View Information Collection (IC)
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Work Opportunity Tax Credit (WOTC)
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-9062
Conditional Certification Work Opportunity Tax Credit
ETA Form 9062 - Conditional Certification [clean edit].docx
Yes
Yes
Fillable Fileable
Form
ETA-9063
Employer Certification Work Opportunity Tax Credit
ETA Form 9063 - Employer Certification [clean edit].docx
Yes
Yes
Fillable Fileable
Form
ETA-9061
Individual Characteristics Form (ICF) Work Opportunity Tax Credit
ETA Form 9061 - Individual Characteristics Form [clean edit].docx
Yes
Yes
Fillable Fileable
Form
ETA-9175
LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF)
ETA Form 9175 - LTUR Self Attestation Form [clean].docx
Yes
Yes
Fillable Fileable
Form
ETA-9198
Employer Representative Declaration
ETA Form 9198 - Employer Representative Declaration Form .docx
Yes
Yes
Fillable Fileable
Form
ETA-9061
Individual Characteristics Form (Spanish)
ETA Form 9061 - Individual Characteristics Form [clean edit] (1).docx
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
9,185,562
0
1,351,967
0
0
7,833,595
Annual IC Time Burden (Hours)
7,134,120
0
4,548,894
0
0
2,585,226
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ETA-9061- Tracked
ETA Form 9061 - redline draft.docx
02/14/2023
ETA 9062 - Tracked
ETA Form 9062 - redline draft.docx
02/14/2023
ETA 9175 - Tracked
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.
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