Form 8850--Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits

Forms and Documents

Document Name	Status
Form Form 8850 Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits Form	Modified
Non-Display Expiration Date Statement.docx Supplementary Document	2011-12-12
8850.Supporting Statement.doc Supporting Statement A	2011-12-15
Summary of Changes (Inst. 8850).pdf Supplementary Document	2011-11-18
Summary of Changes (Form 8850).pdf Supplementary Document	2011-11-18

IC Document Collections

IC ID	Document Title	Status
18507	Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits Form	Modified

ICR Details

OMB Control No: 1545-1500	ICR Reference No: 201111-1545-031
Status: Historical Active	Previous ICR Reference No: 200903-1545-029
Agency/Subagency: TREAS/IRS	Agency Tracking No: EC-1545-1500-031
Title: Form 8850--Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/25/2012
	Date Received in OIRA: 12/29/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	36 Months From Approved	04/30/2012
Responses	440,000	0	440,000
Time Burden (Hours)	3,335,200	0	2,081,200
Cost Burden (Dollars)	0	0	0

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Abstract: 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 their state workforce agency (SWA) as part of a written request for certification.

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Authorizing Statute(s): US Code: 26 USC 51 Name of Law: Amount of credit
  

Citations for New Statutory Requirements: US Code: 26 USC 61 Name of Law: Returning Heroes and Wounded Warriors Work Opportunity Tax Credits
PL: Pub.L. 111 - 5 1221 Name of Law: American Recovery and Reinvestment Tax Act
PL: Pub.L. 109 - 73 et al. Name of Law: Katrina Emergency Tax Relief Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 47648	08/05/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 81557	12/28/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits	Form 8850, Form 8850	Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credits ,   Pre-Screening Notice and Certification Request for the Work Opportunity and Welfare-to-Work Credit

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	440,000	440,000	80,000	-80,000	0	0
Annual Time Burden (Hours)	3,335,200	2,081,200	1,860,400	-606,400	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: R-Line 1 was deleted since the law for Hurricane Katrina expired (Katrina Emergency Tax Relief Act of 2005 [Pub. L. 109-73]) -The last bullet under new checkbox 2 was deleted since the target group for disconnected youth expired at the end of 2010. (IRC section 51(d) – enacted by the Section 1221 of the American Recovery and Reinvestment Tax Act of 2009 (ARRTA, Pub. L. 111-5). As a result, the program expects approximately 80,000 "less" filers to complete Form 8850, and a decrease in burden of 606,400 hours. These program changes are attributed to expiring statutes. -A new box 3 was added to expand the target group for unemployed veterans. Per 26 U.S.C. 261 and the VOW to Hire Heroes Act of 2011, HR 674, Form 8850 a pre-screening form for an employee to qualify for the Work Opportunity Credit. The VOW to Hire Heroes Act of 2011, allows veterans that were unemployed for four weeks to qualify for the Work Opportunity Credit. It expands the definition of target group for qualified veterans. As a result, the program expects approximately 80,000 new filers to complete Form 8850, for an increase in burden of 1,860,400 hours. These program changes are attributed to new statute.

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Annual Cost to Federal Government: $1,604

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/29/2011

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