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Federal forms, ICRs, and supporting documents

Information Collection Request

Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

ICR 200510-1545-027 · OMB 1545-1500 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
18507 Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits Form Migrated
ICR Details
1545-1500 200510-1545-027
Historical Active 200211-1545-005
TREAS/IRS
Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits
Extension without change of a currently approved collection   No
Regular
Approved without change 12/19/2005
Retrieve Notice of Action (NOA) 10/27/2005
  Inventory as of this Action Requested Previously Approved
12/31/2008 12/31/2008 12/31/2005
400,000 0 400,000
1,596,000 0 1,596,000
0 0 0
A job applicant completes and signs, under penalties of perjury, the top portion of the form to indicate that he or she is a member of a targeted group. If the employer has a belief that the applicant is a member of a targeted group, the employer signs the other portion of the form under penalties of perjury and submits it to the SESA as part of a written request for certification.
None
None
No
1
IC Title Form No. Form Name
Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits 8850
  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 400,000 400,000 0 0 0 0
Annual Time Burden (Hours) 1,596,000 1,596,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/27/2005