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OMB Control No: 1205-0371	ICR Reference No: 202302-1205-001
Status: Historical Active	Previous ICR Reference No: 201912-1205-010
Agency/Subagency: DOL/ETA	Agency Tracking No:
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: 05/04/2023
	Date Received in OIRA: 03/13/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	36 Months From Approved	05/31/2023
Responses	18,604,708	0	13,527,028
Time Burden (Hours)	10,205,416	0	4,454,205
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 November 2016 - Certification Workload and Characteristics of Certified Individuals • ETA Form 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. 97 - 34 261(f)(2) Name of Law: Economic Recovery Act of 1981
   PL: Pub.L. 104 - 188 1201 Name of Law: Small Business Job Protection Act of 1996
   US Code: 26 USC 51 Name of Law: Internal Revenue Code of 1986
   US Code: 26 USC 3111 Name of Law: Internal Revenue Code of 1986
   PL: Pub.L. 116 - 260 113 Name of Law: Consolidated Appropriations Act, 2021
   PL: Pub.L. 101 - 508 11405(c) Name of Law: The Omnibus Budget Reconciliation Act of 1990

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:
	87 FR 69048	11/17/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 15457	03/13/2023
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Certification Workload and Characteristic of Certified Individuals	ETA-9065, ETA-9058	,
Individual Characteristics	ETA-9061, ETA-9062, ETA-9198, ETA-9061	, , ,
Qualified Long-term Unemployment Recipient (LTUR)	ETA-9175
Work Opportunity Tax Credit (WOTC)	ETA-9061, ETA-9062, ETA-9063, ETA-9061, ETA-9175, ETA-9198	, , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	18,604,708	13,527,028	5,248,377	-170,697
Annual Time Burden (Hours)	10,205,416	4,454,205	5,780,226	-29,015
Annual Cost Burden (Dollars)	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are burden hour changes to the information collection compared to the prior ICR approval (March 2020). Since the previously approved ICR, the burden analysis has been updated to reflect 53 state respondents as opposed to 52, and the estimated total annual responses have been increased to reflect fiscal year 2021 WOTC program data. Other changes reflect normal increases to wage rates for state and Federal staff since the last approval of this ICR. The specific changes impacting burden hours is the introduction of ETA Form 9198. The Department estimates that the use of ETA Form 9198 will increase response burden by 0.33 hour for each respondent, based on relative burden time that was estimated for similar IC requirements. Since Form 9198 is optional in use, and many SWAs will use their automated systems to process Form 9198, alleviating any undue necessary burden hours on employers and states, The data collection process is not changing significantly from the last iteration. There are no administrative program changes from the previously approved ICR, however; states may be required to spend minimal time updating / uploading the revised forms in their automated systems. The anticipated burden for uploading the revised forms into automated systems is negligible and not expected to impact the burden estimate hours. The WOTC processing and administrative forms have been updated to reflect general grammatical, syntax, and/or form formatting revisions. Full specific form revisions are listed on the supporting document.

Annual Cost to Federal Government: $12,962

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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? No

Agency Contact: Patrice Gibson 202 693-0158 gibson.patrice.a@dol.gov

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