Form 9058 - Tracked Changes

ETA Form 9058 - redline edits.rtf

Work Opportunity Tax Credit

Form 9058 - Tracked Changes

OMB: 1205-0371

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U.S. Department of Labor

Employment and Training Administration



Certification Workload and Characteristics of Certified Individuals

Work Opportunity Tax Credit - Report No. 1


OMB Control No. 1205-0371 Expiration Date: March 31, 2023U.S. Department of Labor

Employment and Training Administration


Certification Workload and Characteristics of Certified Individuals

Work Opportunity Tax Credit - Report No. 1



State:_Quarter Ending:


Quarter Ending:

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents' obligation to reply to these reporting requirements is mandatory (P.L. 104--188). Public reporting burden for this collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the U.S. Department of Labor, Employment and Training Administration, Division of National Programs, Tools, &Technical Assistance, 200 Constitution Ave., NW, Room C-4510, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0371).

OMB Control No. 1205-0371 Expiration Date:

March 31, 2023

PART I. CERTIFICATION WORKLOAD



CERTIFICATION REQUESTS (System Inputs)



CERTIFICATION REQUESTS (System Outputs)

A) Incomplete Requests

B) Requests Needing Action

C) New Requests

C2) Out of State Requests

D) Total Requests tto Bbe Processed

E) Certified Requests

F) No. Denied Requests


G)

Incomplete Requests

H) Requests Needing Action

F1.

F2.

F3.


PART II. CHARACTERISTICS OF CERTIFIED INDIVIDUALS

I) By WOTC Target GroupTargeted Group

(a) No. of of CCs Resulting in Certifications

(b) No. of Certified Individualss


J) By Occupation

(a) No. of Certified Individuals


J) By Occupation (Cont.)

(a) No. Certified Individualsls


K) By Starting Starting Hourly Wage

(a) No. Certified Individualsls

1. IV-A (TANF) Recipient1.IV-A TANF Recipient



Namme -Code No.


Name-Code No.


1. Under FedFederal eral Minimumimum Wage*


2Ba. Veteran Receiving SNAP Benefits (V)2Ba. Veteran Receiving SNAP benefits (V)




1. Management Occupations 11



12. Protective Services 33




2. At FederalAt Federal

Minimum Wage$7.25 - $8.259.99


2Bb. Disabled Veteran (DV)




2. Business & Financial Operations 13





13. Food Preparation & Serving 35




3. Above Federal Minimum$7.25 Wage - $9.99$8.2610.00 $812.99



2Bc. DV Unemployed for 6 months



14. Bldg.uilding & Grounds Cleaning & Maintenance 37




4. $10.00 -$14.99

2Bd. V Unemployed for 4 weeeeks




3. Computer & Mathematical 15



15. Personal Care & Service - 39


5. $15.00 -$19.994. $10.00 -$94.993.00 -$915.99


2Be. V Unemployed for 6 months




4. Architecture & Engineering 17



16. Sales & Related Occupations 41


6. $20.00 - more 5. $15.00 -$19.991016.00 Higher$19.99


3. Ex-Felon




5. Life, Physical & Social Sciences 19


17. Office/Administrative Support 43


7. TOTAL (For Qtr)6. TOTAL (For Qtr.)$20.00- more$20.00 - Higher


4. Summer Youth Employee




6. Community & Social Services 21



18. Farming, Fishing & Forestry 45


7. Total (For Qtr.)



5. Designated Community ResidentCommunity Resident




7. Legal Occupations 23



19. Construction & Extraction 47


7. TOTAL (For Qtr)

6a. Voc. Rehab (VR) Referral




8. Education, Training, & Library 25


20. Installation/Maintenance / Repair - 49




6b. Ticket Ticket Holder (Ticket to Work)



9. Arts, Design, Entertainment, Sports / Media

Occupations 27





21. Production Occupations 51




7. SNAP Recipient





10. Healthcare Practitioner & Technical 29


22. Transportation & Material Moving

Production Occupations 53




8. SSI Recipient




11. Healthcare Support Occupations 31


23. Military Specific Occupations 55




9. Long-Tterm TANF Recipient









24. TOTAL (For Qtr)




10. LTUR









11. TOTAL (For Qtr.)








12. TOTAL (YTD)








2425. Name and Title of Responsible Certifying Official:

25. Signature Title:

26. Signature:26. Date Signed:

27. Total (For Qtr.)

27. Date:


Shape1 Instructions for Preparing ETA Form 9058, Report 1 –“Certification Workload and Characteristics of Certified Individuals,” Work Opportunity Tax Credit Report


Instructions for Preparing “Certification Workload and Characteristics of Certified Individuals,” ETA Form 9058, Report 1 – Work Opportunity Tax Credit

Introduction. Part I. of this report clarifies and simplifies data reported on certifications issued and provides state workforce agencies’ (SWAs) workload numbers during each reporting quarter. Part II., continues to collect data on selected characteristics of certified individuals.

Form Updates. The Protecting Americans from Tax Hikes Act of 2015 introduced a new WOTC target group, the Long-term Unemployment Recipient (LTUR), see Box 10SWAs will report on two new metrics in the EBSS tax credit reporting system: 1) Out-of-state certification requests received during the reporting period (quarter); and 2) Reason for issuing Denial notifications. See Part I. Certification Workload, Item C, and Item F.


Background. The purpose of ETA Form 9058 is to provide SWAs with a standardized e- reporting format, which accurately reflects program activity levels and outcomes under the Work Opportunity Tax Credit (WOTC). It is important for SWAs to maintain programmatic reporting procedures that account for each tax certification request (IRS Form 8850) received and its subsequent outcome (issuance of a tax certification or denial). A properly completed ETA Form 9058 accurately reflects program use and the level of any programmatic backlog that may exist. To ensure that the WOTC Program can be evaluated accurately at the national level, it is critical that all SWAs report in a standardized manner using the web-based Enterprise Business Service System (EBSS) Tax Credit Reporting System (TCRS).

INSTRUCTIONS FOR COMPLETING THIS FORM:


State. Enter the name of the state of the state workforce agency (SWA) submitting WOTC Report – 1, ETA Form 9058.


Quarter Ending Period. Enter ending date of the fiscal year reporting quarter for the reported applicable program data (i.e. QE 6/30/22).


Part I. "Certification Workload.” SWAs must identify from Part I, Item F on the previous reporting quarter's ETA Form 9058 the number of requests (IRS Form 8850s) determined to be incomplete or Needing Actionthe reporting status for each certification request (IRS Form 8850) included in the SWA’s total workload. This includes any requests (IRS Form 8850s) that the SWA interacted with during the applicable quarter ending. Use the reporting status options for requests, as defined below:


  1. Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received by the SWA prior to the beginning of the current report period, but for which no applicant eligibility determination action (excluding the 48-hourinitial review) was taken. Note: TThis total is to be entered intovalue is auto-populated with the value entered for Part I, Item (AG) of the previous quarter ending’s report on ETA Form 9058.


  1. Number of Requests Needing Action. Enter the total number of requests (IRS Form 8850s) received by the SWA prior to the beginning of the current report period, but for which no review nor eligibility determination was rendered. Note: and This total is to beauto-populated with the value entered into for Part I, , Item (B) of recently revisedof the previous quarter ending’s report on ETA Form 9058.


  1. Number of New Requests. Enter the total number of new requests (IRS Form 8850s) received by the SWA during the current reporting quarter. Note: Some states SWAs may have received targeted group eligibility verification requests (IRS Form 8850s) from other SWAs for individuals who reside (and possibly receive public welfare benefits) in their state, although the employer’s business (per IRS Form 8850) is located in another state. These requests are referred to as “Out of State” (OOS) certification requests. SWAs should record the number of “out-of-state” certification requests received in Part I, Item (C2). that were not previously recorded and/or reported on any prior quarterly report ETA 9058 for various reasons. It is Important for the SWAs to report all certification requests (IRS Form 8850s) received. Therefore, any requests that were received outside of the current reporting quarter, which have , which has not been previously been recorded/ reported on a prior ETA Form 9058, should be included with in the count for the n‘Number of New Rrequests for the applicable quarter ending report for when the certification request is initially reviewed by the SWAreceived during the current reporting period. That total should be entered as the number of "New Requests". This total (new requests and previously uncounted requests) is toshould be entered into Part I, Item (C) of ETA Form 9058.

  2. Total Requests to Be be Processed. Enter the sum of Items (A, ) + (B) & + (C). This total represents the number of requests (IRS Form 8850s) received by the SWA, which are available to be processed as of the quarter ending date. Note: This total is auto-tabulated based on the completion formula: Item (A +B + C) = Item D. This value total is to be entered under Part I, Item (D) of ETA Form 9058. Note. A denial is a certification request (IRS Form 8850) determined by the SWA to be ineligible for the WOTC.

  3. Number of Requests Certified. Enter the total number of WOTC Employer Ccertifications (ETA Form 9063) issued by the SWA during the current report period. Note: This value must match the value entered for Part II, Items I)11, J)24, and K)7.


  1. Number of Requests Denied. Enter the total number of requests (IRS Form 8850s) Ddenied by the SWA during the current report period. Provide the number of Denials for the the twoF1, F2, and F3 categoriesies defined below.

  2. Note. : A denial Denial is a request (IRS Form 8850) determined by the SWA to be ineligible for the WOTCby the SWA.


F1. Enter the total number of Ddenials issued due to “failure to meet IRS Form 8850 timely -filing requirements.”


F2. Enter the total number of Ddenials issued that diddue to “applicant does not meet targeted group(s) eligibility requirements.


F3. Enter the total number of Denials issued due to “ineligible rehires” (applicant previously worked for the employer seeking WOTC certification.



  1. Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received and reviewed by the SWA during the current report period, but for which the SWA could neither approve certify nor deny by the end of the report period, due to such things as, but not limited to, : the need for additional eligibilitymissing supporting documentation (for which the SWA has made a formal request to the employer to obtain), authorized tax consultant, or other third party entit;y, missing or incomplete ETA Form 9061/9062; SWA processing delays due to automated system malfunctions not submitted, etc.

  2. Note. : This number value will also beauto-populate as the value entered in Part 1I, Item (A). of the subsequent quarterly quarter ending report, report ETA Form 9058.

(H) Number of Requests Needing Action. Enter the number of requests (IRS Form 8850s) received by the SWA during the current report period, but for which no review and/or processing action has yet been taken to determine applicant eligibility. This total represents the SWA’s existing “backlog” of pending requests and is auto-tabulated based on the following completion formula: Item H = Item D – (Item E + F + G). Note: This value will auto-populate as the value entered in Part I, Item (B) of the subsequent quarter ending report, ETA Form 9058. Enter the number of requests (IRS Form 8850s) received by the SWA during the current report period, but for which no review and/or action has yet been taken to determine applicant eligibility.


Note. This value will also be entered in Part I, Item B. of the subsequent quarterly report ETA Form 9058. Part I, Item H is the sum of Item D, minus Item E, minus Item F, minus Item G.



Part I. Completion Formulas:


Item (A +B + C) = Item D; same as: Items (A+B+C) = Item D

and


Item D (E + F + G) = Item H; Same as: same asItems (A+B+C) = D: and Items (D-E-F-G) = Item H

Shape2

Shape3

Part II. "Characteristics of Certified Individuals by Tax Credit." SWAs must identify the individual characteristics (of the new hire/ applicant) for each Certification issued by the SWA during the current report period. Note: This pPart IIart is divided into three subsections: (Section (I), Section (J), and Section (K).


Section (I) reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by WOTC targeted groups. Section (J) reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by (applicant) occupation. Section (K) reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period by (applicant) starting hourly wage.


Section (I).


Section I, Column (a). Enter the total number of Certifications issued by the SWA, by targeted group, during the current report period, which resulted from the issuance of a conditional certification i.e., ETA Form 9062.


Section I, Column (b). Enter the total number of Certifications issued by the SWA, by target ed group, during the current report period.

Section I, Line #1. Enter the total number of Certifications issued by the SWA during the current report period, for the Qualified IV-A (TANF) Recipients.

Section I, Line #2Ba. Enter the total number of Certifications issued by the SWA during the current report period, for Veterans receiving SNAP benefits.


Section I, Line #2Bb. Enter the total number of Certifications issued by the SWA during the current report period, for Disabled Veterans receiving compensation for a service-connected disability.

Section I, Line #2Bc. Enter the total number of Certifications issued by the SWA during the current report period, for Disabled Veterans unemployed for 6 months.

Section I, Line #2Bd. Enter the total number of Certifications issued by the SWA during the current report period, for Veterans unemployed for at least 4 weeks but less than 6 months.

Section I, Line #2Be. Enter the total number of Certifications issued by the SWA during the current report period, for Veterans unemployed for at least 6 months.

Section I, Line #3. Enter the total number of Certifications issued by the SWA during the current report period for Ex-felons.

Section I, Line #4. Enter the total number of Certifications issued by the SWA during the current report period for Summer Youth Employees.

Section I, Line #5. Enter the total number of Certifications issued by the SWA during the current report period for Designated Community Residents (DCRs).

Section I, Line #6a. Enter the total number of Certifications issued by the SWA during the current report period for Vocational Rehabilitation (VR) Referrals.


Section I, Line #6b. Enter the total number of Certifications issued by the SWA during the current report period for “Ticket Holders” (authorized under the Social Security Administration’s ‘Ticket to Work’ Program).


Section I, Line #7. Enter the total number of Certifications issued by the SWA during the current report period for SNAP (formerly known as Food Stamps) recipients.

Section I, Line #8. Enter the total number of Certifications issued by the SWA during the current report period, for SSI recipients.

Section I, Line #9. Enter the total number of Certifications issued by the SWA during the current report period for Long-term Family Assistance (TANF) Recipients.

Section I, Line #10. Enter the total number of Certifications issued by the SWA during the current report period, for Long-term Unemployment Recipients (LTURs).

Section I, Line #11. Enter the sums of columns (a) and (b) for the current reporting quarter as TOTAL (For Qtr.) Note: The quarterly totals for Column I. “By WOTC Targeted Group” (Line#11); Column J. “By Occupation” (Line#27); and Column K.B y S t a r t i n g H our l y W a ge” (Li ne#7 ), must all equal the same value. Note: For the first quarter ending report (ETA Form 9058) of the federal fiscal year (October 1 - December 31), the values for Section I, Line #11 (For Qtr) and Line #12 (YTD) should be the same. Also, the total (For Qtr.) of Part II, Section I, Line #12, columns (a) & (b) should equal the total entered in Part I. Item E.Certified Requests.”


Shape4 Section I, Line #12. After Quarter 1, for all subsequent quarters, enter the cumulative fiscal Year-to-Date (YTD) totals of columns (a) and (b). R em i n d er: For the first quarterly report of the fiscal year (October 1- December 31), the totals of Section I, Line #11 and Line #12 should be the same value.

Section J.

Section J, Column (a). Enter the total number of WOTC Certifications issued by the SWA during the current report period, By Occupation. Note: The total for Section J, Column (a), Line #27 is the sum of the column and must equal the total for Section I, Columns (a) & (b), Line # 11.

The occupational data reported in Section J, Boxes 1-23, derive from the job titles reported on ETA Forms 9061// 9062. To prepare this report, SWAs must use the O*NET job families of occupations (standard occupation classifications) and their two-digit corresponding codes, as illustrated in the following table.



O*NET SOC JOB FAMILIES


OCCUPATION NAME CODE

Management Occupations

11

Business & Financial Operations

13

Computer & Mathematical Occupations

15

Architecture & Engineering

17

Life, Physical & Social Sciences

19

Community & Social Services

21

Legal Occupations

23

Education, Training, & Library

25

Arts, Design, Entertainment, Sports and Media Occupations

27

Healthcare Practitioner & Technical

29

Healthcare Support Occupations

31

Protective Service Occupations

33

Food Preparation & Serving Related

35

Bldg. & Grounds Cleaning & Maintenance

37

Personal Care & Service

39

Sales & Related Occupations

41

Office & Administrative Support

43

Farming, Fishing, Forestry

45

Construction & Extraction

47

Installation, Maintenance & Repair

49

Production Occupations

51

Transportation & Material Moving

53

Military Specific Occupations

55




Section K.


Section K, Column (a). Enter the total number of Certifications issued by the SWA during the current report period, “By Starting Hourly Wage.” Note: The TOTAL (For Qtr) for Section K, Column (a), Line #6, is the sum for that quarter, and must be equal to the total for Section I, Column (b), Line #11, “Number of Certified Individuals.” *Federal Minimum Wage information is located at https://www.dol.gov/general/topic/wages/minimumwage.


Convert annual earnings to hourly wages as follows:



Unit of Time


Calculated Hourly Wage

Day

Amount divided by 8

W eek

Amount divided by 40

Month

Amount divided by 172



  1. Name and Title of Certifying Official. Enter the name and title of the authorized signatory official.

  2. Signature. Enter the signature of the authorized signatory official.

Shape5 Date. Enter the date of signature.

Page 1 of 5

ETA Form 9058 (Rev. Feb 2023)


File Typetext/rtf
File TitleCertification Workload and Characteristics of Certified Individuals - ETA Form 9058 (Rev. November 2016)
AuthorDeloris Norris
Last Modified ByNshom, Yufanyi - ETA
File Modified2023-02-03
File Created2021-04-30

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