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

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 7 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.Prior Employee? 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 to 21. Eligibility questions
Box 22. Sources List all documentation provided
Box 23(a). Signature Signature of person completing form
Box 23(b). Completed By Indicate who signed form
Box 24. Signature Date Date the form was signed

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