Certification Workload and Characteristic of Certified Individuals

Work Opportunity Tax Credit

Documents and Forms

Document Name Document Type
Form ETA-9065 Certification Workload and Characteristic of Certified Individuals Form and Instruction
Form ETA-9065 Certification Workload and Characteristic of Certified Individuals Form and Instruction
ETA-9065 Audit Summary Worksheet ETA_Form_9065_Audit_Summary_Wrksht_ADVR.pdf Form and Instruction
ETA-9065 Audit Summary Worksheet ETA_Form_9065_Audit_Summary_Wrksht_ADVR.pdf Form and Instruction
ETA Form 9058 Certification Workload and Characteristics of Certified ETA_Form_9058_WOTC_Report_1_Certification_Workload_Characteristics_of_Certified_Individuals.pdf Form and Instruction
ETA Form 9058 Certification Workload and Characteristics of Certified ETA_Form_9058_WOTC_Report_1_Certification_Workload_Characteristics_of_Certified_Individuals.pdf Form and Instruction
ETA Form 9058 - redline edits.rtf Form 9058 - Tracked Changes IC Document
ETA Form 9058 - redline edits.rtf Form 9058 - Tracked Changes IC Document

Information Collection (IC) Details

IC Title:	Certification Workload and Characteristic of Certified Individuals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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	Audit Summary Worksheet	ETA_Form_9065_Audit_Summary_Wrksht_ADVR.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	ETA Form 9058	Certification Workload and Characteristics of Certified Individuals	ETA_Form_9058_WOTC_Report_1_Certification_Workload_Characteristics_of_Certified_Individuals.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	424	424
Annual IC Time Burden (Hours)	424	424
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Form 9058 - Tracked Changes	ETA Form 9058 - redline edits.rtf	02/14/2023

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