Individual Characteristics

Work Opportunity Tax Credit

Documents and Forms

Document Name Document Type
Form ETA-9061 Individual Characteristics Form and Instruction
Form ETA-9061 Individual Characteristics Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) ETA_Form_9061_Individual_Characteristics_Form.pdf Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) ETA_Form_9061_Individual_Characteristics_Form.pdf Form and Instruction
ETA-9062 Conditional Certification Form (CC) ETA_Form_9062_Conditional_Certification.pdf Form and Instruction
ETA-9062 Conditional Certification Form (CC) ETA_Form_9062_Conditional_Certification.pdf Form and Instruction
ETA-9198 Employer Representative Declaration ETA_Form_9198_Employer_Representative_Declaration_Form.pdf Form and Instruction
ETA-9198 Employer Representative Declaration ETA_Form_9198_Employer_Representative_Declaration_Form.pdf Form and Instruction
ETA-9061 Individual Characteristics Form (Spanish) ETA_Form_9061_Individual_Characteristics_Form.pdf Form and Instruction
ETA-9061 Individual Characteristics Form (Spanish) ETA_Form_9061_Individual_Characteristics_Form.pdf Form and Instruction
ETA Form 9061 - redline draft.docx ETA 9061 - Tracked Changes IC Document
ETA Form 9061 - redline draft.docx ETA 9061 - Tracked Changes IC Document
ETA Form 9062 - redline draft.docx ETA-9062 Tracked Changes IC Document
ETA Form 9062 - redline draft.docx ETA-9062 Tracked Changes IC Document

Information Collection (IC) Details

IC Title:	Individual Characteristics	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9061	Individual Characteristics Form (ICF)	ETA_Form_9061_Individual_Characteristics_Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9062	Conditional Certification Form (CC)	ETA_Form_9062_Conditional_Certification.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9198	Employer Representative Declaration	ETA_Form_9198_Employer_Representative_Declaration_Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Individual Characteristics Form (Spanish)	ETA_Form_9061_Individual_Characteristics_Form.pdf	Yes	Yes	Fillable Fileable

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: 9,185,562	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,185,562	9,185,562
Annual IC Time Burden (Hours)	3,031,235	3,031,235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 9061 - Tracked Changes	ETA Form 9061 - redline draft.docx	02/14/2023
ETA-9062 Tracked Changes	ETA Form 9062 - redline draft.docx	02/14/2023

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