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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit
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 9065
Agency Declaration of Verificatino Results
WOTC_ETA_FORM_9065 - Rev June 2012.pdf
Yes
Yes
Paper Only
Form and Instruction
ETA 9063
Employer Certification
ETA Form 9063 (Exp 6-30-15 F7-19-12) AY (C) Fnl 7-23-12).doc
Yes
Yes
Fillable Fileable Signable
Form and Instruction
ETA 9061
Individual Characteristics Form
ETA Form 9061 3 4 2013.doc
Yes
Yes
Fillable Fileable Signable
Form and Instruction
ETA 9062
COnditional Certification
ETA Form 9062 3 4 2013.doc
Yes
Yes
Fillable Fileable Signable
Form and Instruction
ETA 9058
Certification Workload and Characteristics of Certifed Individuals
ETA Form 9058 - Report 1 3 4 2013.doc
Yes
Yes
Fillable Fileable Signable
Other-TEGL
TEGL_34_12.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:
52
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
1,430,624
0
0
0
0
1,430,624
Annual IC Time Burden (Hours)
520,745
0
0
0
0
520,745
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.