OMB control number
Work Opportunity Tax Credit
OMB 1205-0371 · DOL/ETA.
The Work Opportunity Tax Credit (WOTC) is a Federal tax credit available to employers for hiring individuals from certain target groups who have consistently faced significant barrier to employment. This submission includes seven WOTC program forms as follows: • ETA Form 9175, Revised November 2016 – Self-Attestation Form (SAF) for the Long-Term Unemployment Recipient • ETA Form 9058 - Report 1, Revised November 2016 - Certification Workload and Characteristics of Certified Individuals • ETA Form 9061, Revised November 2016 - Individual Characteristics Form • ETA Form 9062, Revised April 2016 - Conditional Certification • ETA Form 9063, Revised April 2016 - Employer Certification • ETA Form 9065, Revised April 2016 - Agency Declaration of Verification Results Worksheet
The latest form for Work Opportunity Tax Credit expires 2026-06-30 and can be found here.
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Justification for No Material/Nonsubstantive Change |
Supporting Statement A |
Form ETA 9061 ETA Form 9061 - Individual Characteristics Form (Spanish)
1205-0371 - Spanish Form 9061 no material change request_.docx
Work Opportunity Tax Credit (WOTC) Work Opportunity Tax Credit (WOTC)
Federal Enterprise Architecture: Workforce Management - Training and Employment
| Form ETA-9061 | Individual Characteristics Form (ICF) Work Opportunity Tax Credit | Fillable Fileable | Form and instruction |
| Form ETA 9061 | ETA Form 9061 - Individual Characteristics Form (Spanish) | Fillable Fileable | Form |
| Form ETA-9198 | Employer Representative Declaration | Fillable Fileable | Form and instruction |
| Form ETA-9175 | LONG-TERM UNEMPLOYMENT RECIPIENT (LTUR) SELF-ATTESTATION FORM (SAF) | Fillable Fileable | Form |
| Form ETA-9063 | Employer Certification Work Opportunity Tax Credit | Fillable Fileable | Form and instruction |
| Form ETA-9062 | Conditional Certification Work Opportunity Tax Credit | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.