Items 16 – 22 Submit the bottom portion of the ETA Form instead of Form , State agency use only-ETA Form , Conditional Certification Form. Federal Forms and Information. ETA Form – Individual Characteristics Form – Work Opportunity Tax Credit; ETA Form – Conditional Certification. April – Individual Characteristics Form; ETA Form , Rev. April – Conditional Certification; ETA Form , Rev. April – Employer Certification.

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The second form must meet the day filing requirement in order for it to be considered timely and in order for Job Service to consider it for processing.

WOTC – Forms and Publications

If you need a response, please locate the contact information elsewhere frm this page or in the footer. Employers can obtain copies of IRS by visiting www.

Have your company representative complete, sign, and date the back of the form. Complete ONE of the following required U. Amount of the Credit The amount of the tax credit is based on a percentage of qualified wages paid to the new employee for the first year of employment only with the exception of the long term TANF recipient.

Please do not include personal or contact information. The employer completes Part II of the form. If you need to mail Form separately to meet the day filing requirement, write on the form that other documents are being mailed separately. We use your feedback to help us improve this site but we are not able to respond directly. It is the employer’s responsibility to read the instructions for forms and and to know what forms to complete, how to properly complete them, and where and how to submit them.

Give this form to the new hire and have him or her complete, sign, and date the front of the form. The amount of the tax credit is forrm on a percentage of qualified wages paid to the new employee for the first year of employment only with the exception of the long term TANF recipient.


The form that is submitted to Job Service North Dakota must contain the foorm signatures of the new hire and the employer. The first step is pre-screening to determine eligibility. If the 28th day falls on a Saturday, Sunday, or fom holiday, the next business day is considered the 28th filing day. For more fork and additional filing options fax, email, onlinecontact the Department of Career Services at This form indicates the individual was tentatively determined as eligible for a WOTC target group.

Before mailing the forms to JSND, make sure frm contain the required signatures, review them for completeness, and make copies for your records. If the new hire is under age 18 on the hire date, a parent or guardian must sign and date the form. Feedback Did you find what you tea looking for on this webpage? The employer has the new hire complete question 8 on the top of the form and answer the characteristics questions.

Form is required to apply for the WOTC. In these cases, if an employer can resubmit a properly completed Form within the day filing requirement, Job Service will consider that form for processing. Either the new hire or employer may sign and date the form. The employer and the job seeker must sign the Formunder penalty of perjury, attesting that the job seeker is a member of a target group.

Both the percentage and the cap on qualifying wages vary based on which target group the new employee falls into. The employer completes 9026 top portion of the form, making sure all the blanks are completed. The employer then forwards the forms to the Department of Career Services no later than the 28th day after the job seeker begins work at the following address:.


Obtain the current forms and their instructions: Application Process Corm first step is pre-screening to determine eligibility. If you need to report child abuse, any other kind of abuse, or need urgent assistance, please click here.

How Does an Employer Apply for WOTC?

The Work Opportunity Tax Credit WOTC is a Federal tax credit incentive that employers may receive for hiring individuals from certain target groups who have consistently faced significant barriers to employment.

Department of Labor forms, as appropriate: The job seeker or the employer must complete the following forms: The employer must hire the individual by the date indicated in Question 15 in order to possibly be qualified for a tax credit.

Additionally, there are situations when an employer will receive a Notice of Denial from Job Service because Form was missing original signatures. For more details on WOTC benefit amounts, go to www. Auxiliary aids and services are available upon request to individuals with disabilities. Mail all required forms and documentation together. Job Service North Dakota.

The employer makes sure the individual has signed the form. Form has a specific day filing requirement. Postal Service postmark or postage meter mail stamp dated no later than the 28th calendar day after the date the new flrm began work.

If these are not in place or if signature areas are left blank, Form must be denied.

The job seeker or the employer must complete the following forms:. The mailing envelope must contain a U.