If the WOTC is extended and the form is revised, the agency will amend the date-of-birth line, pursuant to IRS Announcement 96-116 and to any changes to the WOTC, as appropriate. The agency will also reissue the DOB guidance from Announcement 96-116 with future mailings of form 941 to employers. The agency is not required to display the expiration date.
Inventory as of this Action
Requested
Previously Approved
02/29/2000
02/29/2000
02/28/1997
400,000
0
400,000
1,480,000
0
1,480,000
0
0
0
A job applicant completes and signs, under penalties of perjury, the top portion of the form to indicate that he or she is a member of a targeted group. If the employer has a belief that the applicant is a member of a targeted group, the employer signs the other portion of the form under penalties of perjury and submits it to the SESA as part of a written request for certification.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Work Opportunity Credit Prescreening Notice and Certification Request