Document Name Document Type
Form ETA-9062 Work Opportunity Tax Credit (WOTC) Form and Instruction
Form ETA-9062 Work Opportunity Tax Credit (WOTC) Form and Instruction
ETA-9062 Conditional Certification Work Opportunity Tax Credit ETA_Form_9062_Conditional_Certification.pdf Form and Instruction
ETA-9062 Conditional Certification Work Opportunity Tax Credit ETA_Form_9062_Conditional_Certification.pdf Form and Instruction
ETA-9063 Employer Certification Work Opportunity Tax Credit ETA_Form_9063_Employer_Certification.pdf Form and Instruction
ETA-9063 Employer Certification Work Opportunity Tax Credit ETA_Form_9063_Employer_Certification.pdf Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T ETA_Form_9061_Individual_Characteristics_Form.pdf Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) Work Opportunity T ETA_Form_9061_Individual_Characteristics_Form.pdf Form and Instruction
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION ETA_Form_9175_LTUR_Self-Attestation_Form.pdf Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION ETA_Form_9175_LTUR_Self-Attestation_Form.pdf Form
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 ETA Form 9061 - Individual Characteristics Form (Spanish ETA_9061_Individual_Characteristics_Form_ES.pdf Form
ETA 9061 ETA Form 9061 - Individual Characteristics Form (Spanish ETA_9061_Individual_Characteristics_Form_ES.pdf Form
ETA Form 9061 - redline draft.docx ETA-9061- Tracked IC Document
ETA Form 9061 - redline draft.docx ETA-9061- Tracked IC Document
ETA Form 9062 - redline draft.docx ETA 9062 - Tracked IC Document
ETA Form 9062 - redline draft.docx ETA 9062 - Tracked IC Document
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA 9175 - Tracked IC Document
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA 9175 - Tracked IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Opportunity Tax Credit (WOTC)	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-9062	Conditional Certification Work Opportunity Tax Credit	ETA_Form_9062_Conditional_Certification.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9063	Employer Certification Work Opportunity Tax Credit	ETA_Form_9063_Employer_Certification.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Individual Characteristics Form (ICF) Work Opportunity Tax Credit	ETA_Form_9061_Individual_Characteristics_Form.pdf	Yes	Yes	Fillable Fileable
Form	ETA-9175	LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF)	ETA_Form_9175_LTUR_Self-Attestation_Form.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	ETA 9061	ETA Form 9061 - Individual Characteristics Form (Spanish)	ETA_9061_Individual_Characteristics_Form_ES.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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)	7,134,120	7,134,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ETA-9061- Tracked	ETA Form 9061 - redline draft.docx	02/14/2023
ETA 9062 - Tracked	ETA Form 9062 - redline draft.docx	02/14/2023
ETA 9175 - Tracked	ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx	02/14/2023

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

Work Opportunity Tax Credit (WOTC)

Work Opportunity Tax Credit

OMB: 1205-0371

IC ID: 43791

View Information Collection (IC)