Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit

Forms and Documents

Document Name	Status
Form ETA 9065 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit Form and Instruction	Modified
Form ETA 9175 Qualified Long-term Unemployment Recipient (LTUR) Form	New
Form ETA 9061 Spanish V Individual Characteristics Form	Modified
BILLS-114hr2029enr see p815.pdf Supplementary Document	2016-04-20
Wu Memo for 1205-0371.pdf Supplementary Document	2016-04-29
1205-0371 Supporting Statement_FINAL 5.9.16.docx Supporting Statement A	2016-05-09

IC Document Collections

IC ID	Document Title	Status
43791	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit Form and Instruction	Modified
221431	Qualified Long-term Unemployment Recipient (LTUR) Form	New
184551	Individual Characteristics Form	Modified

ICR Details

OMB Control No: 1205-0371	ICR Reference No: 201604-1205-005
Status: Historical Active	Previous ICR Reference No: 201502-1205-006
Agency/Subagency: DOL/ETA	Agency Tracking No: 012-05-01-02-02-2025-00.
Title: Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/13/2016
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/17/2016
	Date Received in OIRA: 05/10/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	6 Months From Approved	08/31/2018
Responses	5,840,620	0	2,420,624
Time Burden (Hours)	1,960,774	0	847,445
Cost Burden (Dollars)	0	0	0

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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 Long-Term Unemployment Recipient Self-Attestation Form (SAF) 9175 • ETA Form 9058 - Report 1, Revised (Rev.) April 2016 - Certification Workload and Characteristics of Certified Individuals • ETA Form 9061, Rev. April 2016 - Individual Characteristics Form • ETA Form Spanish 9061, Rev. April 2016 - Individual Characteristics Form • ETA Form 9062, Rev. April 2016 - Conditional Certification • ETA Form 9063, Rev. April 2016 - Employer Certification • ETA Form 9065, Rev. April 2016 - Agency Declaration of Verification Results Worksheet.

Emergency Justfication: The U.S. Department of Labor’s Employment and Training Administration (ETA) requests OMB to authorize emergency clearance for Information Collection Request for ETA Forms 9058- Report 1, 9061(English and Spanish), and 9062 (OMB Control No. 1205-0371). Additionally, ETA seeks emergency clearance for a Self-Attestation Form to help facilitate the eligibility determination and verification process for a new target group, Qualified Long-term Unemployment Recipients. See attached Work Opportunity Tax Credit (WOTC) forms. Immediate Effect of Statutory Requirement Justifies Emergency Clearance Request On December 18, 2015, President Obama signed into law the Protecting Americans from Tax Hikes Act of 2015, Pub. L. No. 114-113, div. Q (PATH Act). The PATH Act created a new target group, Qualified Long-term Unemployment Recipients, under WOTC. WOTC is a Federal tax credit available to employers for hiring individuals from certain target groups who have consistently faced significant barrier to employment. WOTC is authorized under §§ 51 and 3111(e) of the Internal Revenue Code (Code), as extended and amended by the PATH Act. Legislative authority for the new group took immediate effect, January 1, 2016; consequently, emergency clearance procedures are justified to engage in the collection of information as soon as possible under the circumstances..

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Authorizing Statute(s): PL: Pub.L. 101 - 508 11405(c) Name of Law: Omnibus Budget Reconciliation Act of 1989
   PL: Pub.L. 97 - 34 261(f)(2) Name of Law: Economic Recovery Act of 1981
   PL: Pub.L. 97 - 248 233(e) Name of Law: Tax Equity and Fiscal Responsibility Act of 1982
   PL: Pub.L. 98 - 369 1041(b) Name of Law: Tax Equity and Fiscal Responsibility Act of 1982
   PL: Pub.L. 99 - 514 1701(d) Name of Law: Tax Equity and Fiscal Responsibility Act of 1982
  

Citations for New Statutory Requirements: PL: Pub.L. 114 - 113 171 Name of Law: Protecting Americans from Tax Hikes Act of 2015 (PATH Act)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	ETA 9058, ETA 9065, ETA 9063, ETA 9062, ETA 9061	Agency Declaration of Verificatino Results ,   Employer Certification ,   Individual Characteristics Form ,   Conditional Certification ,   Certification Workload and Characteristics of Certifed Individuals
Qualified Long-term Unemployment Recipient (LTUR)	ETA 9175	LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM
Individual Characteristics	ETA 9061 Spanish Version, ETA 9061, ETA 9062	Individual Characteristics Form, Spanish Version ,   Individual Characteristics Form ,   Conditional Certification

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,840,620	2,420,624	95,741	0	3,324,255	0
Annual Time Burden (Hours)	1,960,774	847,445	16,276	0	1,097,053	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The addition of a new target group, Qualified Long-term Unemployment Recipient (LTUR), ETA created a national SAF. The SAF is to be completed by the new hire only. This results in a burden increase due to new statutory requirements of 16,276 hours.

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Annual Cost to Federal Government: $11,480

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/10/2016

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