Work Opportunity Tax Credit Form Field Explanations

Overview

To apply for the Work Opportunity Tax Credit, employers must submit the following:

• A complete IRS Form 8850, Pre-Screening Notice and Certification Request for the Work Opportunity Credit; and
• A complete ETA Form 9061, Individual Characteristics Form (ETA Form 9062, Conditional Certification, provided to the job seeker by TWC or a participating agency, may be submitted in lieu of the ETA Form 9061).

If one of the submitted forms is incomplete, you will receive a letter asking you to complete the form.

Please review your copy of the IRS Form 8850 and ETA Form 9061 against the following list of requirements and common errors to determine the necessary information that is required to continue processing your claim.

Requirements for IRS Form 8850 and ETA Form 9061:

• Both forms must be submitted to process the request.
• Both forms must be legible.
• The Spanish version of the forms can only be used for translation purposes and cannot be used as a substitution for the English version.
• The employer must submit the most current version of the forms; older versions are not accepted.

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IRS Form 8850 - Page 1

Field	Explanation
Your name	New hire name
Social security number	New hire’s SSN (must be 9 characters long)
Street address where you live	Physical street address where the new hire resides (P.O. Box not acceptable)
City or town, state, and ZIP code	City, state, and zip code where the new hire resides
If you are under age 40, enter your date of birth (month, day, year)	New hire’s birth date (MM/DD/YY)
Number 1 through 6	Check all boxes that the new hire would qualify for
Job applicant’s signature	New hire signature
Date	Date new hire signed the form

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IRS Form 8850 - Page 2

Field	Explanation
Employer name	Employer’s name that the certification should be issued under.
Telephone number	Employer’s telephone number (include area code)
EIN	Employer’s EIN number (must be 9 characters long)
Street Address	Employer’s physical street address
City or town, state and ZIP code	Employer’s city, state and ZIP code
Person to Contact, if different from above	Consultant’s firm name and EIN number
Telephone Number	Consultant’s telephone number (include area code)
Street Address	Consultant’s street address
City or town, state, and ZIP code	Consultant’s city, state and ZIP code
Gave information	Date applicant was given information on the position
Was offered job	Date the applicant was offered the position
Was hired*	Date the applicant was hired
Started job*	Date the applicant started working for employer
Employer’s signature	Employer’s signature
Title	Employer’s title
Date	Date the employer signed the form

* The hired date cannot be a later date than the start date. Please verify that the dates entered in both of the sections are correct.

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ETA Form 9061

Field	Explanation
Box 3. Employer Name	Company’s name
Box 4. Employer Address and Telephone	Employer’s complete physical address and phone number
Box 5. Employer Federal ID Number (EIN)	Employer’s EIN number (must be 9 characters long)
Box 6. Applicant Name (Last, First, MI)	New hire’s name with last name first, first name second, and middle initial, if applicable
Box 7. Social Security Number	SSN for new hire (must be 9 characters long)
Box 8.	Questions for the new hire
Box 9. Employment Start Date	Date new hire started working for employer
Box 10. Starting Wage	Wage offer
Box 11. Position	Position offered to new hire (or O*Net code)
Box 12. Age Question	New hire date of birth
Box 13 to 21.	Eligibility questions
Box 23(a). Signature	Signature of person completing form
Box 23(b).	Indicate who signed form
Box 24. Date	Date the form was signed

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