Information Collection

Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit

IC 43791 under ICR 201005-1205-009 · OMB 1205-0371.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0371 can be found here:

Documents and Forms

Document Name Document Type
Form ETA-9059 Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit Form and Instruction
ETA-9059 Verification Results: Audit Summary Worksheet, for SWA I ETA Form 9059 Verification Results (Rev F7-07).doc Form and Instruction
ETA-9058 Consolidated Work Opportunity Tax Credit Report #1 ETA From 9058 - Report 1 Certification Wrkload & Characts Cert Individuals (COF 6-25-07).doc Form and Instruction
ETA-9065 Agency Declaration of Verification Results ETA Form 9065 ADVR (Rev. F6-07).doc Form and Instruction
ETA-9062 Conditional Certification ETA Form 9062 Conditional Certification (Rev F6-07).doc Form and Instruction
ETA-9057 Conditional Certifications Issued ETA Form 9057 Conditional Certifications Issued (Rev. F6-07).doc Form and Instruction
ETA-9063 Employer Certification ETA Form 9063 Certification (Rev F6-07).doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Opportunity Tax Credit (WOTC) and Welfare-to-Work (WtW) Tax Credit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-9063	Employer Certification	ETA Form 9063 Certification (Rev F6-07).doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA-9058	Consolidated Work Opportunity Tax Credit Report #1	ETA From 9058 - Report 1 Certification Wrkload & Characts Cert Individuals (COF 6-25-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9057	Conditional Certifications Issued	ETA Form 9057 Conditional Certifications Issued (Rev. F6-07).doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	ETA-9062	Conditional Certification	ETA Form 9062 Conditional Certification (Rev F6-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9065	Agency Declaration of Verification Results	ETA Form 9065 ADVR (Rev. F6-07).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9059	Verification Results: Audit Summary Worksheet, for SWA Internal Unse Only	ETA Form 9059 Verification Results (Rev F7-07).doc	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	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	1,431,028	1,431,028
Annual IC Time Burden (Hours)	521,625	521,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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