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	ETA Form 9065_FINAL 4.18.16.doc		Yes	Yes	Paper Only
Form and Instruction	ETA 9063	Employer Certification	ETA Form 9063_FINAL 5.9.16.doc		Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9061	Individual Characteristics Form	ETA Form 9061 English_FINAL 5.9.16.doc		Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9062	Conditional Certification	ETA Form 9062_FINAL 5.9.16.doc		Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA 9058	Certification Workload and Characteristics of Certifed Individuals	ETA Form 9058_FINAL 4.18.16.doc.docx		Yes	Yes	Fillable Fileable Signable

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	3,830,058	0	0	2,399,434	0	1,430,624
Annual IC Time Burden (Hours)	1,312,608	0	0	791,863	0	520,745
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 9065	ETA Form 9065 (track changes) 4.15.16.doc	04/20/2016
ETA 9063	ETA Form 9063 (track changes) 4.15.16.doc	04/20/2016
ETA 9061	ETA Form 9061 English (track changes) 4.15.16.doc	04/20/2016
ETA 9062	ETA Form 9062 (track changes) 4.15.16.doc	04/20/2016
ETA 9058	ETA Form 9058 (track changes) 4.15.16.doc.docx	04/20/2016
TEGL	Dept. Clearance TEGL WOTC 2015 Reauthorization 4.15.16.docx	05/08/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.