View Information Collection (IC)
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Agenda
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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 and Instruction
ETA-9062
Conditional Certification Work Opportunity Tax Credit
ETA_Form_9062_Conditional_Certification.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
ETA-9063
Employer Certification Work Opportunity Tax Credit
ETA_Form_9063_Employer_Certification.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
ETA-9061
Individual Characteristics Form (ICF) Work Opportunity Tax Credit
ETA_Form_9061_Individual_Characteristics_Form.pdf
Yes
Yes
Fillable Fileable
Form
ETA-9175
LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF)
ETA_Form_9175_LTUR_Self-Attestation_Form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
ETA-9198
Employer Representative Declaration
ETA_Form_9198_Employer_Representative_Declaration_Form.pdf
Yes
Yes
Fillable Fileable
Form
ETA 9061
ETA Form 9061 - Individual Characteristics Form (Spanish)
ETA_9061_Individual_Characteristics_Form_ES.pdf
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
0
0
0
9,185,562
Annual IC Time Burden (Hours)
7,134,120
0
0
0
0
7,134,120
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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