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VOW Act veteran Work Opportunity Tax Credit guidance
Summary ETA explained how the VOW to Hire Heroes Act expanded the veteran groups eligible for the Work Opportunity Tax Credit for hires from November 22, 2011 through 2012. State workforce agencies received instructions for verifying service and unemployment, certifying eligibility, and handling employer Form 8850 submissions. The advisory also included IRS guidance and sample processing forms; ETA now lists it Canceled.
Document
Federal guidance
Agency
U.S. Department of Labor, Employment and Training Administration (ETA)
Document number
TEGL No. 30-11
Date issued
May 24, 2012
Status
Withdrawn
ETA lists this advisory Canceled as of 2026-10-24; its PDF prints Expiration Date: Continuing and Rescissions: None. It describes VOW Act provisions that applied to hires before January 1, 2013.
Status last verified October 24, 2026
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Accessible letter PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL30-11acc.pdf
CLASSIFICATION
EMPLOYMENT AND TRAINING ADMINISTRATION WOTC
ADVISORY SYSTEM CORRESPONDENCE SYMBOL
U.S. DEPARTMENT OF LABOR
Washington, D.C. 20210
OWI
DATE
May 24, 2012
TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 30-11
TO: ALL STATE WORKFORCE AGENCIES
ALL STATE WORKFORCE LIAISONS
FROM: JANE OATES /s/
Assistant Secretary
SUBJECT: Information and Guidance on the Work Opportunity Tax Credit
Provisions Introduced by the Veterans Opportunity to Work (VOW)
to Hire Heroes Act of 2011, and IRS Guidance on Submission of
Form 8850
1. Purpose. The purpose of this advisory is to inform the State Workforce
Agencies (SWAs) of new provisions that affect the Work Opportunity Tax
Credit (WOTC) Veteran target group, to provide guidance for the effective
and timely implementation of eligibility determinations for this group and its
new categories, and to inform SWAs of Internal Revenue Service (IRS)
guidance on the submission of Form 8850.
2. References. VOW to Hire Heroes Act of 2011 (the VOW Act) (Pub. L. 112-56);
the American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5,
Recovery Act); Internal Revenue Code of 1986, Section 51, as amended;
Paperwork Reduction Act of 1995; Internal Revenue Notice 2012-13, 2012-9
I.R.B.492 (Feb. 27, 2012); the Job Creation and Worker Assistance Act of 2002
(Pub. L. 107-147); the Tax Relief and Health Care Act of 2006 (Pub. L. 109-432);
the Working Families Tax Relief Act of 2004 (Pub. L. 108-311); the Small
Business and Work Opportunity Tax Credit Act of 2007 (Pub. L. 110-28);
Training and Employment Guidance Letter (TEGL) No. 15-11, Work
Opportunity Tax Credit (WOTC) Procedural Guidance During Authorization Lapse
for Non-Veteran WOTC Target Groups; TEGL No. 21-10, Change 1, Clarification
of Certain Work Opportunity Tax Credit (WOTC) Programmatic Policy Issues,
December 21, 2011; TEGL No. 21-10, End Date for the Work Opportunity Tax
Credit (WOTC) American Recovery and Reinvestment Act of 2009 (Recovery Act)
Temporary Target Groups, March 21, 2011; TEGL No. 19-05, New Streamlined
Reporting Requirements and Extension of the Information Collection for the Work
Opportunity and Welfare-to-Work Tax Credits; TEGL No. 20-06, Reauthorization of
the Work Opportunity Tax Credit and Other Program Changes; TEGL No. 05-07,
RESCISSIONS EXPIRATION DATE:
Continuing
None
Reauthorization of the Work Opportunity Tax Credit and Other Program Changes;
TEGL No. 11-08, Extension of the Information Collection for the Consolidated Work
Opportunity Tax Credit Program: Revised Reporting and Processing Forms; TEGL
No. 11-08, Change 1, Extension Period Granted to the State Workforce Agencies
and Employers for the Uninterrupted Use of All 2007 and 2008 Work Opportunity
Tax Credit Program Processing Forms; ETA Handbook No. 408, November 2002,
Third Edition (the Handbook); and the updated November 2009 Addendum
to the Handbook (Addendum, OMB No. 1205-0371).
3. Background. On November 21, 2011, President Obama signed into law the
VOW Act (Pub. L. 112-56). Title II, subtitle D, section 261, “Returning Heroes
and Wounded Warriors Work Opportunity Tax Credits,” of the VOW Act
amends and expands the definition of the WOTC “Qualified Veteran” target
group in section 51 of the Internal Revenue Code (IRC) to grant a tax credit to
employers for hiring certain qualified veterans.
The changes and new provisions in the VOW Act apply to individuals who
begin to work for an employer on or after November 22, 2011, and before
January 1, 2013. Section 261 amends the IRC Section 51(d)(3) definition of
“Qualified Veteran” by adding two new unemployed veteran categories and
also extends the availability of the existing veterans receiving Supplemental
Nutrition Assistance Program (SNAP) and disabled veteran categories. The
VOW Act also makes WOTC available to “qualified tax-exempt
organizations” that hire qualified veterans.
The VOW Act only extends the availability of the WOTC for hiring members
of the qualified veteran target group. All other WOTC target groups expired
on December 31, 2011. The VOW Act also does not reauthorize the
disconnected youth and unemployed veteran target groups that were enacted
by the Recovery Act, which expired on December 31, 2010.
4. IRS Notice 2012-13. On February 9, 2012, the IRS issued Notice 2012-13
which provides procedural information for the SWAs and guidance for
employers and their authorized representatives on the provisions in the VOW
Act, and provides requirements related to the submission of IRS Form 8850.
This Notice is provided as Attachment A and can also be found at
http://www.irs.gov/pub/irs-drop/n-12-13.pdf.
5. Overview of WOTC Provisions in the VOW Act. The VOW Act includes the
following provisions:
a) Extends the current category for veterans receiving SNAP benefits with
the same qualified wages cap ($6,000) for a maximum tax credit of up to
$2,400.
b) Extends the current category for veterans with a service-connected
disability with the same qualified wages cap ($12,000) for a maximum tax
credit of up to $4,800.
c) Extends the current category for veterans with a service-connected
disability unemployed for at least 6 months, with the qualified wages cap
increased to $24,000 for a maximum tax credit increase of up to $9,600.
d) Establishes two new unemployed veterans categories as follows:
• Veterans unemployed for at least 4 weeks with a qualified wages cap
of $6,000 and a maximum tax credit of up to $2,400.
• Veterans unemployed for at least 6 months with a qualified wages cap
of $14,000 and a maximum tax credit of up to $5,600.
e) Makes WOTC available to “qualified tax-exempt organizations” that hire
qualified veterans.
6. Program Administration. The VOW to Hire Heroes Act does not change the
SWAs’ certification and program operation responsibilities from those
described in the November 2002, Third Edition of ETA Handbook 408 (The
Handbook) and the 2009 Addendum to the Handbook. These responsibilities
include procedures for: a) determining targeted group eligibility by
conducting verification activities and issuing certifications and denials; b)
establishing working partnerships with different participating agencies at the
state and local levels for resolving veteran-related technical issues and issuing
conditional certifications; c) complying with quarterly reporting
requirements; and d) complying with requirements for record retention time
periods.
7. Definitions for WOTC Veteran Group. Section 51(d)(3) of the IRC provides a
two-part definition of the term Qualified Veteran as follows:
First, section 51(d)(3)(B) defines veteran as any individual certified by a SWA
as:
Having: 1) served on active duty (other than active duty for training)
for period of more than 180 days in the Armed Forces of the United
Section of America, or 2) been discharged or released from active duty
in the Armed Forces of the United States of America for a service-
connected disability; and
Not having, during the 60-day period ending on the hiring date, any
day of extended active duty in the Armed Forces in the United States
of America.
Second, section 51(d)(3)(A) of the IRC identifies and defines five categories of
veterans that comprise the second part of the Qualified Veteran definition.
Three of the categories for the Qualified Veteran target group are unchanged.
A Qualified Veteran is any veteran who is certified by a SWA as:
• Being a member of a family receiving assistance under the
Supplemental Nutrition Assistance Program (SNAP) for at least a
three-month period ending during the 12-month period, that ends
before the hiring date (section 51(d)(3)(A)(i)); or
• Entitled to compensation for a service-connected disability; and
o having a hiring date which is not more than one year after
discharge or release from active duty (section 51(d)(3)(A)(ii)(I)); or
o having aggregate periods of unemployment of six months or more
during the one-year period ending on the hiring date (section
51(d)(3)(A)(ii)(II)).
The VOW to Hire Heroes Act adds two new unemployed veteran categories
to the Qualified Veteran definition. For these categories, a Qualified Veteran
is any veteran who is certified by a SWA as:
• Having aggregate periods of unemployment of at least 4 weeks but
less than 6 months in the year prior to being hired (Section
51(d)(3)(A)(iii)).
• Having aggregate periods of unemployment of 6 months or more in
the year prior to being hired (section 51(d)(3)(A)(iv)).
Note 1. The Recovery Act unemployed veteran category is not the same as
the VOW Act unemployed veteran category, and the Recovery Act
unemployed veteran category has expired.
Note 2. The requirement that a veteran had been discharged or released
during the five-year period ending on the hiring day that was part of the
definition of the Recovery Act unemployed veteran category is not part of the
new unemployed veteran category authorized under the VOW Act.
8. Eligibility Determinations and Documentation Requirements. The
documentary evidence that can be used for eligibility certifications for the
Qualified Veteran target group and its new categories is provided below.
a) Veteran
For all of the categories in the amended and expanded veteran target group,
the following documentation can be used to determine that the individual
satisfies the definition of veteran:
• Form DD-214,
• Discharge papers, or
• Documentation for service-connected disability as described below.
b) Service-Connected Disability
The Department of Veterans Affairs (VA) stopped issuing Form Letter 21-802,
which had been used by SWAs to verify a “service-connected disability” for
the WOTC disabled veteran categories. SWAs should accept other
documentation that would verify that an individual is eligible to receive or is
receiving compensation for a “service-connected disability,” so long as these
documents are issued by the VA, are on agency letterhead or have an agency
stamp, and include a signature and contact information from the individual
at the agency who verified the disability information.
For example, the VA regularly issues letters to veterans after separation from
the Armed Forces indicating that the individual has a service-connected
disability for use in civil service preference or the receipt of benefits. If a
veteran does not have such a letter, he or she may contact the national VA call
center, at 1-800-827-1000, or his/her VA vocational rehabilitation counselor to
obtain the letter.
c) Periods of Unemployment
For the four-week unemployed veteran category, the six-month unemployed
veteran category, and the six-month unemployed disabled veteran category,
the following documentation can be used to verify the required periods of
aggregate unemployment:
• Unemployment Insurance (UI) claims records, or
• UI wage records.
9. Determination of Periods of Unemployment. As amended by the VOW Act,
IRC Section 51 contains five veterans categories described in more detail in
section 7 of this TEGL. Three of those categories relate to unemployment.
They are:
• A four-week unemployed veteran category
• A six-month unemployed veteran category
• A six-month unemployed disabled veteran category
For all three of these categories, SWAs will certify a veteran as having the
required aggregate periods of unemployment if the veteran received
unemployment compensation for the relevant length of time -- either at least
four weeks or at least six months. The required periods of unemployment do
not need to be continuous, and can be cumulative throughout the one-year
period preceding the hiring date. Therefore, receipt of unemployment
compensation does not need to be continuous, and can be any four weeks or
six months, respectively, in the one-year period before the hiring date.
UI claims records are the best source of documentation to verify that a
veteran received unemployment compensation. However, the Employment
and Training Administration (ETA) recognizes that despite being
unemployed, some veterans may not have received unemployment
compensation during the required four-week or six-month periods, but
nonetheless were unemployed during those periods. For example, an
individual may have been unemployed, but chose not to apply for
unemployment compensation; or an individual may have received
unemployment compensation, but has since exhausted those benefits.
Therefore, if unemployment cannot be verified through UI claims records,
then states also must us UI wage records to determine whether an individual
meets the unemployment criteria for the unemployed veteran or the disabled
unemployed veteran categories by verifying that there are no earnings in the
required time periods.
Most states maintain UI wage records on a quarterly basis. Regarding
quarterly UI wage records, it is not possible to determine whether an
individual is unemployed on a monthly or weekly basis by looking at that
individual’s wage records. Therefore, these states will only be able to verify
the periods of unemployment if an entire quarter of wage records indicates
no earnings. Specifically, section can determine whether a veteran meets the
required periods of unemployment as follows:
• For the four-week unemployed veteran category, a veteran meets the
unemployment criteria if there are no earnings in the individual’s
wage records in at least one of the quarters in the one-year period
prior to the hiring date.
• For the six-month unemployed veteran category and six-month
disabled veteran category, a veteran meets the unemployment criteria
if there are no earnings in the individual’s wage records in any two of
the quarters in the one-year period prior to the hiring date. The two
quarters of no earnings do not need to be continuous.
Some states maintain UI wage records on a weekly or monthly basis. These
states can determine whether a veteran meets the required periods of
unemployment as follows:
• For the four-week unemployed veteran category, a veteran meets the
unemployment criteria if there are no earnings in the individual’s
wage records for any month, or any four weeks, in the one-year period
prior to the hiring date. The four weeks of no earnings do not need to
be continuous.
• For the six-month unemployed veteran category and six-month
disabled veteran category, a veteran meets the unemployment criteria
if there are no earnings in the individual’s wage records for any six
months, or any 24 weeks, in the one-year period prior to the hiring
date. The six months or 24 weeks of no earnings do not need to be
continuous.
10. Accessing Unemployment Insurance Claims and Wage Records. SWAs will
need to use UI claims records and UI wage records to verify the required
periods of unemployment for veterans. SWAs must negotiate with their state
UI agency to determine the most efficient and effective way to access the UI
claims records and wage data. Claim and wage information is required to be
kept confidential by the state UI agency, and may only be disclosed under
certain circumstances. Regulations at 20 CFR 603.5(g) permit the disclosure of
unemployment compensation information “to a public official for use in the
performance of his or her official duties.”
Depending on the volume of anticipated requests and whether SWAs can
provide the state UI agency with an informed consent release, SWAs may
have to enter into a data exchange agreement. These agreements would
provide for safeguarding the claim and wage information, allow for
reimbursement of the costs to the UI agency, and include penalties for the
misuse or unauthorized redisclosure of the information.
Further, if the SWA anticipates a large volume of data requests, this
agreement with the state UI agency will include a description of the specific
information to be furnished, the purposes for which the information is
sought, and information on the method and timing of requests, as well as the
format to be used for the requests and responses.
To obtain information from the state UI agency, SWAs must provide a Social
Security Number for each participant for whom claim or wage data is sought.
In those instances where the SWA anticipates a large volume of requests for
data, the state UI agency may require that the request be made electronically.
If only a few requests for claim or wage data are anticipated, it may be easier
to obtain an informed consent release from the employee. State UI agencies
are not required to obtain reimbursement for providing the requested
information if the amount of staff time in responding to the request is
incidental and only nominal processing costs are involved in making the
disclosure. SWAs that choose to use informed consent releases from
employees will need to work with employers to ensure that informed consent
releases are collected at the time of hire. Because confidentiality laws vary by
state, SWAs should work with their state UI agencies to determine the
necessary form and content of the informed consent release.
11. ETA Program Forms. ETA has revised and updated all program processing,
administrative and reporting forms to reflect the amendments and new
provisions introduced by the VOW Act, as well as the expiration of the
Recovery Act target groups. A package seeking clearance of the forms and a
three-year extension, through December 31, 2015, has been submitted to the
Office of Management and Budget (OMB). Upon approval from OMB, ETA
will release the final forms.
To facilitate the processing job by the SWAs and the application process by
employers or their representatives, ETA is providing advanced drafts of ETA
Forms 9061, 9062, 9063, 9065 and 9058, stamped with the watermark
“SAMPLE” as Attachment I. These are unofficial forms, not to be used by the
SWAs or employers/representatives until final clearance by OMB. At that
time, ETA will issue a TEGL transmitting all program forms and related
procedural guidance for use of the approved forms. The revised ETA forms
will then be available at:
http://www.doleta.gov/business/incentives/opptax/forms.cfm. Until
forms are officially issued, SWAs and the business sector are to continue to
follow the interim instructions on filing forms that were released on
December 2, 2011 (for employers) and on quarterly reporting that were
released on December 27, 2011 (for SWAs), and both updated in April 2012.
12. IRS Form 8850. The IRS has updated IRS Form 8850, Pre-Screening Notice and
Certification Request for the Work Opportunity Tax Credit, and its instructions to
reflect the provisions introduced by the VOW Act. (The updated form and
instructions are available at: www.irs.gov/form8850.)
13. Transition Relief for Employer Submission of Form 8850. Section III of IRS
Notice 2012-13 provides employers with transition relief from the 28-day
timely filing requirement by providing additional time to file the pre-
screening notice, IRS Form 8850, with SWAs. Accordingly, an employer who
hires a qualified veteran on or after November 22, 2011 and before May 22,
2012 can satisfy the timely filing requirement if the employer submits IRS
Form 8850 along with ETA Form 9061 or Form 9062 to the SWA to request
certification not later than June 19, 2012. An employer that hires a qualified
veteran on or after May 22, 2012 and before January 1, 2013 must meet the
28-day timely filing requirement.
14. Qualified Tax-Exempt Organizations. Section 261(e) of the VOW Act also
makes WOTC available to “qualified tax-exempt organizations.” Specifically,
the Act provides that qualified tax-exempt organizations that hire qualified
veterans on or after November 22, 2011 and before January 1, 2013 may claim
a credit against the employer’s share of social security tax. A qualified tax-
exempt organization for purposes of the WOTC is an organization described
in IRC section 501(c) that is exempt from tax under IRC section 501(a). IRS
Notice 2012-13 provides detailed information on the use of WOTC by tax-
exempt organizations. Information on 501(c) organizations is available in the
IRS Publication 557, Tax-Exempt Status for Your Organization, available at:
http://www.irs.gov/pub/irs-pdf/p557.pdf.
15. Filing of Form 8850 with Electronic Signatures. Section IV of IRS Notice
2012-13 provides the following guidance on the filing of Form 8850 with
electronic signatures:
Before any employer may claim the WOTC for hiring any member of a targeted group
(or, for qualified tax-exempt organizations, the § 3111(e) credit for hiring a qualified
veteran), that individual must be certified by the [SWA] as a member of a targeted
group. Section 51(d)(13)(A)(ii)(II) requires that, not later than the 28th day after the
individual begins work for the employer, the employer submit a notice, signed by the
employer and the individual under penalties of perjury, to the [SWA] as part of a
written request for certification. For purposes of this Section IV, “employer” refers to
any employer required to submit a Form 8850 in order to obtain the WOTC under §
51 or the equivalent credit under § 3111(e), or an authorized representative of such
an employer.
Employers may submit Form 8850 to the [SWA] electronically if the employer’s
system satisfies the requirements in Ann. 2002-44, 2002-1 C.B. 809. This Notice
makes available to employers two alternative methods of certification using electronic
signatures in addition to the electronic submission of Form 8850 as provided in Ann.
2002-44. The alternative methods are available to any employer required to submit a
Form 8850 in order to obtain the WOTC for any member of any targeted group under
§ 51 or the equivalent credit under § 3111(e).
First, an employer may print out a paper copy of the Form 8850 that was signed
electronically by both the applicant and the employer in accordance with the
requirements of Ann. 2002-44, and transmit that paper copy to the [SWA] (by mail
or by facsimile following the rules in Section V of this notice).
Second, an employer may file Form 8850 using a method under which the applicant
signs electronically but the employer signs in ink. More specifically, the applicant
signs Form 8850 electronically and the Form 8850 is transmitted electronically to the
employer in accordance with the requirements detailed below. Once received and
printed out, the paper copy of the Form 8850 shows “signed electronically” in the
field for the applicant’s signature. The employer signs that paper copy of that Form
8850 in ink, complying with the signature and jurat requirements on Form 8850 and
the Form 8850 instructions for the paper copy of Form 8850, and transmits that
paper copy to the [SWA] (by mail or by facsimile following the rules in Section V of
this notice). Under this second alternative method, the employer must satisfy all five
of the following requirements with respect to the Form 8850 that is electronically
signed by the applicant:
(i) In General. The electronic system must ensure that the information received
is the information sent, and it must document all occasions of access that result
in the transmission of a Form 8850. In addition, the design and operation of the
electronic system, including access procedures, must make it reasonably certain
that the applicant signing the Form 8850, accessing the system, and submitting
the Form 8850 is the applicant identified in the form.
(ii) Same Information as Paper Form 8850. The electronically signed Form
8850 must provide the [SWA] with exactly the same information as the paper
Form 8850.
(iii) Jurat and Signature Requirements. The Form 8850 must be signed
electronically by the applicant under penalties of perjury.
(A) Jurat. The jurat (perjury statement) must contain the language that
appears on the paper Form 8850 for the applicant. The electronic system
must inform the applicant that he or she must make the declaration
contained in the jurat and that the declaration is made by signing the
Form 8850. The instructions and the language of the jurat must
immediately follow the information provided by the applicant, and must
immediately precede the applicant’s electronic signature.
(B) Electronic Signature. The electronic signature must (1) identify the
applicant whose name is on the Form 8850 and the employer submitting
the Form 8850, and (2) authenticate and verify the form. For this
purpose, the terms “authenticate” and “verify” have the same meaning as
they do when applied to a written signature on a paper Form 8850. An
electronic signature can be in any form that satisfies the foregoing
requirements.
(iv) Copies of Form 8850. The employer must be able to supply and, upon
request by the IRS, the employer must supply (1) a paper copy of the Form 8850
submitted to the [SWA], and (2) a statement that, to the best of the employer's
knowledge, the Form 8850 was submitted by the employer with respect to the
named applicant. The paper copy of the electronically signed Form 8850 must
provide exactly the same information as, but need not be a facsimile of, the paper
Form 8850.
(v) Retention of Forms 8850 by the [SWAs] and Employers. Forms 8850 with
an applicant’s electronic signature have the same status as paper Forms 8850.
Therefore, guidance that applies to paper Forms 8850 also applies to these
Forms 8850. For example, as is the case for paper Forms 8850, electronic Forms
8850 are required to be retained by employers under their established record-
keeping systems. For further information, see Rev. Proc. 98-25, 1998-1 C.B.
689, on information regarding the retention of records within an Automatic
Data Processing System.
For additional information, a copy of IRS Notice 2012-13 and Announcement
2002-44 are included as attachments to this guidance.
Note 1. The IRS instructions to Form 8850 also indicate that electronic filing
of Form 8850 is permitted and include a list of states equipped to receive the
form electronically at the time the instructions were published. However,
this list was not intended to limit electronic filing of Form 8850 to only those
states. SWAs may implement electronic filing as long as all of the
requirements in IRS Announcement 2002-44 and IRS Notice 2012-13 are met.
SWAs do not need prior approval from either ETA or the IRS for electronic
submission of Form 8850.
Note 2. The IRS guidance regarding filing of Form 8850 with electronic
signatures, as well as the alternative method of filing or signing by facsimile
addressed below, applies to all targets groups authorized under WOTC.
Therefore, when the non-veteran WOTC groups are re-authorized by
Congress, then this guidance will be applicable to those target groups as well.
16. Alternative Method of Filing or Signing Form 8850 – Filing or Signing by
Facsimile. Section V of IRS Notice 2012-13 provides the following guidance
on alternative methods of filing or signing Form 8850 by facsimile:
In addition to the electronic signature method of filing Form 8850 described in
Section IV [of IRS Notice 2012-13], the IRS will also allow the facsimile transmission
of applicant and employer signatures on a Form 8850 if the applicable [SWA] accepts
Form 8850 via facsimile, the applicant and employer intend the signatures on the
faxed copy to be their signatures for purposes of the document, and the requirements
of paragraphs (1) and (2) below are satisfied:
(1) Same Information as Paper Form 8850. The facsimile submission is a
reproduction of Form 8850 that provides the [SWA] with exactly the same
information as the paper Form 8850.
(2) Signature and Transmission Requirements. The Form 8850 is signed by the
applicant and the employer, under penalties of perjury, and transmitted to the
[SWA] in the following manner:
(i) An original Form 8850 is completed in paper copy and then signed in ink
by the applicant;
(ii) The original Form 8850, signed by the applicant, is delivered to the
employer either in person or by facsimile;
(iii) The employer signs in ink either the paper copy of Form 8850 that was
signed by the applicant or the facsimile of that paper copy; and
(iv) The employer mails or faxes the signed Form 8850 to the [SWA] within
the time prescribed by § 51(d)(13)(A)(ii) (or within the period authorized
under Section III of this notice).
For purposes of this Section V, “employer” refers to any employer required to submit
a Form 8850 in order to obtain the WOTC for any member of any targeted group
under § 51 or the equivalent credit under § 3111(e), or an authorized representative
of such an employer.
Note 1. SWAs may choose to accept the facsimile transmission of the Form
8850, but are not required to do so.
17. Action Requested. ETA requests SWA administrators to:
a) Provide this information to appropriate program staff, employers and
their representatives, participating agencies, and other interested partners;
b) Ensure that the SWAs and participating agencies administer the new
provisions and changes to the veteran groups in accordance with the
guidance in this TEGL, the Handbook, and sections 51, 52 and 3111(e) of
the IRC of 1986, as amended;
c) Remind SWAs and employers to wait for the TEGL transmitting the OMB
approved and final forms before using the new WOTC forms. During this
waiting period both SWAs and employers must follow the Interim
Instructions ETA released in December 2011 and updated in April 2012;
and
d) Ensure that state coordinators receive copies of the attached “sample”
forms, VOW legislation and IRS guidance notice.
18. Inquiries. Direct all questions to the appropriate Regional WOTC
Coordinator, whose names and contact information are available at:
http://www.doleta.gov/business/incentives/opptax/contacts.cfm.
19. Attachments.
• Attachment A. IRS Notice 2012-13
• Attachment B. Section 261 of the VOW to Hire Heroes Act of 2011, Title II,
Subtitle D, (P. L. 112-56), November 21, 2011
• Attachment C. Drafts of “SAMPLE” ETA Forms 9061, 9062, 9063, 9065 and
9058
• Attachment D. IRS Announcement 2002-44
Attachment 1: IRS Notice 2012-13 (https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL30-11aA.pdf).
Part III - Administrative, Procedural, and Miscellaneous
Section 51 - Work Opportunity Tax Credit; Section 52 – Special Rules;
Section 3111(e) – Credit for Employment of Qualified Veterans
Notice 2012-13
I. PURPOSE
This notice provides guidance on Returning Heroes and Wounded Warriors Work
Opportunity Tax Credits, included as § 261 of the VOW to Hire Heroes Act of 2011, Tit.
II, subtitle D, of Pub. L. No. 112-056 (Act), enacted on November 21, 2011. Section 261
of the Act amended §§ 51, 52, and 3111 of the Internal Revenue Code to provide a
credit for hiring certain qualified veterans. This notice also provides employers who hire
qualified veterans additional time beyond the 28-day deadline in § 51(d)(13) for
submitting Form 8850, Pre-screening Notice and Certification Request for the Work
Opportunity Credit, to Designated Local Agencies (DLAs).
This notice provides additional guidance on electronic signature and electronic
submission of Form 8850 and also informs all employers that the Internal Revenue
Service (IRS) will allow the signature and submission of Form 8850 by facsimile to
DLAs that choose to accept such submissions.
This notice also requests comments on alternative methods for certification of a
veteran as a qualified veteran described in clause (ii)(II), (iii), or (iv) of § 51(d)(3)(A),
II. BACKGROUND
Section 51 provides for a Work Opportunity Tax Credit (WOTC) for employers
who hire individuals who are members of targeted groups. An employer must obtain
certification that an individual is a targeted group member before the employer may
claim the credit. Certification of an individual’s targeted group status is obtained from a
DLA. A DLA is a State employment security agency established in accordance with 29
U.S.C. §§ 49-49n. An employer must submit Form 8850 to the DLA not later than the
28th day after the individual begins work for the employer.
The WOTC applies to certain wages paid or incurred by employers with respect
to a member of a targeted group. Prior to enactment of the Act, § 51(c)(4)(B) provided
that wages paid or incurred with respect to an individual who begins work for the
employer after December 31, 2011, are not taken into account for purposes of the
WOTC. Thus, the credit is not available with respect to wages for persons who begin
work after December 31, 2011, other than qualified veterans. The Act extended the
2
credit only with respect to qualified veterans who begin work for the employer on or
before December 31, 2012.
The Act amends § 51(d)(3) to add two new categories to the qualified veteran
targeted group. Under new § 51(d)(3)(A)(iii) and (iv), a qualified veteran is a veteran
certified as having aggregate periods of unemployment of at least 4 weeks but less than
6 months in the year prior to being hired or certified as having aggregate periods of
unemployment of 6 months or more in the year prior to being hired.
The amount of wages that an employer may take into account in computing the
credit differs for the various categories of qualified veterans. The Act amends
§ 51(b)(3), which provides the amount of qualified wages that an employer may take
into account in calculating the WOTC. Section 51(b)(3), as amended, provides that the
amount of qualified wages taken into account is limited to $6,000 per year in the case of
any individual who is a qualified veteran by reason of subsection (d)(3)(A)(i) (a veteran
certified as being a member of a family receiving assistance under a supplemental
nutrition assistance program under the Food and Nutrition Act of 2008 for at least a 3-
month period ending during the 12-month period ending on the hiring date) and
subsection (d)(3)(A)(iii) (a veteran certified as having aggregate periods of
unemployment of at least 4 weeks but less than 6 months in the year prior to being
hired); $12,000 per year in the case of any individual who is a qualified veteran by
reason of subsection (d)(3)(A)(ii)(I) (a disabled veteran who is certified as having a
hiring date which is not more than 1 year after discharge or release from active duty);
3
$14,000 per year in the case of any individual who is a qualified veteran by reason of
subsection (d)(3)(A)(iv) (a veteran certified as having aggregate periods of
unemployment of 6 months or more in the year prior to being hired); and $24,000 per
year in the case of any individual who is a qualified veteran by reason of subsection
(d)(3)(A)(ii)(II) (a disabled veteran who is certified as having aggregate periods of
unemployment of 6 months or more in the year prior to being hired).
The Act amends § 51(d)(13)(D) to provide that a veteran will be treated as being
certified as having the requisite aggregate period of unemployment by the DLA if the
veteran is certified as being in receipt of unemployment compensation for the applicable
period. The Act also allows the Secretary of the Treasury to provide, at the Secretary’s
discretion, alternative methods for certification of a veteran as a qualified veteran
described in clause (ii)(II), (iii), or (iv) of § 51(d)(3)(A).
The Act amends § 51(c)(4)(B) to extend the credit and allow an employer to
claim the WOTC for qualified wages paid or incurred by the employer to a qualified
veteran who begins work on or before December 31, 2012.
The Act also amends § 52 and § 3111 to make a credit available to “qualified tax-
exempt organizations” that hire qualified veterans for which the WOTC would have been
allowable under § 51 if the organization were not a qualified tax-exempt organization.
Specifically, the Act adds new § 3111(e), which permits qualified tax-exempt
4
organizations that hire qualified veterans on or after November 22, 2011, to claim a
credit against the employer share of social security tax imposed under § 3111(a).
The credit under § 3111(e)(1) is a credit against the tax imposed by § 3111(a) on
wages paid by the qualified tax-exempt organization with respect to employment of all
employees of the organization during the applicable period. Section 3111(e)(4) defines
the “applicable period” as the 1-year period beginning with the day the qualified veteran
begins work for the organization. The amount of the credit under § 3111(e) equals the
amount of the credit determined under § 51 (after application of the modifications under
§ 3111(e)(3)) with respect to wages paid to the qualified veteran during the applicable
period. However, under § 3111(e)(2), the aggregate amount allowed as a credit under
§ 3111(e) for all qualified veterans for any period with respect to which tax is imposed
under § 3111(a) cannot exceed the amount of the employer social security tax imposed
by § 3111(a) on all wages paid by the employer during such period.
As indicated above, the amount of the credit under § 3111(e) is determined
under § 51 but is subject to modifications under § 3111(e)(3). Specifically, § 3111(e)(3)
modifies the amount of the credit available to the qualified tax-exempt organization to
16.25 percent (rather than 25 percent) of the qualified first-year wages for the applicable
period if the veteran performs less than 400 hours but at least 120 hours of service, or
26 percent (rather than 40 percent) of the qualified first-year wages for the applicable
period if the veteran performs at least 400 hours of service for the qualified tax-exempt
organization. Further, to calculate the amount of the credit, the qualified tax-exempt
5
organization only takes into account the wages paid to a qualified veteran for services in
furtherance of activities related to the purpose or function constituting the basis of the
organization's exemption under § 501. For example, wages for services in an unrelated
trade or business (as defined in § 513) are not counted for purposes of the credit.
Although wages are defined for purposes of the WOTC under § 51 as wages under the
Federal Unemployment Tax Act, for purposes of the credit available to qualified tax-
exempt organizations under § 3111(e), the term “wages” refers to wages under the
Federal Insurance Contributions Act.
New § 3111(e)(5)(A) defines “qualified tax-exempt organization” as an employer
that is an organization described in § 501(c) and exempt from taxation under § 501(a).
Accordingly, an employer that is an agency or instrumentality of the federal government,
or of a state, local, or Indian tribal government, is not a qualified tax-exempt
organization unless it is an organization described in § 501(c) that is exempt from tax
under § 501(a).
The requirements for certification under § 51, as amended by the Act, apply to
qualified tax-exempt organizations as well as to taxable employers. Accordingly, a
qualified tax-exempt organization must obtain certification, as required under § 51, that
an individual is a qualified veteran before it may claim the credit. The transition relief,
guidance on filing Forms 8850 with electronic signatures, and allowance of signature
and submission of Form 8850 by facsimile provided for in this notice apply to all
employers, including qualified tax-exempt organizations.
6
III. TRANSITION RELIEF
Section 51(d)(13)(A) provides that an individual shall not be treated as a member
of a targeted group unless (1) on or before the day the individual begins work, the
employer obtains certification from the DLA that the individual is a member of a targeted
group; or (2) the employer completes a pre-screening notice (Form 8850) on or before
the day the individual is offered employment and submits such notice to the DLA to
request certification not later than 28 days after the individual begins work. Because the
credit, as amended, became effective on the day after enactment, the Treasury
Department and the IRS believe it is appropriate to provide employers with additional
time to file Form 8850 with a DLA. Accordingly, any employer who hires any qualified
veteran described in § 51(d)(3) on or after November 22, 2011, and before May 22,
2012, will be considered to satisfy the requirements of § 51(d)(13)(A)(ii) if the employer
submits the completed pre-screening notice to the DLA to request certification not later
than June 19, 2012.
IV. FILING OF FORM 8850 WITH ELECTRONIC SIGNATURES
Before any employer may claim the WOTC for hiring any member of a targeted
group (or, for qualified tax-exempt organizations, the § 3111(e) credit for hiring a
qualified veteran), that individual must be certified by the DLA as a member of a
targeted group. Section 51(d)(13)(A)(ii)(II) requires that, not later than the 28th day after
7
the individual begins work for the employer, the employer submit a notice, signed by the
employer and the individual under penalties of perjury, to the DLA as part of a written
request for certification. For purposes of this Section IV, “employer” refers to any
employer required to submit a Form 8850 in order to obtain the WOTC under § 51 or
the equivalent credit under § 3111(e), or an authorized representative of such an
employer.
Employers may submit Form 8850 to the DLA electronically if the employer’s
system satisfies the requirements in Ann. 2002-44, 2002-1 C.B. 809. This Notice
makes available to employers two alternative methods of certification using electronic
signatures in addition to the electronic submission of Form 8850 as provided in Ann.
2002-44. The alternative methods are available to any employer required to submit a
Form 8850 in order to obtain the WOTC for any member of any targeted group under
§ 51 or the equivalent credit under § 3111(e).
First, an employer may print out a paper copy of the Form 8850 that was signed
electronically by both the applicant and the employer in accordance with the
requirements of Ann. 2002-44, and transmit that paper copy to the DLA (by mail or by
facsimile following the rules in Section V of this notice).
Second, an employer may file Form 8850 using a method under which the
applicant signs electronically but the employer signs in ink. More specifically, the
applicant signs Form 8850 electronically and the Form 8850 is transmitted electronically
8
to the employer in accordance with the requirements detailed below. Once received
and printed out, the paper copy of the Form 8850 shows “signed electronically” in the
field for the applicant’s signature. The employer signs that paper copy of that Form
8850 in ink, complying with the signature and jurat requirements on Form 8850 and the
Form 8850 instructions for the paper copy of Form 8850, and transmits that paper copy
to the DLA (by mail or by facsimile following the rules in Section V of this notice). Under
this second alternative method, the employer must satisfy all five of the following
requirements with respect to the Form 8850 that is electronically signed by the
applicant:
(i) In General. The electronic system must ensure that the information
received is the information sent, and it must document all occasions of
access that result in the transmission of a Form 8850. In addition, the
design and operation of the electronic system, including access
procedures, must make it reasonably certain that the applicant signing the
Form 8850, accessing the system, and submitting the Form 8850 is the
applicant identified in the form.
(ii) Same Information as Paper Form 8850. The electronically signed
Form 8850 must provide the DLA with exactly the same information as the
paper Form 8850.
9
(iii) Jurat and Signature Requirements. The Form 8850 must be signed
electronically by the applicant under penalties of perjury.
(A) Jurat. The jurat (perjury statement) must contain the language that
appears on the paper Form 8850 for the applicant. The electronic system
must inform the applicant that he or she must make the declaration
contained in the jurat and that the declaration is made by signing the Form
8850. The instructions and the language of the jurat must immediately
follow the information provided by the applicant, and must immediately
precede the applicant’s electronic signature.
(B) Electronic Signature. The electronic signature must (1) identify the
applicant whose name is on the Form 8850 and the employer submitting
the Form 8850, and (2) authenticate and verify the form. For this purpose,
the terms “authenticate” and “verify” have the same meaning as they do
when applied to a written signature on a paper Form 8850. An electronic
signature can be in any form that satisfies the foregoing requirements.
(iv) Copies of Form 8850. The employer must be able to supply and,
upon request by the IRS, the employer must supply (1) a paper copy of
the Form 8850 submitted to the DLA, and (2) a statement that, to the best
of the employer's knowledge, the Form 8850 was submitted by the
employer with respect to the named applicant. The paper copy of the
10
electronically signed Form 8850 must provide exactly the same
information as, but need not be a facsimile of, the paper Form 8850.
(v) Retention of Forms 8850 by the DLAs and Employers. Forms 8850
with an applicant’s electronic signature have the same status as paper
Forms 8850. Therefore, guidance that applies to paper Forms 8850 also
applies to these Forms 8850. For example, as is the case for paper
Forms 8850, electronic Forms 8850 are required to be retained by
employers under their established record-keeping systems. For further
information, see Rev. Proc. 98-25, 1998-1 C.B. 689, on information
regarding the retention of records within an Automatic Data Processing
System.
V. ALTERNATIVE METHOD OF FILING OR SIGNING FORM 8850--FILING OR
SIGNING BY FACSIMILE
In addition to the electronic signature method of filing Form 8850 described in
Section IV, the IRS will also allow the facsimile transmission of applicant and employer
signatures on a Form 8850 if the applicable DLA accepts Form 8850 via facsimile, the
applicant and employer intend the signatures on the faxed copy to be their signatures
for purposes of the document, and the requirements of paragraphs (1) and (2) below
are satisfied:
11
(1) Same Information as Paper Form 8850. The facsimile submission is a
reproduction of Form 8850 that provides the DLA with exactly the same information as
the paper Form 8850.
(2) Signature and Transmission Requirements. The Form 8850 is signed by the
applicant and the employer, under penalties of perjury, and transmitted to the DLA in
the following manner:
(i) An original Form 8850 is completed in paper copy and then signed in ink by
the applicant;
(ii) The original Form 8850, signed by the applicant, is delivered to the employer
either in person or by facsimile;
(iii) The employer signs in ink either the paper copy of Form 8850 that was
signed by the applicant or the facsimile of that paper copy; and
(iv) The employer mails or faxes the signed Form 8850 to the DLA within the
time prescribed by § 51(d)(13)(A)(ii) (or within the period authorized under
Section III of this notice).
For purposes of this Section V, “employer” refers to any employer required to
submit a Form 8850 in order to obtain the WOTC for any member of any targeted group
12
under § 51 or the equivalent credit under § 3111(e), or an authorized representative of
such an employer.
VI. GUIDANCE FOR TAX-EXEMPT ORGANIZATIONS
Qualified tax-exempt organizations entitled to a credit under § 3111(e) must use
Form 5884-C, Work Opportunity Credit for Qualified Tax-Exempt Organizations Hiring
Qualified Veterans, to claim the credit. Although the credit under § 3111(e) is applied
against the employer social security tax liability for the employment tax period in which
the credit is claimed, the liability reported on the qualified tax-exempt organization’s
employment tax return (e.g., Form 941) is not reduced when that return is filed. Rather,
the IRS will process Form 5884-C separately and refund the amount properly claimed
on Form 5884-C to the qualified tax-exempt organization, subject to the limit of the
amount of employer social security tax liability for the period in which the credit is
claimed. Because Form 5884-C will generally not be processed simultaneously with the
qualified tax-exempt organization’s employment tax return, it is recommended that
qualified tax-exempt organizations not reduce their required deposits in anticipation of
any credit. A qualified tax-exempt organization that reduces its required employment
tax deposits in anticipation of a credit under § 3111(e) may receive a system-generated
notice; however, the balance due, including any related penalties and interest, resulting
from the reduction in deposits to reflect the credit under § 3111(e), will be abated when
the credit is applied, generally without any taxpayer action.
13
Form 5884-C is filed separately and should not be attached to any other return
filed by the qualified tax-exempt organization. Form 5884-C should be filed after the
qualified tax-exempt organization files its employment tax return for the tax period for
which the credit is claimed and in accordance with the Form 5884-C instructions. Form
5884-C can be filed immediately after the qualified tax-exempt organization files its
employment tax return and it must be filed within 2 years from the date the tax reported
on the employment tax return was paid, or 3 years from the date the employment tax
return was filed, whichever is later.
The qualified tax-exempt organization using Form 5884-C must calculate the
cumulative credit to which the qualified tax-exempt organization is entitled under
§ 3111(e) for all qualified veterans hired on or after November 22, 2011. The qualified
tax-exempt organization must reduce the cumulative credit by any credits claimed on
any Forms 5884-C filed for prior tax periods. The amount refunded will be limited to the
amount of employer social security tax reported on the employment tax return filed by
the qualified tax-exempt organization for the employment tax period for which the credit
is claimed. Any excess credit (i.e., any credit that exceeds the employer social security
tax for the period the credit is claimed) may be carried forward and will be included in
the qualified tax-exempt organization’s cumulative calculation on Form 5884-C filed for
a subsequent tax period to the extent provided in the instructions to Form 5884-C.
VII. REQUEST FOR COMMENTS
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The Treasury Department and the IRS request comments on alternative methods
for certification of a veteran as a qualified veteran described in § 51(d)(3) in addition to
the methods of signing and filing electronically or by facsimile described in this notice.
In particular, comments related to certification of a veteran as a qualified veteran
described in clause (ii)(II), (iii), or (iv) of § 51(d)(3)(A) are requested. Comments are
also requested on alternative methods of filing Form 8850. Comments must be
submitted by April 12, 2012. All materials submitted will be available for public
inspection and copying. Comments should be submitted to Internal Revenue Service,
CC:PA:LPD:RU (Notice 2012-13), Room 5203, PO Box 7604, Ben Franklin Station,
Washington, DC 20224. Submissions may also be hand-delivered Monday through
Friday between the hours of 8 a.m. and 4 p.m. to the Courier's Desk, 1111 Constitution
Avenue, NW, Washington, DC 20224, Attn: CC:PA:LPD:RU (Notice 2012-13), Room
5203. Submissions may also be sent electronically via the internet to the following
email address: [email protected]. Include the notice number
(Notice 2012-13) in the subject line.
VIII. EFFECT ON OTHER DOCUMENTS
This Notice supplements Ann. 2002-44, 2002-1 C.B. 809.
EFFECTIVE DATE
Amendments made to § 51, § 52, and § 3111 by the Act are effective for
individuals who begin work for the employer on or after November 22, 2011. As
15
described in Section III, any employer who hires any qualified veteran described in
§ 51(d)(3) on or after November 22, 2011, and before May 22, 2012, will be considered
to satisfy the requirements of § 51(d)(13)(A)(ii) if the employer submits the completed
pre-screening notice to the DLA to request certification not later than June 19, 2012.
The alternative methods of signing and filing Forms 8850, as described in Sections IV
and V, are effective for Forms 8850 filed with a DLA on or after March 10, 2012.
DRAFTING INFORMATION
The principal authors of this notice are Robin Ehrenberg and Ligeia Donis of the
Office of Division Counsel/Associate Chief Counsel (Tax Exempt and Government
Entities). For further information on the submission of comments or the comments
submitted, contact Regina Johnson at (202) 622-7180 (not a toll-free number). For
further information regarding the WOTC for qualified veterans, electronic filing, and
facsimile submissions, contact Ms. Ehrenberg at (202) 622-6080 (not a toll-free
number). For further information on how to claim the WOTC on behalf of tax-exempt
organizations, contact Ligeia Donis at (202) 622-6040 (not a toll-free number).
16
Attachment 2: Section 261 of the VOW to Hire Heroes Act of 2011 (https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL30-11aB.pdf).
ATTACHMENT B
Public Law 112-56, November 21, 2011.
The Vow to Hire Heroes Act of 2011
Subtitle E—Other Matters
SEC. 261. RETURNING HEROES AND WOUNDED WARRIORS WORK
OPPORTUNITY TAX CREDITS.
(a) IN GENERAL.—Paragraph (3) of section 51(b) of the Internal Revenue Code of 1986 is amended by
striking ‘‘($12,000 per year in the case of any individual who is a qualified veteran by reason
of subsection (d)(3)(A)(ii))’’and inserting ‘‘($12,000 per year in the case of any individual who is a
qualified veteran by reason of subsection (d)(3)(A)(ii)(I), $14,000 per year in the case of any individual
who is a qualified veteran by reason of subsection (d)(3)(A)(iv), and $24,000 per year in the case of any
individual who is a qualified veteran by reason of subsection (d)(3)(A)(ii)(II))’’.
(b) RETURNING HEROES TAX CREDITS.—Subparagraph (A) of section 51(d)(3) of the Internal Revenue Code
of 1986 is amended—
(1) by striking ‘‘or’’ at the end of clause (i),
(2) by striking the period at the end of clause (ii)(II), and
(3) by adding at the end the following new clauses:
‘‘(iii) having aggregate periods of unemployment during the 1-year period ending on the hiring date
which equal or exceed 4 weeks (but less than 6 months), or
‘‘(iv) having aggregate periods of unemployment during the 1-year period ending on the hiring date
which equal or exceed 6 months.’’.
(c) SIMPLIFIED CERTIFICATION.—Paragraph (13) of section 51(d) of the Internal Revenue Code of 1986 is
amended by adding at the end the following new subparagraph:
‘‘(D) CREDIT FOR UNEMPLOYED VETERANS.—
‘‘(i) IN GENERAL.—Notwithstanding subparagraph
(A), for purposes of paragraph (3)(A)—
‘‘(I) a veteran will be treated as certified by the designated local agency as having aggregate
periods of unemployment meeting the requirements of clause (ii)(II) or (iv) of such paragraph
(whichever is applicable) if such veteran is certified by such agency as being in receipt of unemployment
compensation under State or Federal law for not less than 6 months during the 1-year period
ending on the hiring date, and
‘‘(II) a veteran will be treated as certified by the designated local agency as having aggregate
periods of unemployment meeting the requirements of clause (iii) of such paragraph if such
veteran is certified by such agency as being in receipt of unemployment compensation under
State or Federal law for not less than 4 weeks (but less than 6 months) during the 1-year period
ending on the hiring date.
‘‘(ii) REGULATORY AUTHORITY.—The Secretary may provide alternative methods for certification of a
veteran as a qualified veteran described in clause (ii)(II),
(iii), or (iv) of paragraph (3)(A), at the Secretary’s discretion.’’.
(d) EXTENSION OF CREDIT.—Subparagraph (B) of section 51(c)(4) of the Internal Revenue Code of 1986 is
amended to read as follows:
‘‘(B) after—
ATTACHMENT B
‘‘(i) December 31, 2012, in the case of a qualified veteran, and
‘‘(ii) December 31, 2011, in the case of any other individual.’’.
(e) CREDIT MADE AVAILABLE TO TAX-EXEMPT ORGANIZATIONS
IN CERTAIN CIRCUMSTANCES.—
(1) IN GENERAL.—Subsection (c) of section 52 of the Internal Revenue Code of 1986 is amended—
(A) by inserting ‘‘(1) IN GENERAL.—’’ before ‘‘No credit’’, and
(B) by adding at the end the following new paragraph:
‘‘(2) CREDIT MADE AVAILABLE TO QUALIFIED TAX-EXEMPT ORGANIZATIONS EMPLOYING QUALIFIED
VETERANS.—For credit against payroll taxes for employment of qualified veterans by qualified
tax-exempt organizations, see section 3111(e).’’.
(2) CREDIT ALLOWABLE.—Section 3111 of such Code is amended by adding at the end the following new
subsection:
‘‘(e) CREDIT FOR EMPLOYMENT OF QUALIFIED VETERANS.—
‘‘(1) IN GENERAL.—If a qualified tax-exempt organization hires a qualified veteran with respect to whom a
credit would be allowable under section 38 by reason of section 51 if the organization were not a qualified
tax-exempt organization, then there shall be allowed as a credit against the tax imposed by subsection (a)
on wages paid with respect to employment of all employees of the organization during the applicable
period an amount equal to the credit determined under section 51 (after application of the modifications
under paragraph (3))with respect to wages paid to such qualified veteran during
such period.
‘‘(2) OVERALL LIMITATION.—The aggregate amount allowed as a credit under this subsection for all
qualified veterans for any period with respect to which tax is imposed under subsection (a) shall not exceed
the amount of the tax imposed by subsection (a) on wages paid with respect to employment
of all employees of the organization during such period.
‘‘(3) MODIFICATIONS.—For purposes of paragraph (1), section 51 shall be applied—
‘‘(A) by substituting ‘26 percent’ for ‘40 percent’ in subsection (a) thereof,
‘‘(B) by substituting ‘16.25 percent’ for ‘25 percent’ in subsection (i)(3)(A) thereof, and
‘‘(C) by only taking into account wages paid to a qualified veteran for services in furtherance of the
activities related to the purpose or function constituting the basis of the organization’s exemption under
section 501.
‘‘(4) APPLICABLE PERIOD.—The term ‘applicable period’ means, with respect to any qualified veteran, the
1-year period beginning with the day such qualified veteran begins work for the organization.
‘‘(5) DEFINITIONS.—For purposes of this subsection—
‘‘(A) the term ‘qualified tax-exempt organization’ means an employer that is an organization described in
section 501(c) and exempt from taxation under section 501(a), and
‘‘(B) the term ‘qualified veteran’ has meaning given such term by section 51(d)(3).’’.
(3) TRANSFERS TO FEDERAL OLD-AGE AND SURVIVORS INSURANCE TRUST FUND.—There are hereby appropriated
to the Federal Old-Age and Survivors Trust Fund and the Federal Disability Insurance Trust Fund
established under section 201 of the Social Security Act (42 U.S.C. 401) amounts equal to the reduction in
revenues to the Treasury by reason of the amendments made by paragraphs (1) and (2). Amounts
appropriated by the preceding sentence shall be transferred from the general fund at such times and in such
manner as to replicate to the extent possible the transfers which would have occurred to such Trust Fund
had such amendments not been enacted.
(f) TREATMENT OF POSSESSIONS.—
(1) PAYMENTS TO POSSESSIONS.—
ATTACHMENT B
(A) MIRROR CODE POSSESSIONS.—The Secretary of the Treasury shall pay to each possession of the United
States with a mirror code tax system amounts equal to the loss to that possession by reason of the
amendments made by this section. Such amounts shall be determined by the Secretary of the Treasury
based on information provided by the government of the respective possession of the United States.
(B) OTHER POSSESSIONS.—The Secretary of the Treasury shall pay to each possession of the United States
which does not have a mirror code tax system the amount estimated by the Secretary of the Treasury as
being equal to the loss to that possession that would have occurred by reason of the amendments made by
this section if a mirror code tax system had been in effect in such possession.
The preceding sentence shall not apply with respect to any possession of the United States unless such
possession establishes to the satisfaction of the Secretary that the possession has implemented (or, at the
discretion of the Secretary, will implement) an income tax benefit which is substantially equivalent to the
income tax credit in effect after the amendments made by this section.
(2) COORDINATION WITH CREDIT ALLOWED AGAINST UNITED STATES INCOME TAXES.—The credit allowed
against United States income taxes for any taxable year under the amendments made by this section to
section 51 of the Internal Revenue Code of 1986 to any person with respect to any qualified veteran shall
be reduced by the amount of any credit (or other tax benefit described in paragraph (1)(B)) allowed to such
person against income taxes imposed by the possession of the United States by reason of this subsection
with respect to such qualified veteran for such taxable year.
(3) DEFINITIONS AND SPECIAL RULES.—
(A) POSSESSION OF THE UNITED STATES.— For purposes of this subsection, the term ‘‘possession of the
United States’’ includes American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the
Commonwealth of Puerto Rico, and the United States Virgin Islands.
(B) MIRROR CODE TAX SYSTEM.—For purposes of this subsection, the term ‘‘mirror code tax system’’ means,
with respect to any possession of the United States, the income tax system of such possession if the income
tax liability of the residents of such possession under such system is determined by reference to the income
tax laws of the United States as if such possession were the United States.
(C) TREATMENT OF PAYMENTS.—For purposes of section 1324(b)(2) of title 31, United States Code, the
payments under this subsection shall be treated in the same manner as a refund due from credit provisions
described in such section.
(g) EFFECTIVE DATE.—The amendments made by this section shall apply to individuals who begin work for
the employer after the date of the enactment of this Act.
Attachment 3: Sample ETA WOTC forms (https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL30-11aC.pdf).
ATTACHMENT C
U.S. Department Labor OMB No. 1205-0371
Employment and Training Administration Expiration Date: April 30, 2012
Individual Characteristics Form (ICF)
Work Opportunity Tax Credit
1. Control No. (For Agency use only) 2. Date Received (For Agency Use only)
APPLICANT INFORMATION
(See instructions on reverse)
EMPLOYER INFORMATION
3. Employer Name 4. Employer Address and Telephone 5. Employer Federal ID Number (EIN)
APPLICANT INFORMATION
6. Applicant Name (Last, First, MI) 7. Social Security Number 8. Have you worked for this employer
before? Yes ____ No ____
If YES, enter last date of
employment: ____________
APPLICANT CHARACTERISTICS FOR WOTC TARGET GROUP CERTIFICATION
9. Employment Start Date 10. Starting Wage 11. Position
12. Are you at least age 16, but under age 40? Yes ___ No ___
SAMPLE
If YES, enter your date of birth _____________________
13. Are you a Veteran of the U.S. Armed Forces? Yes ___ No ___
If NO, go to Box 14.
If YES, are you a member of a family that received Supplemental Nutrition Assistance
Program (SNAP) benefits (Food Stamps) for at least 3 months during the 15 months
before you were hired? Yes ___ No ___
If YES, enter name of primary recipient _______________________ and
city and state where benefits were received _________________.
OR, are you a veteran entitled to compensation for a service-connected disability? Yes ___ No ___
If YES, were you discharged or released from active duty within a year before you were hired? Yes ___ No ___
OR, were you unemployed for a combined period of at least 6 months (whether or not
consecutive) during the year before you were hired? Yes ___ No ___
14. Are you a member of a family that received Supplemental Nutrition Assistance Program
(SNAP) benefits (Food Stamps) for the 6 months before you were hired? Yes ___ No___
OR, received Food Stamps for at least a 3-month period within the last 5 months
But you are no longer receiving them? Yes ___ No___
If YES to either question, enter name of primary recipient _____________________
And city and state where benefits were received _____________________.
15. Were you referred to an employer by a Vocational Rehabilitation Agency approved by
a State? Yes ___ No___
OR, by an Employment Network under the Ticket to Work Program? Yes ___ No___
OR, by the Department of Veterans Affairs? Yes ___ No___
1 ETA Form 9061 – (Rev. February 2012)
16. Are you a member of a family that received TANF assistance for at least the last 18 months
before you were hired? Yes___ No___
OR, are you a member of a family that received TANF benefits for any 18 months beginning
after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended
within 2 years before you were hired? Yes___ No___
OR, did your family stop being eligible for TANF assistance within 2 years before you were hired
because a Federal or state law limited the maximum time those payments could be made? Yes___No___
If NO, are you a member of a family that received TANF assistance for any 9 months during
the 18-month period before you were hired? Yes___No___
If YES, to any question, enter name of primary recipient ________________________ and
the city and state where benefits were received _________________________.
17. Were you convicted of a felony or released from prison after a felony conviction during
the year before you were hired?
SAMPLE
If YES, enter date of conviction ________________ and date of release _________________.
Yes___No___
Was this a Federal ____ or a State conviction_____? (Check one)
18. Do you live in a Empowerment Zone or Rural Renewal Community? Yes___No ___
19. Did you receive Supplemental Security Income (SSI) benefits for any month ending within
60 days before you were hired? Yes___ No___
20. Are you an Unemployed Veteran who served on active duty (other than active duty for training)
in the Armed Forces of the United States for a period of more than 180 days? Yes___ No___
OR were you discharged or released from active duty in the Armed Forces for a
service-disconnected disability? Yes___ No___
If YES, were you discharged or released from active duty at any time during the 5-year ending
on the hiring date? Yes___ No___
If YES, did you receive unemployment compensation for not less than four weeks during the
One-year period ending on the hiring date? Yes___ No___
21. Are you a member of the Disconnected Youth group because you are at least age 16 but
under age 25? and Yes___ No___
Not regularly attending any secondary, technical, or post-secondary school during the 6-month
period before your hiring date? and Yes___ No___
Not regularly employed (other than occasionally) during that 6-month period? and Yes___ No___
Not employable for lacking a sufficient number of basic skills? Yes___ No___
20. Are you a veteran unemployed for a combined period of at least 6 months (whether or not
consecutive) during the year before you were hired? Yes___ No___
21. Are you a veteran unemployed for a combined period of at least 4 weeks but less than 6 months (whether or not
consecutive) during the year before you were hired? Yes___ No___
22. Sources used to document eligibility: (Employers/Consultants: List all documentation provided or forthcoming. SWAs:
List all documentation used in determining target group eligibility and enter your initials and date when determination was made.)
I certify that this information is true and correct to the best of my knowledge. I understand that the
information above may be subject to verification.
23(a). Signature: (See instructions for Box 21 for who signs this 23. (b) Indicate with a who signed the 24. Date:
signature block) form:
Employer, Consultant, SWA,
Participating Agency, Applicant, or
Parent/Guardian (if applicant is a
minor)
2 ETA Form 9061 – (Rev. February 2012)
INSTRUCTIONS FOR COMPLETING THE INDIVIDUAL CHARACTERISTICS FORM (ICF), ETA 9061. This form is used together with IRS Form 8850 to
help state workforce agencies (SWAs) determine eligibility for the Work Opportunity Tax Credit (WOTC) Program. The form may be completed, on behalf of
the applicant, by: 1) the employer or employer representative, the SWA, a participating agency, or 2) the applicant directly (if a minor, the parent or guardian
must sign the form) and signed by the individual completing the form. This form is required to be used, without modification, by all employers (or their
representatives) seeking WOTC certification. Every certification request must include an IRS Form 8850 and an ETA Form 9061 or 9062, if a Conditional
Certification was issued to the individual pre-certifying the new hire as “eligible” under the requested tart group.
Boxes 1 and 2. SWA. For agency use only.
Boxes 3-5. Employer Information. Enter the name, address including ZIP code, telephone number, and employer Federal ID number (EIN) of the
employer requesting the certification for the WOTC. Do not enter information pertaining to the employer’s representative, if any.
Boxes 6-11. Applicant Information. Enter the applicant’s name and social security number as they appear on the applicant’s social security
card. In Box 8, indicate whether the applicant previously worked for the employer, and if Yes, enter the last date or approximate last
date of employment. This information will help the “48-hour” reviewer to, early in the verification process, eliminate requests for
former employees and to issue denials to these type of requests, or certifications in the case of “qualifying rehires” during valid
“breaks in employment” (see pages III-12 and III-13, Nov. 2002, Third Ed., ETA Handbook 408) during the first year of employment.
Boxes 12-21. Applicant Characteristics. Read questions carefully, answer each question, and provide additional information where requested.
Box 22 Sources to Document Eligibility. The applicant or employer is requested to provide documentary evidence to substantiate the YES answers in
Boxes 12 through 21. List or describe the documentary evidence that is attached to the ICF or that will be provided to the SWA. Indicate in
parentheses next to each document listed whether it is attached (A) or forthcoming (F). Some examples of acceptable documentary evidence are
provided below. A letter from the agency that administers a relevant program may be furnished specifically addressing the question to which the
applicant answered YES. For example, if an applicant answers YES to either question in Box 14 and enters the name of the primary recipient and the
city and state in which the benefits were received, the applicant could provide a letter from the appropriate Food Stamp agency stating to whom Food
Stamp benefits were paid, the months for which they were paid, and the names of the individuals included on the grant for each month. SWAs will
use this box to document the sources used when verifying target group eligibility, followed by their initials and the date the determination was
completed.
Examples of Documentary Evidence and Collateral Contacts. Employers/Consultants: You may check with
your SWA to find out what other sources you can use to prove target group eligibility. (You are encouraged to provide
copies of documentation or names of collateral contacts for each question for which you answered YES.)
3
QUESTION 12 QUESTION 17
Birth Certificate
Driver’s License
SAMPLE Parole Officer’s Name or Statement
1 Correction Institution Records
School I.D. Card Court Records Extracts
1
Work Permit
1
Federal/State/Local Gov’t I.D. QUESTION 18
Copy of Hospital Record of Birth
Driver’s License
QUESTION 13 Work Permit
Utility Bills
DD-214 or Discharge Papers W-4
Reserve Unit Contacts Lease Papers
Letter Issued Only by the Department of Veterans Affairs (VA) on Library Card
2
DVA Letterhead Certifying the Veteran Has a Service-Connected
Voter Registration Card
Disability.
SNAP (Food Stamp) Award Letter
Selective Service Registration Card
To determine if a Designated Community Resident lives in
QUESTIONS 14 & 16
a RRC, visit the site: www.usps.com. Click on Find Zip
TANF/SNAP (Food Stamp) Benefit History Code; Enter & Submit Address/Zip Code; Click on
Signed Statement from Authorized Individual with Specific Mailing Industry Information; Download and Print the
Description of the Months Benefits Were Received Information, then compare the county of the address to
Case Number Identifier the list in the Jan. 2012 Instructions to IRS 8850.
QUESTION 19
QUESTION 15
SSI Record or Authorization
Vocational Rehabilitation Agency Contact SSI Contact
Veterans Administration for Disabled Veterans Evidence of SSI Benefits
Signed Letter from Authorized Individual in DVA Letter
Head with Specific Description of Months Benefits Notes. 1. Where a Federal/State/Local Gov’t., School I.D. Card, or Work Permit
Received does not contain age or birth date, another valid document must be obtained to
verify an individual’s age.
For SWAs: To determine Ticket Holder (TH) eligibility, 2. Where a Library Card does not contain the holder’s address, another document
Fax page 1 of Form 8850 to MAXIMUS at 703-683-1051 to issued i showing the jurisdiction where the RRC is located must be obtained showing the
verify if applicant: 1) is a TH, and 2) has an Individual Work holder’s address.
Plan from an Employment Network. 3. ESPL No. 05-98, dated 3/18/98, officially rescinded the authority to use Form I-9
as proof of age and residence. Therefore, the I-9 is no longer a valid
piece of documentary evidence.
3 ETA Form 9061 – (Rev. February 2012)
QUESTIONS 20 and 21
Unemployment Insurance (UI) Claims Records
UI Wage Records
_________________________________________________________________________________________________________________________________
Box 23. Signature. The person who completes the form signs the signature block. Options: (a) Employer or Authorized Representative, (b) SWA staff,
(c) Participating Agency staff, or (d) Applicant (If applicant is a minor, the parent or guardian must sign).
Box 24. Date. Enter the month, day and year when the form was completed.
Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. Respondent’s obligation to reply to these
questions is required to obtain and retain benefits per law 104-188. Public reporting burden for this collection of information is estimated to average 20 minutes per
response including the time for reading instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to the U.S.
Department of Labor, Employment and Training Administration, Division of National Programs, Tools, and Technical Assistance, 200 Constitution Ave., NW,
SAMPLE
Room C-4510, Washington, D.C. 20210 (Paperwork Reduction Project Control No. 1205-0371).
………………………………………………………………………………………………………………………………………………………………………………......
(Cut along dotted line and keep in your files)
TO: THE JOB APPLICANT OR EMPLOYEE,
Privacy Act Statement: The Internal Revenue Code of 1986, Section 51, as amended and its enacting
legislation, P.L. 104-188, specify that the State Workforce Agencies are the "designated" agencies
responsible for administering the WOTC certification procedures of this program. The information you have
provided completing this form will be disclosed by your employer to the State Workforce Agency. Provision
of this information is voluntary. However, the information is required for your employer to receive the
federal tax credit. IF THE INFORMATION YOU PROVIDE IS ABOUT A MEMBER OF YOUR FAMILY,
YOU SHOULD PROVIDE HIM/HER A COPY OF THIS NOTICE.
4 ETA Form 9061 – (Rev. February 2012)
ATTACHMENT C
Individual Characteristics Form (ICF) U.S. Department of Labor
Work Opportunity Tax Credit Employment and Training Administration
1. Numero de Control (Para uso de SPANISH VERSION OMB No. 1205-0371
la Agencia solamente) Fecha de Expiración: April 30, 2012
Información del Solicitante 2. Fecha en que la información fue
recibida.
(Esta forma en Español NO es la oficial.
Úsela solo para familiarizarse con las
preguntas. Luego conteste, firme, y
feche la forma en Ingles)
INFORMACION DEL PATRONO
3. Nombre del Patrono 4. Dirección y Teléfono del Patrono 5. Numero Federal ID (EIN)
(Patrono)
INFORMACION DEL SOLICITANTE
6. Nombre del Solicitante (Apellido, 7. Numero Seguro Social: 8. Ha trabajado para este patrono
Primer, Inicial) antes?
Si ____ No ____
Si contesta Si provea la fecha de
su ultimo empleo:
_____________________
REQUISITOS QUE HACEN AL SOLICITANTE ELEGIBLE PARA CERTIFICACION BAJO WOTC
9. Fecha en que comenzó a 10. Salario: 11. Posicion/Titulo:
Trabajar:
12. Tiene Ud., por lo menos 16 años, pero es menor de 40? Si ___ No ___
SAMPLE
Si contesta SI, provea su fecha de nacimiento: _____________________
13. Es Ud. un Veterano de las Fuerzas Armadas de los Estados Unidos de América (USA)? Si ___ No ___
Si contesta NO, llene el encasillado 14.
Si contesta SI, es Ud. miembro de una familia que recibió beneficios de “Pan y Trabajo”
(Aplica a Puerto Rico solamente o que recibió Cupones para Alimentos (Programa
Suplementario de Asistencia Nutricional (SNAP) (o sea Food Stamps) por
lo menos por 3 mese durante los 15 meses antes de ser empleado? Si ___ No___
Si contesta SI, provea nombre del beneficiario principal _______________________ y
el nombre de la ciudad/estado donde recibió los beneficios _________________,
O, es Ud. un Veterano con derecho a beneficios por Incapacidad Física relacionados con
su servicio militar? Si ___ No ___
Si contesta SI, fue Ud. dado de baja del servicio activo militar un año antes de ser empleado? Si ___ No ___
O, estuvo Ud. desempleado por un periodo de por lo menos 6 meses durante el año antes
de ser empleado? Si ___ No ___
14. Es Ud. miembro de una familia que recibió beneficios bajo el Programa Pan y Trabajo (en P.R.)
o beneficios bajo el Programa Suplementario de Asistencia Nutricional (SNAP) Cupones
de Alimento (o sea Food Stamps) durante los 6 meses antes de ser empleado? Si ___ No___
O, recibió beneficios bajo el programan SNAP (Cupones de Alimentos) por un periodo de
3 meses durante los 5 meses antes de ser empleado pero ya no recibe estos beneficios? Si ___ No ___
Si contesta SI, a cualquiera de las preguntas, provea el nombre del
beneficiario principal ________________________ y la ciudad/estado donde los beneficios
fueron recibidos____________________________.
Ciudad/Estado
Pagina 1 de 2 ETA Forma 9061 (Rev. Aug. 2009)
Individual Characteristics Form (ICF) U.S. Department of Labor
Work Opportunity Tax Credit Employment and Training Administration
(Continuacion) SPANISH VERSION
15. Fue Ud. referido a un patrono por una Agencia de Rehabilitación Vocacional Estatal? Si___ No ___
O, por un “Employment Network” bajo el programa “Ticket to Work” del Seguro Social? Si___ No ___
O, por el Departamento de Asuntos del Veterano? Si___ No ___
16. Es Ud., miembro de una familla que recibió asistencia TANF por lo menos en los últimos
18 meses antes de ser empleado? Si ___ No ___
O, es Ud. miembro de una familia que recibió asistencia TANF por cualquier periodo de
18 meses comenzando estos beneficios después del 5 de agosto de 1997, y el ultimo periodo
de 18 meses que comenzó después del 5 de agosto de1997, termino 2 años antes de Ud. ser empelado?
Si ___ No ___
O, su familia no cualificó para asistencia TANF durante 2 años antes de ser empleado pero
una ley Federal o estatal limito el período máximo para Ud. recibir esos pagos? Si ___ No ___
Si contesta No, es Ud., miembro de una familia que recibió asistencia TANF por 9 meses
durante los 18 meses antes de ser empleado? Si ___ No ___
Si contesta Si, provea el nombre del beneficiario principal _________________________
Nombre
y el nombre de la ciudad/estado donde los beneficios fueron recibidos ___________________________.
Ciudad/Estado
17. Fue Ud. convicto por un delito o violación a la ley y puesto en libertad después de la
encarcelación durante el año antes de Ud. ser empleado? Si___ No ___
SAMPLE
Si contesta SI, provea la fecha de apresamiento (o encarcelación) __________________ y
la fecha de excarcelación (o cuando fue puesto en libertad) _________________________.
Indique con un () si esta fue una convicción Federal ____ o Estatal ____.
18. Vive Ud. en un “Empowerment Zone” o “Renewal Community?” Si ___ No ___
O, en un “Rural Renewal County (RRC) o Condado?” Si ___ No ___
Si contesta SI, provea el nombre del RRC _________________________.
Nombre del RRC
19. Recibió Ud. beneficios de “Supplemental Security Income (SSI)” por cualquier mes que
termino 60 días antes de ser empleado? Si ___ No ___
20. Es Ud., un Veterano Desempleado que estuvo en servicio activo militar (excepto servicio
activo para adiestramiento) en las Fuerzas Armadas de los Estados Unidos de America (EUA)
por un periodo mayor de 180 días? Si ___ No ___
O, fue dado de baja del servicio activo militar de las Fuerzas Armadas de los EUA debido a
una Incapacidad Física como resultado de su servicio militar? Si ___ No ___
Si contesto SI, fue Ud., dado de baja del servicio activo militar de las Fuerzas Armadas de
los EUA en cualquier fecha durante un periodo de 5 años antes de ser empleado? Si ___ No ___
Si contestó SI, recibió Ud., beneficios por desempleo (UI) por un periodo no menor de 4
semanas durante el año inmediatamente antes de ser empleado? Si ___ No ___
21. Es Ud., miembro del grupo de Jóvenes Desconectados (Disconnected Youth) porque tiene
por lo menos 16 años de edad pero menos de 25? Si ___ No ___
Si contestaste SI, no has ido regularmente a ninguna escuela secundaria, técnica,
o post-secundaria durante un periodo de 6-meses antes de la fecha en que fuiste empleado? Si ___ No ___
Si contestaste SI, no has sido empleado regularmente (excepto ocasionalmente) durante
dicho periodo de 6 meses, Y Si ___ No ___
Si contestaste SI, no eres candidato para ser empleado debido a que no tienes las destrezas
laborables necesarias? Si ___ No ___
20. Es Ud., un Veterano y ha estado desempleado por un período combinado de 6 meses (consecutivos o no)
durante el año inmediatamente antes de ser empleado? Si___ No___
21. Es Ud., un Veterano y ha estado desempleado por un periodo combinado de, por lo menos, 4 semanas pero
menos de 6 meses durante el año inmediatamente antes de ser empleado? Si___ No___
Pagina 2 de 2 (Rev. Aug. 2009)
______________________________________________________________________________________________
20. Evidencia para documentar elegibilidad: (Patronos: Favor nombrar los documentos que envió con esta forma o los que
enviara luego. SWAs: indiquen los documentos que usaron para determinar si el individuo es elegible o no. Entre sus iniciales y la
fecha en que completo esta determinación) SAMPLE
Pregunta 13:
Carta Recibida de la Administración de Veteranos (VA) Con Información Sobre Incapacidad Física (Ej.
Compensación o Beneficios) Debido Al Servicio Militar. Debe tener el membrete oficial de VA y estar debidamente
firmada por personal oficial.
Patrono o Veterano:
Documentación necesaria para corroborar su estado como Veterano Desempleado durante el periodo requerido:
Preguntas 20 y 21.
Expedientes de Reclamo Beneficios por Desempleo (UI)
Expedientes de Salario, Unidad de Beneficios por Desempleo (UI)
Certifico que esta información es verídica y correcta y entiendo que dicha información esta sujeta a verificación .
21. Firma: (Vea instrucciones en Ingles para saber quien firma 21. (b) Indique con un quien firmo la forma: 22. Fecha:
este encasillado) Patrono, Representante, SWA,
Agencia Participante, Solicitante, o
Padre/Guardián (si el solicitante es menor de edad)
Pagina 3 de 3 ETA Form 9061 (Rev. February 2012)
ATTACHMENT C
U.S. Department Labor OMB No. 1205-0371
Employment and Training Administration Expiration Date: April 30, 2012
Conditional Certification
Work Opportunity Tax Credit
EMPLOYERS!
This form must be accompanied by IRS Form 8850.
If you do not have IRS Form 8850, call 202-693-2786 for a copy or download it from www.irs.gov
Be sure to complete Part II of this form and IRS 8850, sign and date both forms BEFORE sending them to the
State Workforce Agency (SWA) within 28 days after the new hire’s employment-start date. IRS granted a “Relief Filing Period” that applies to veterans’
applications. See additional information in the “Note to Employer” section below.
1. INITIATING AGENCY CODE (For Agency Use Only) 2. CONTROL NO. (For Agency Use Only) “” 3. TYPE OF CONDITIONAL
One) CERTICATION
a. Original
(For Summer Youth ONLY, “” One)
CODE: ___________ ____ Participating Agency
____ SWA a. Original b. Revalidation
4. FOR EX-FELON TARGET GROUP ONLY 5. DATE COMPLETED (MM/DD/YY)
a. Conviction Date: _________________ c. Correction’s ID No.___________
__________________________
b. Release Date: ___________________
6. STATE WORKFORCE AGENCY’s NAME/ADDRESS 7. SIGNATURE (Authorized Official) 8. TELEPHONE No.
9. NAME OF APPLICANT (Last, First, Middle)
SAMPLE
PART I. APPLICANT’S INFORMATION AND CONDITIONAL CERTIFICATION (CC):
10. SOCIAL SECURITY No. 11. ENTER TARGET GROUP CODE
OTHER THAN “Veteran”:
________________________________
12. ADDRESS (Street, City, State, Zip Code) &Telephone No. 13a. VETERAN TARGET GROUP CODES (“” One):
2Ba. Qualified Veteran receiving SNAP benefits
2Bb. Disabled Veteran
2Bc. Disabled Veteran unemployed for 6 months
2Bd. Veteran unemployed for 4 weeks but less than 6 months
2Be. Veteran unemployed for 6 months
13b. TARGET GROUP CODE (Cont):: 14. APPLICANT SIGNATURE:
_______________________________________
Unemployed Veteran Disconnected Youth
NOTE TO EMPLOYER:
15. The above named individual may be eligible for certification
In the event you hire this person, you should request the certification necessary for you to
under the Work Opportunity Tax Credit. If individual is not
claim a Work Opportunity Tax Credit (WOTC). Simply complete and sign the Employer
employed before the date in the box below (Mo., Day, Yr.), this
Declaration below, submit to the SWA together with IRS Form 8850, not later than June 19,
eligibility determination is subject to review. 2012 for veterans that began employment for you on or after November 22, 2011 and
before May 22, 2012. For veterans who began employment for you after May 22, 2012
and before January 1, 2013, submit to the SWA not later than 28 days after the
applicant started work. The WOTC Employer Certification will be sent to you, if all statutory
requirements have been met.
PART II. EMPLOYER DECLARATION: I, hereby, declare that the above named person is or will be employed by:
16. NAME OF FIRM AND ADDRESS: 17. POSITON/JOB TITLE: 18. EMPLOYMENT-START DATE: 19. STARTING WAGE:
$ ___________ per hr
ATTN SWA: Please send a WOTC Certification for this employee. The pre-certification is for the purpose of requesting Certification to obtain the WOTC under
Sec. 51 and 52 of the Internal Revenue Code. Employers are advised that such credit will cease immediately upon notification of any subsequent
invalidation/revocation. Employers are further advised that if the certification herein requested is for a member of the SUMMER YOUTH target group, the tax
credit for which he/she may be eligible is subject to the limits described at Sec. 51 (d)(7) of the Internal Revenue Code.
NOTE: Falsification of data on this form is a FEDERAL CRIME in violation of 18 USC 1001. Falsification of work or concealment of information is
PUNISHABLE by a fine or imprisonment.
20. EMPLOYER’S NAME: 21. EMPLOYER’S SIGNATURE: 22. DATE: ((MM/DD/YY)
ETA Form 9062 (Rev. February 2012)
CONDITIONAL CERTIFICATION (CC) ETA FORM 9062. When a SWA or Participating Agency (PA) determines that a job-ready
applicant is, tentatively, ELIGIBLE as a member of a target group under WOTC, it shall use this required form, without modification, to
show that an eligibility determination was made for this person. Note. The CC serves as an official record of the pre-certification,
alerts prospective employers to the availability of the tax credit if this veteran is hired, and provides a means for employers to request
a WOTC certification for this person.
INSTRUCTIONS FOR COMPLETING THE “CONDITIONAL CERTIFICATION” FORM. (Boxes 1-15 are for Participating
Agency (PA) and SWA use only)
Box 1: Initiating Agency Code. If the CC was issued by a Participating Agency, enter its code. SWAs assign codes to
designate each PA and indicate the initiating source for the eligibility determination process. If the eligibility
determination was performed by the SWA, enter the SWA code, if available. Indicate with a check mark “” if initiating
agency is a PA or SWA.
Box 2: Control Number. Usually the PA determines the control number (CN). However, SWAs may, for internal control purposes,
develop their own CN system. It may be a case number or some other appropriate designation (e.g., alpha-numeric
designation), which permits easy filing, certification and retrieval of forms. Enter corresponding CN and indicate with a check
mark “” whether the source is a PA or a SWA.
Box 3: Type of Conditional Certification. This system distinguishes between “Original,” if the individual is being processed for the
first time, or “Revalidation,” if the eligibility process was performed within the previous 12-month period, (e.g. , 45 days for the
Summer Youth target group only). Otherwise, the Conditional Certification is counted as “Original.” Indicate with a check mark
“” whether the eligibility determination is “Original” or “Revalidation.”
Box 4: For Ex-Felon Target Group Only. For items a - c, enter the corresponding information. This information will help you in
verifying target group eligibility.
SAMPLE
Box 5: Date Completed. Enter the month, day, year in which the eligibility determination was completed.
Box 6: SWA’s Name and Address. If known, enter or stamp the name and address, including zip code, of the SWA responsible for
Certification requests for the employer indicated in Box 16. Leave blank if SWA’s name and address is unknown.
Box 7: Signature. Enter signature of the authorized conditionally-certifying official.
Box 8: Telephone No. Enter corresponding SWA or PA area code, telephone number and extension, if available.
PART I. APPLICANT’S INFORMATION AND CONDITIONAL CERTIFICATION (CC):
Box 9: Name of Individual. Enter the individual’s/applicant’s full name (i.e., last name, first name and middle initial).
Box 10: Social Security Number. Enter the individual’s/applicant’s Social Security Number.
Box 11: Target Group Code. Enter the code or name of the pre-certified non-veteran group.
Box 12: Address/Telephone No. Enter the individual’s/applicant’s home address, including apartment number and zip code. After
address, enter individual’s telephone number, including area code.
Box 13a: Target Group Code. The 1996 original target group designation for a Qualified Veteran is “B.” To facilitate the identification of
the different veteran categories created by the VOW to Hire Heroes Act of 2011 (P.L. 112-56,), ETA is using the same alpha-
numeric designations used to collect the number of certifications issued for the amended veteran categories in ETA Form 9058
– Report 1. To ensure a simple, uniform and consistent certification system which can be used by the SWAs nationwide each
new veteran category is preceded by “B” and followed by the alpha-numeric code used in ETA Form 9058. All the SWAs
need to do is enter a check mark “” in front of the veteran group certified.
Box 13b: Target Group Code (Continued). Enter a check mark “” to indicate if individual is being pre-certified as “Unemployed
Veteran” or “Disconnected Youth” meeting the requirements introduced by the Recovery Act of 2009, P.L. 111-5.
Box 14: Signature. Get applicant’s signature. If a minor, parent or guardian must sign here.
Box 15: CC Validity Period. (This box is to be completed by the SWA or PA). Enter the month/day/year when the CC expires
(e.g., 45 days for Summer Youth)
Page 2 of 3
ETA Form 9062 (Rev. February 2012)
Part II. EMPLOYER DECLARATION:
Box 16: Name of Firm. Enter full name of the employing firm (the firm where the employee will actually work).
Box 17: Position/Job Title. Enter the position or job title the employee will hold.
Box 18: Employment-Start Date. Enter the date the employee began or will begin work for the employing firm.
Box 19: Starting Wage. Enter the wage or salary which the employee will be paid. If not known, enter an estimated wage.
Box 20: Employer’s Name and Signature. Enter your name as the hiring employer.
Box 21: Employer’s Signature. Affix your electronic or ink signature here.
Box 22: Date. Enter month, day and year when you signed this form.
SAMPLE
Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number.
Respondents’ obligation to reply to these questions is required for obtaining the tax credit per P.L. 104-188. Public reporting burden
for this collection of information is estimated to average .33 minutes per response, including the time for reading instruction, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing the
burden to the U.S. Department of Labor, Employment and Training Administration, Division of National Programs, Tools, and
Technical Assistance, 200 Constitution Ave., NW, Room C-4510, Washington, D.C. 20210 (Paperwork Reduction Project 1205-
0371)
Privacy Act Statement: The Internal Revenue Code of 1986, Section 51, as amended and its enacting legislation, P.L.
104-188, specify that the State Workforce Agencies are the "designated" agencies responsible for administering the WOTC
certification procedures of this program. The information you have provided completing this form will be disclosed by your
employer to the State Workforce Agency. Provision of this information is voluntary. However the information is required
for your employer to receive the federal tax credit. IF THE INFORMATION YOU PROVIDE IS ABOUT A MEMBER OF
YOUR FAMILY, YOU SHOULD PROVIDE HIM/HER A COPY OF THIS NOTICE.
Page 3 of 3
ETA Form 9062 (Rev. February 2012)
ATTACHMENT C
U.S. Department Labor OMB No. 1205-0371
Employment and Training Administration Expiration Date: April 30, 2012
Employer Certification
Work Opportunity Tax Credit
(OPTIONAL FORMAT)
1. NAME/ADDRESS OF CERTIFYING 2. CONTROL NO. (For 3. DATE COMPLETED:
Agency Use Only)
AGENCY AND TELEPHONE NO.
4. INITIATING AGENCY CODE (For Agency Use Only)
PART A. EMPLOYER
5. NAME/ADDRESS OF FIRM/TELEPHONE NO. 6. EMPLOYER TAX EIN #: 7. REPRESENTATIVE’S NAME, TITLE &
SAMPLE
ADDRESS.
PART B. EMPLOYEE
8. SOCIAL SECURITY NO. 9. EMPLOYMENT START DATE (Mo/ Day/Yr.)
10. NAME AND ADDRESS OF EMPLOYEE: 12. VETERAN TARGET GROUP CODES: (“” those that apply)
2Ba. Qualified Veteran receiving SNAP benefits
2Bb. Disabled Veteran
2Bc. Disabled Veteran unemployed for 6 months
2Bd. Veteran unemployed for 4 weeks but less than 6 months
11. NON-VETERAN TARGET GROUP CODE AND 2Be. Veteran unemployed for 6 months
NAME:
Unemployed Veteran
Disconnected Youth
________________________________________
PART C. CERTIFICATION
I HEREBY CERTIFY that the individual named in Part B meets the eligibility criteria of Sec. 51 of the Internal Revenue Code.
13. NAME OF CERTIFYING OFFICER (Print or Type) 14. SIGNATURE. (Certifying Officer) 15. DATE ISSUED:
Comments to Employers:
* The VOW to Hire Heroes Act of 2011 (P.L. 112-56) extends and amends the current veteran group, creates two additional
categories of unemployed veterans in Section 51 of the Internal Revenue Code, and makes the WOTC available to
qualified tax-exempt organizations in Section 52. The VOW Act grants the WOTC to employers that hire certain qualified
veterans who begin employment on or after November 22, 2011 and before January 1, 2013. This Act did not extend the
non-veteran WOTC categories, which expired on December 31, 2011.
For additional information on filing certification requests to the State Workforce Agencies (SWA) and veterans’ eligibility
requirements visit WOTC’s national website at www.doleta.gov/wotc to obtain an e-copy of TEGL No. xx-xx, a brochure on
“WOTC and Veterans” and a Fact Sheet that provides an overview of the provisions in the VOW Act. Employers are also
encouraged to visit IRS’s website at www.irs.gov to obtain e-copies of IRS’s Notice 2012 -13 and the January 2012 IRS Form
8850 and Instructions.
EMPLOYERS: Before you can claim the WOTC, your new hire(s) must work the required number of hours to meet the
Minimum Employment or Retention Period. Visit IRS’s website at: www.irs.gov for additional information on this and other
requirements.
Note. More information is available in the instructions for IRS Form 8850 & 5884, Work Opportunity Credit, for tax year 2012.
NOTE: Falsification of data to obtain this Certification is a FEDERAL CRIME in violation of 18 USC 1001. Falsification of work or concealment of information
is PUNISHABLE by a fine or imprisonment
Page of 1 of 2 ETA Form 9063 (Rev. February 2012)
INSTRUCTIONS FOR COMPLETING AND ISSUING THE CERTIFICATION FORM (CF) ETA 9063.
Documentary evidence of eligibility and/or collateral contacts is required to issue a WOTC Certification.
Information on the Certification substantiates the employer is entitled to claim a tax credit against the
first-year wages paid to the new hire.
Note: SWAs must inform each employer who receives a WOTC Certification of the required Minimum
Employment Period as stated in the "Comment Box" of the Certification. However, enforcement of this
requirement is, strictly, an IRS responsibility.
Boxes to be completed on the Certification:
Box 1: Name and Address. Identify the SWA and include the appropriate address and zip code.
Box 2. Control Number. Enter the control number developed by the SWA for its own use.
Box 3. Date Completed. Enter the month, day and year when the form was completed.
Box 4. Initiating Agency Code. Enter agency code developed by SWA for its own use.
Box 5. Name and Address of Firm. Enter employer's name and address including zip code.
Box 6. Employer Tax EIN Number. Enter employer’s taxpayer identification.
Box 7.
SAMPLE
Representative's Name, Title and Address. Enter the name, title and office location of the
individual authorized by the employer to act on the employer’s behalf.
Box 8. Social Security No. Enter the employee's social security number.
Box 9. Employment Start Date. Enter the month, day and year when the employee began to work for the
employing firm.
Box 10. Name and Address of Employee. Enter the employee's full name (i.e., last name, first and initial)
and address including zip code and telephone number, if available.
Box 11. Targeted Groups. Enter SWA Code and target group name for the certified non-veteran group.
Box 12. Targeted Groups. Indicate, with a check mark ( “ “), which veteran group is being certified.
Box 13. Certifying Official. Key in/print full name and title of authorized certifying official.
Box 14. Signature. Enter authorized, certifying official's signature.
Box 15. Date. Enter month, day and year when the Certification is issued by the certifying official.
Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control
Number. Respondent's obligation to reply to these requirements is mandatory under P.L. 104-188. Public reporting burden
for this collection of Information is estimated to average .33 minutes per response, including the time for reading
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Division of National Programs, Tools,
and Technical Assistance, Room C-4510, Washington, D.C. 20210 (Paperwork Reduction Project Control No. 1205-
0371).
============================================================================================
Privacy Act Statement: The Internal Revenue Code of 1986, Section 51, as amended and its enacting legislation, P.L.
104-188, specify that the State Workforce Agencies are the "designated" agencies responsible for administering the
WOTC certification procedures of this program. The information you have provided completing this form will be disclosed
by your employer to the State Workforce Agency. Provision of this information is voluntary. However the information is
required for your employer to receive the federal tax credit. IF THE INFORMATION YOU PROVIDE IS ABOUT A
MEMBER OF YOUR FAMILY, YOU SHOULD PROVIDE HIM/HER A COPY OF THIS NOTICE.
Page 2 of 2 ETA Form 9063 (Rev. February 2012)
Page 2 of 2 ETA Form 9063 (Rev. February 2012)
Work Opportunity Tax Credit (For SWAs’ Internal Use Only)
U. S. Department of Labor OMB No. 1205-0371
Employment & Training Administration Expiration Date: April 30, 2012
1. NAME OF INDIVIDUAL 2. SOCIAL SECURITY NO.
Agency Declaration of Verification
Results Worksheet
3. EMPLOYER’S NAME, TELEPHONE NO., AND ADDRESS:
THE SECTION BELOW IS TO BE COMPLETED BY THE SWA CERTIFYING AGENCY ONLY.
4. CERTIFYING AGENCY: (Check one) 5. DATE CERTIFIED:
SAMPLE
CC Issued By: ___ Participating Agency or ___ SWA
6. SOURCES USED TO DOCUMENT ELIGIBILITY:
7. AUDIT SAMPLE RESULTS (Complete ONLY if selected as part of RANDOM SAMPLE in quarterly audit)
a. I have reviewed/contacted the source(s) indicated in box 6 above and have confirmed that the certified individual is
ELIGIBLE.
b. I have reviewed/contacted the source(s) indicated in box 6 above and have confirmed that the certified individual is INELIGIBLE for
the following reason(s):
c. I have not been able to establish that the certified individual is INELIGIBLE because:
NOTE: Falsification of data on this form is a FEDERAL CRIME in violation of 18 USC 1001. Falsification of work or
concealment of information is PUNISHABLE by a FINE or IMPRISONMENT.
8. NAME AND TITLE OF REVIEWER (Type or Print): 9. SIGNATURE (Certifying Officer) 10. DATE:
Persons are not required to respond to this collection of information unless it displays a valid OMB Control Number. Respondent's
obligation to reply to these requirements is mandatory by P.L. 104-188. Public reporting burden for this collection of information is
estimated to average 1 hour per response, including the time for reading instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the information. Send comments regarding the burden estimate or any other
aspect of this collection of information including suggestions for reducing this burden to the US. Department of Labor, Division of National
Programs, Tools, and Technical Assistance, Room C-4510, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0371).
Privacy Act Statement: The Internal Revenue Code of 1986, Section 51, as amended and its enacting legislation, P.L. 104-
188, specify that the State Workforce Agencies are the "designated" agencies responsible for administering the WOTC
certification procedures of this program. The information you have provided completing this form will be disclosed by your
employer to the State Workforce Agency. Provision of this information is voluntary. However the information is required for
your employer to receive the federal tax credit. IF THE INFORMATION YOU PROVIDE IS ABOUT A MEMBER OF YOUR
FAMILY, YOU SHOULD PROVIDE HIM/HER A COPY OF THIS NOTICE.
Page of 1 of 2 ETA Form 9065 (Rev. February 2012)
Previous versions usable
Instructions for Completing the Agency Declaration of Verification Results (ADVR) Worksheet, ETA FORM 9065.
Background: The Omnibus Budget Reconciliation Act of 1990, P. L. 101-508, § 11405(c), extended indefinitely the $5 million set-
aside (cited below) for testing whether individuals certified as members of WOTC targeted groups are eligible for certification
(including the use of statistical sampling techniques). As long as there is a WOTC appropriation, this requirement continues in
force. These provisions apply in full force to the certification process under the consolidated WOTC Program. Section 261(f)(2) of the Economic
Recovery Tax act of 1981 (P .L. 97-34), as amended, states that:
“(A) $5,000,000, shall be used to test whether individuals certified as members of targeted groups under
section 51of such Code [Internal Revenue] are eligible for such certification (including the use of
statistical sampling techniques), and (B) the remainder shall be distributed under performance standards
prescribed by the Secretary of Labor.”
Note. Verification activities require testing the validity of all Certifications issued by the SWAs, including the Conditional Certifications issued by
Participating Agencies (PAs) and other documentation, which results in Certifications. Quality reviews and audits are both parts of the
certification process. A General Accounting Office (GAO) report recommended that verification activities be done by "other than the person who
originally processed..." the Individual Characteristics [ETA Form 9061] or the Conditional Certification [ETA Form 9062] forms.
DEFINITIONS:
1. Quality Reviews - the reviews conducted at specific points in the eligibility determination/certification process of forms and
SAMPLE
other documentation including the Certification itself to ensure that the required information is complete, consistent and accurately
recorded.
2. Audit - the post-issuance examination of a random sample of Certifications and supporting documentation to verify the validity of
the Certifications issued.
INSTRUCTIONS FOR COMPLETING THE AGENCY DECLARATION OF VERIFICATION RESULTS (ADVR) FORM.
Box 1. Name of Individual. Enter the full name (last, first and middle initial) of the certified target group member/employee.
Box 2. Social Security No. Enter the employee's social security number.
Box 3. Employer Name, Telephone No., & Address. Enter employer's name and address including zip code and telephone
number.
Box 4. Certifying Agency. Enter name of SWA issuing the Certification. Indicate with a check mark “” whether
the CC was issued by a Participating Agency or a SWA.
Box 5. Date Certified. Enter month, day and year when the Certification was issued.
Box 6. Documentary Sources. List and/or describe the documentary evidence or sources of collateral contacts that are attached to
the Certification request (IRS 8850) and/or Individual Characteristics Form.
Box7. Audit Sample Results. Indicate with a check mark “” if individual is "eligible," "ineligible” or “eligibility cannot be determined”
and follow the instructions below.
a. If review of documentation reveals that the certified individual is eligible, enter a check mark“.”
b. If review of documentation reveals that the certified individual is ineligible, explain why, and for Conditional
Certifications (CCs) prepare and send the following notices:
Notification of Invalidation (NOI) - to the applicant, the SWA, PA staff; and employer/consultant. The NOI notifies
the employer/consultant to whom applicant was referred that the CC (ETA form 9062) is invalid because of missing or
incorrect information/items and that without such information a Certification cannot be issued.
Notice of Revocation (NOR) - prepare and send to employer/consultant an NOR explaining the reasons for
revocation and send a copy to the Regional Office and IRS in your state since employer eligibility for the tax credit
does not cease until the date that the employer is, officially, notified in writing that the Certification (ETA Form
9063) has been invalidated; thereby, revoked.
c. If review of documentation reveals that the SWA has not been able to establish eligibility explain the reason.
Box 8. Name and Title of Reviewer. Enter full name and title of authorized staff conducting audit review.
Box 9. Signature. Enter signature of authorized reviewer conducting audit.
Box 10. Date. Enter month, day and year when audit was conducted.
Page 2 of 2 ETA Form 9065 (Rev. February 2012)
Certification Workload and Characteristics of Certified Individuals U.S. Department of Labor
Work Opportunity Tax Credit - Report No. 1 ATTACHMENT C Employment and Training Administration
State: Quarter Ending: Persons are not required to respond to this collection of information unless it displays a currently valid OM B control number. Respondents' obligation to reply to these reporting OMB No. 1205-0371
requirements is mandatory (P.L. 104-188). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing Expiration
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding Date: April 30, 2012
this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Labor, Employment and Training
Administration, Division of National Programs, Tools, and Technical Assistance, 200 Constitution Ave., NW, Room C-4510, Washington, D.C. 20210 (Paperwork Reduction
Project 1205-0371).
PART I. CERTIFICATION WORKLOAD
SAMPLE
CERTIFICATION REQUESTS (System Inputs) CERTIFICATION REQUESTS (System Outputs)
A) Incomplete B) Requests Needing Action C) New Requests D) Total Requests E) Certified Requests F) Denied Requests G) Incomplete H) Requests Needing
Requests to Be Processed Requests Action
PART II. CHARACTERISTICS OF CERTIFIED INDIVIDUALS
(a) No. of CCs (b) No. (a) No. (a) No. (a) No.
I) By WOTC Target Resulting in Certified J) By Occupation Certified J) By Occupation (Cont.) Certified K) By Starting Certified
Group Certifications Individuals Individuals Individuals Hourly Wage Individuals
1. Under Federal
1. IV-A TANF Recipient Name-Code Name-Code Minimum Wage
2Ba. Veteran Receiving 1. Management Occupations – 11 12. Protective Services – 33 2. $7.25 - $8.25
SNAP benefits (V)
2Bb. Disabled Veteran (DV) 13. Food Preparation & Serving – 3
2. Business & Financial Operations – 13 3. $8.26 – $8.99
2Bc. DV unemployed for 6 14. Bldg. & Grounds Cleaning &
months Maintenance – 37
2Bd. V unemployed for 4 3. Computer & Mathematical – 15 15. Sales & Related Occupations – 41 4. $9.00 - $9.99
weeks
2Be. V unemployed for 6 4. Architecture & Engineering – 17 16. Office/Administrative Support – 43 5. $10.00 - Higher
months
3. Ex-Felon 5. Life, Physical & Social Sciences – 19 17. Farming, Fishing & Forestry – 45 6. TOTAL (For Qtr.)
4. Designated
Community Resident 6. Community & Social Services – 21 18. Construction & Extraction – 47
5a. Voc. Rehab Referral 7. Legal Occupations – 23 19. Installation/Maintenance/Repair- 49
5b. Ticket Holder 8. Education, Training, & Library – 25 20. Production Occupations – 51
9. Arts, Design, Entertainment, 21. Transportation & Material Moving
6. Summer Youth Sports/Media Occupations – 27 Production Occupations – 53
6. SNAP Recipient 10. Healthcare Practitioner & Technical – 29 22. Military Specific Occupations – 55
7. SSI Recipient 11. Healthcare Support Occupations – 31
8. Unemployed veteran
9. Disconnected Youth
8. Long-term TANF
Recipient
9. TOTAL (For Qtr.)
10. Total TOTAL (YTD)
23. Name and Title of Responsible Official: 24. Signature Title: 25. Date Signed: 26. Total (For Qtr.)
Page 1 of 5 ETA Form 9058 (Rev. February 2012)
Instructions for Preparing ETA Form 9058, Report 1 –“Certification Workload and Characteristics of
Certified Individuals,” Work Opportunity Tax Credit Report
REVISED INSTRUCTIONS
Introduction. Part I. of this report clarifies and simplifies data reported on certifications issued and
provides state workforce agencies’ (SWAs) workload during each reporting quarter. Part II. continues to
collect data on selected characteristics of certified individuals. Boxes 2a through 2e were added to collect
data from the expanded Veteran groups and provisions introduced by the VOW to Hire Heroes Act of
2011 (P.L. 112-56). Box 6. Summer Youth was deleted because the legislative authority for HUD’s urban
and USDA’s rural Empowerment Zones (EZs) expired on December 31, 2011 and the statutory definition
for this group requires that the youth must reside in an EZ. Box 7, SNAP Recipient became number 6
and Boxes 7-13 were renumbered as follows: Box 7. SSI Recipient, Box 8. Long-Term TANF, Box 9.
TOTAL (For QTR.) and Box 10. TOTAL (YTD)
Explanation of VOW to Hire Heroes Act of 2011 Changes. Since 1996, SWAs use the “B” alpha
statutory classification for the Veteran group for verification of and issuing certifications to the “qualified
veteran” group. To distinguish among the current and new veteran categories and provide the SWAs with
a uniform system to report the number of certifications issued by each new group, the “B” classification
has been added and is followed by alpha-numeric identifiers for Veteran Boxes No. 2a through 2e as
follows:
SAMPLE
Box 2Ba. Added (V) after “Veteran receiving SNAP benefits,”
Box 2Bb. Added (DV) after “Disabled Veteran”
Added Box 2Bc. and titled it “DV unemployed for 6 months”
Added Box 2Bd. and titled it “V unemployed for 4 weeks”
Added Box 2Be. and titled it “V unemployed for 6 months”
The two WOTC ARRA target groups – Unemployed Veterans and Disconnected Youth – authorized by
the American Recovery and Reinvestment Act (P.L. 111-5) expired on December 31, 2010. These target
groups (formerly Boxes 10 and 11) have been removed.
Background. The purpose of ETA Form 9058 (Updated February 2012) is to provide SWAs with a
standardized e-reporting format, which accurately reflects program activity levels and outcomes under the
Work Opportunity Tax Credit (WOTC). It is important for SWAs to maintain programmatic reporting
procedures that account for each tax request (IRS Form 8850) received and its subsequent outcome
(issuance of a tax certification or denial). A properly completed ETA Form 9058 accurately reflects program
use and the level of any programmatic backlog that may exist. To ensure that the WOTC Program can be
accurately evaluated at the national level, it is critical that all SWAs report in a standardized manner using
the web-based Enterprise Business Service System (EBSS) Tax Credit Reporting System (TCRS).
INSTRUCTIONS FOR COMPLETING THIS FORM:
State. Enter the name of the state submitting ETA Form 9058.
Quarter Ending Period. Enter ending date of the quarter for the reported program data.
Part I. "Certification Workload.” SWAs must identify from Part I, Item F on the previous reporting quarter's
ETA Form 9058 the number of requests (IRS Form 8850s) determined to be incomplete or Needing Action,
as defined below:
(A) Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received by the
SWA prior to the beginning of the current report period, but for which no applicant eligibility determination action
(excluding the 48-hour review) was taken. This total is to be entered into Part I, Item (A) of ETA Form 9058.
(B) Number of Requests Needing Action. Enter the total number of requests (IRS Form 8850s) received by
the SWA prior to the beginning of the current report, but for which no review and total is to be entered into Part I,
Item (B) of recently revised ETA Form 9058.
(C) New Requests. Enter the total number of requests (IRS Form 8850s) received by the SWA during the
current reporting quarter. Some states may have received requests (IRS Form 8880s) that were not
previously recorded and/or reported on any prior quarterly report ETA 9058 for various reasons. It is Important
for the SWA to report all requests (IRS Form 8850s) received. Therefore, any request received outside of the
current reporting quarter, which has not previously been reported, should be included with the number of
requests received during the current reporting period. That total should be entered as the number of "New
Requests". This total is to be entered into Part I, Item (C) of ETA Form 9058.
Page 2 of 5 ETA Form 9058 (ETA Form 9858 (Rev. February 2012)
(D) Total Requests to Be Processed. Enter the sum of Items A, B & C. This total represents the
number of requests (IRS Form 8850s) received by the SWA, which are available to be processed. This
total is to be entered under Part I, Item (D) of ETA Form 9058. Note. A denial is a request (IRS Form
8850) determined by the SWA to be ineligible for the WOTC.
(E) Requests Certified. Enter the total number of WOTC certifications issued during the current report period.
(F) Requests Denied. Enter the total number of requests (IRS Form 8850s) denied by the SWA during the
current report period.
Note. A denial is a request (IRS Form 8850) determined by the SWA to be ineligible for the WOTC.
(G) Number of Requests Incomplete. Enter the total number of requests (IRS Form 8850s) received and
reviewed by the SWA, but which the SWA could neither approve nor deny due to such things as, but not
limited to, the need for additional eligibility documentation for which the SWA has made a formal request
to the employer, authorized tax consultant, or other third party entity, ETA Form 9061 not submitted, etc.
Note. This number will also be entered in Part 1, Item A. of the subsequent quarterly report ETA Form
9058.
(H)Number of Requests Needing Action. Enter the number of requests (IRS Form 8850s) received by the
SWA but for which no review and/or action has yet been taken to determine applicant eligibility.
Note. This value will also be entered in Part I, Item B. of the subsequent quarterly report ETA Form 9058.
Part I, Item H is the sum of Item D, minus Item E, minus Item F, minus Item G.
SAMPLE
Part I. Completion Formula:
(A +B + C) = D and
D – (E + F + G) = H Same as: Items (A+B+C) = D and (D-E-F-G) = H
Part II. "Characteristics of Certified Individuals by Tax Credit." This part is divided into three
sections (Section I, Section J, and Section K).
Section I reflects the number of requests (IRS Form 8850s) certified by the SWA during the current report period
by WOTC target groups. Section J reflects the number of requests (IRS Form 8850s) certified by the SWA
during the current report period by occupation. Section K reflects the number of requests (IRS Form 8850s)
certified by the SWA during the current report period by starting hourly wage.
Section I.
Section I, Column (a). Enter the total number of certifications, issued by the SWAs, by target group, during the
current report period, which resulted from the issuance of a conditional certification i.e., ETA Form 9062.
Section I, Column (b). Enter the total number of WOTC certifications issued by the SWAs, by target group,
during the current report period.
Section I, Line #1. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for the IV-A TANF group.
Section I, Line #2Ba. Enter the total number of WOTC certifications issued by the SWA during the current
report period, for Veterans receiving SNAP benefits.
Section I, Line #2Bb. Enter the total number of WOTC certifications issued by the SWA during the current
report period, for “Disabled Veterans” receiving compensation for a service-connected disability.
Section I, Line #2Bc. Enter the total number of WOTC certifications issued by the SWA during the current
report period, for Disabled Veterans unemployed for 6 months.
Section I. Line #2Bd. Enter the total number of WOTC certifications issued by the SWA during the current
report period, for Veterans unemployed for at least 4 weeks but less than 6 months.
Section I. Line #2Be. Enter the total number of WOTC certifications issued by the SWA during the current
report period, for Veterans unemployed for at least 6 months.
Section I. Line #3. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for Ex-felons
________________________________________________________________________________________________________________
Page 3 of 5 ETA Form 9058 (ETA Form 9858 (Rev. February 2012)
Section I. Line #4. P.L. 110-28 changed the name of the High-Risk Youth to “Designated Community
Residents (DCRs).” Enter the total number of WOTC certifications issued by the SWA during the current
report period, for DCRs.
report period, for Vocational Rehabilitation Referrals.
SAMPLE
Section I, Line #5a. Enter the total number of WOTC certifications issued by the SWA during the current
Section I, Line #5b. Enter the total number of WOTC certifications issued by the SWA during the current
report period, for “ticket holders.” (e.g., SSDI, or Voc. Rehab).
Section I, Line #7. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for Summer Youth.
Section I, Line #6. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for SNAP (formerly Food Stamps) recipients.
Section I, Line #7. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for SSI recipients.
Section I, Line #10. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for “Unemployed Veterans” according to P.L. 111-5.
Section I, Line #11. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for “Disconnected Youth” according to P.L. 111-5.
Section I, Line #8. Enter the total number of WOTC certifications issued by the SWA during the current report
period, for “Long-term TANF” Recipients.
Section I. Line #9. Enter the sums of columns (a) and (b). Note. The total (For Qtr.) of Part II, Section I, Line
#9, columns (a) & (b) should equal the total entered in Part I. Item E. Requests Certified.
Section I, Line #10. Enter the cumulative federal program Year-to-Date (YTD) totals of columns (a) and (b).
Note. The first quarterly report of the federal program year (October 1-December 31), the totals of Section I,
Line #9 and Line #10 should be the same.
Section J.
Section J, Column (a). Enter the total number of WOTC Certifications issued by the SWA during the current
report period, by occupation. Note: The total for Section J, Column (a), Line #26 is the sum of the column and
must equal the total for Section I, Column (a) & (b) Line # 9.
The occupational data reported in Boxes 1-22 are derived from the job titles reported on ETA Forms 9061 or
9062. To prepare this report, SWAs must use the O*NET job families of occupations and their two-digit
corresponding codes as illustrated in the following table.
O*NET SOC JOB FAMILIES
Name Code Name Code
Food Preparation & Serving
Management Occupations 11 35
Related
Bldg. & Grounds Cleaning &
Business & Financial Operations 13 37
Maintenance
Computer& Mathematical Occupations 15 Personal Care & Service 39
Architecture & Engineering 17 Sales & Related Occupations 41
Office & Administrative
Life, Physical & Social Sciences 19 43
Support
Community & Social Services 21 Farming, Fishing, & Forestry 45
Legal Occupations 23 Construction & Extraction 47
Installation, Maintenance &
Education, Training, & Library 25 49
Repair
Arts, Design, Entertainment, Sports and Media Occupations 27 Production Occupations 51
Transportation & Material
Healthcare Practitioner & Technical 29 53
Moving
Healthcare Support Occupations 31 Military Specific Occupations 55
Protective Service Occupations 33
Page 4 of 5 ETA Form 9858 (Rev. February 2012)
SAMPLE
Section K
Section K, Column (a). Enter the total number of WOTC certifications issued by the SWA during the
1
current report period, by starting hourly wage . Note. The total for Section K, Column (a), Line #6 is the
sum of the column for that quarter and must equal the total for Section I, column (b), Line #9.
Convert as follows:
Unit of Time Calculated Hourly Wage
Day Amount divided by 8
Week Amount divided by 40
Month Amount divided by 172
23. Name and Title of Responsible Official. Enter the name and title of the authorized signatory official.
24. Signature. Enter the signature of the authorized signatory official.
25. Date. Enter the date of the authorized signatory official’s signature.
26. Total (for qtr). Enter the total number of WOTC Certifications issued by the SWA during the current
report period, by occupation. Note. The total for Section J, Column (a), Line #26 is the sum of the
column for this quarter and must equal the total for Section I, column (b), Line #9.
1
According to the Federal Labor Standards Act (FLSA), the federal minimum salary is $7.25 per hour
effective July 24, 2009. Source: Office of Employment Standards Administration, Division of Wage and
Hour at the U.S. Department of Labor.
_____________________________________________________________________________
Page 5 of 5 ETA Form 9058 (Rev. February 2012)
Attachment 4: IRS Announcement 2002-44 (https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL30-11aD.pdf).
Part IV. Items of General Interest
Electronic Submission of
Form 8850
Announcement 2002–44
Form 8850
Employers submit Form 8850, Pre-
Screening Notice and Certification
Request for the Work Opportunity and
Welfare-to-Work Credits, to State
Employment Security Agencies (SESAs)
as part of the process of obtaining those
tax credits. The Internal Revenue Service
will allow the electronic submission of
Forms 8850 with SESAs that choose to
establish a system to electronically
receive this form. In general, the
electronic
system must meet the requirements
described in paragraphs (1) through (6)
below.
For purposes of this announcement,
“employer” refers to an employer
required to submit a Form 8850 or an
authorized employer representative.
Requirements
(1) In General. The electronic system
must ensure that the information
received
is the information sent, and it must
document all occasions of access that
result in the submission of a Form 8850.
In addition, the design and operation of
the electronic system, including access
procedures, must make it reasonably
certain that the persons signing the Form
8850, accessing the system, and
submitting the Form 8850 are the job
applicant and employer identified in the
form.
(2) Same Information as Paper Form
8850. The electronic submission must
provide the SESA with exactly the same
information as the paper Form 8850.
(3) Jurat and Signature
Requirements.
The electronic submission must be
signed by the job applicant and the
employer under penalties of perjury.
(A) Jurat. The jurats (perjury
statements) must contain the language
that appears on the paper Form 8850 for
the job applicant and the employer,
respectively. The electronic system must
inform the job applicant and the
employer that they must make the
declaration contained in the applicable
jurat and that the declaration is made by
signing the Form 8850. The instructions
and the language of each jurat must
immediately follow the information
provided by the job applicant or the
employer, as applicable, and must
immediately precede that person’s
electronic signature.
(B) Electronic Signatures. The
electronic signatures must (1) identify
the job applicant whose name is on the
electronic Form 8850 and the employer
submitting the electronic Form 8850,
and (2) authenticate and verify the
submission. For this purpose, the terms
“authenticate” and “verify” have the
same meaning as they do when applied
to a written signature on a paper Form
8850. An electronic signature can be in
any form that satisfies the foregoing
requirements. The electronic signature of
the employer must be the final entry in
the submission.
(4) Copies of Electronic Form 8850.
The electronic system must enable the
employer to supply and, upon request by
the Internal Revenue Service, the
employer must supply (A) a hard copy
of the electronic Form 8850 submitted to
the SESA and (B) a statement that, to the
best of the employer’s knowledge, the
electronic Form 8850 was submitted by
the employer with respect to the named
job applicant. The hard copy of the
electronic Form 8850 must provide
exactly the same information as, but
need not be a facsimile of, the paper
Form 8850.
(5) Retention of Forms 8850 by the
SESAs and Employers. Electronic Forms
8850 have the same status as paper
Forms 8850. Therefore, guidance that
applies to paper Forms 8850 also applies
to electronic Forms 8850. For example,
as is the case for paper Forms 8850,
electronic Forms 8850 are required to be
retained by employers under their
established recordkeeping systems. For
further information, see Rev. Proc. 98–
25 (1998–1 C.B. 689) (information
regarding the retention of records within
an Automatic Data Processing System).
Drafting Information
The principal author of this
announcement is Robert Wheeler. For
further information regarding this
announcement, contact Karin Loverud at
(202) 622–6080 (not a toll-free call).
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