Information Collection

Qualified Long-term Unemployment Recipient (LTUR)

IC 221431 under ICR 202604-1205-001 · OMB 1205-0371.

Documents and Forms

Document Name Document Type
Form ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program Qualified Long-term Unemployment Recipient (LTUR) Form
ETA-9175 LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM W ETA_Form_9175_LTUR_Self-Attestation_Form.pdf Form
ETA Form 9175 - LTUR Self Attestation Form redline Edits.docx ETA-9175-Tracked Changes IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Qualified Long-term Unemployment Recipient (LTUR)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA-9175	LONG-TERM UNEMPLOYMENT RECIPIENT SELF-ATTESTATION FORM Work Opportunity Tax Credit (WOTC) Program	ETA_Form_9175_LTUR_Self-Attestation_Form.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: 233,160	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Previously Approved
Annual Number of Responses for this IC	233,160	233,160
Annual IC Time Burden (Hours)	39,637	39,637
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ETA-9175-Tracked Changes	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].