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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 employer must hire eat individual by the date indicated in Question 15 in order to possibly be qualified for a tax credit. For more information and additional filing options fax, email, onlinecontact the Department of Career Services at 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.

Work Opportunity Tax Credit Program (WOTC) Overview

The job seeker or the employer must complete the following forms: Carefully read the instructions for this form to learn about the target groups. What is a Designated Employer Representative? Before mailing the forms to JSND, make sure they 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, tea parent or guardian must sign and date the form.


Skip to main content. The employer completes Part II of the form. We use your feedback to help us improve this site but we are not able to respond 0962.

WOTC – Forms and Publications

Please do not include personal or contact information. If these are not in place or if signature areas are left blank, Form must be denied. Faxed or emailed forms cannot be accepted and will result in a denial. 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?

Feedback Did you find what you were looking for on this webpage? Have your company representative complete, sign, and date the back of the form.

This form indicates the individual was tentatively determined as eligible for a WOTC target group. Employers can obtain copies of IRS by visiting www. 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:. The first step is pre-screening to determine eligibility. Complete ONE of the following required U. Additionally, there are situations when an employer will receive a Notice of Denial from Job Service because Form was missing original signatures.

Work Opportunity Tax Credit Program (WOTC) Overview |

Department of Labor forms, as appropriate: Re-verification of target group eligibility and the date listed in Question 15 on Form may occur by Job Service North Dakota. 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: 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.


The employer completes the top portion of the form, making sure all the blanks are completed. The employer makes sure the individual has signed the form. If the 28th day falls on a Saturday, Sunday, or federal holiday, the next business day is considered the 28th filing day.


The employer has the new hire complete question 8 on the top of the form and answer the characteristics questions. Both the percentage and the cap on et wages vary based on which target group the new employee falls into.

Application Process The first step is pre-screening to determine eligibility. 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.