility Act of 1982
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
81 FR 51497
08/04/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 86341
11/30/2016
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Individual Characteristics
ETA 9061 Spanish Version, ETA 9061, ETA 9062
Individual Characteristics Form, Spanish Version
,
Individual Characteristics Form
,
Conditional Certification
Qualified Long-term Unemployment Recipient (LTUR)
ETA 9175
LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM
Work Opportunity Tax Credit (WOTC)
ETA 9058, ETA 9065, ETA 9063, ETA 9062, ETA 9061
Agency Declaration of Verification Results
,
Employer Certification
,
Individual Characteristics Form
,
Conditional Certification
,
Certification Workload and Characteristics of Certified Individuals
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
5,840,620
5,840,620
0
0
0
0
Annual Time Burden (Hours)
1,960,777
1,960,774
0
0
3
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$11,480
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Walter Parker 202 693-2778 parker.walter@dol.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
11/30/2016
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