ETA Form 9061 at a glance
What it is: The Work Opportunity Tax Credit Individual Characteristics Form (ICF) must be used together with IRS Form 8850 to help state workforce agencies (SWAs) determine eligibility for the Work Opportunity Tax Credit (WOTC).
Who signs: The person who completes the form signs the signature block. If the applicant completes the form and is a minor, the parent or guardian must sign the form.
What to bring and attach to ETA Form 9061
Employers: You may check with your SWA to find out what other sources you can use to verify targeted group eligibility.
You are encouraged to provide copies of documentation for each checked box.
A filled-in ETA Form 9061 example: an employer lists a veteran on page 1
How to fill out ETA Form 9061, box by box
SWA / Agency information
Box 1 and 2 are for the State Workforce Agency (SWA) or Participating Agency, for agency use only.
Employer information
Enter the name, address including ZIP code, telephone number, and employer identification number (EIN) of the employer requesting WOTC certification.
The EIN number must be a tax-identification number that is registered with the state (where the business is located), so the SWA can establish an employer-employee relationship where wages are paid (and federal taxes deducted).
Do not enter information pertaining to the employer's representative, if any.
Job applicant information
Enter the applicant's full name and social security number as they appear on the applicant's social security card.
For job title (position), enter the job applicant's job title or the corresponding standard occupation classification (SOC).
In Box 8, indicate whether the job applicant previously worked for the employer. This information will help the SWA to determine if the job applicant is a first-time, qualifying member of a WOTC targeted group(s).
Qualified IV-A Recipient
Check here if the job applicant is a Qualified IV-A Recipient.
If the job applicant is a member of a family receiving Temporary Assistance for Needy Families (TANF), enter the name of the primary benefits recipient, and the city and state(s) where benefits were received.
Qualified Veteran
Check here if the job applicant is a veteran of the U.S. Armed Forces.
If the job applicant (veteran) is a member of a family receiving Supplemental Nutrition Assistance Program (SNAP) benefits, enter the name of the primary benefits recipient, and the city and state(s) where benefits were received.
Additional information may be requested to determine the job applicant's qualified veteran eligibility, such as proof of being entitled to compensation for a service-connected disability or having aggregate periods of unemployment.
Qualified Ex-Felon
Check here if the job applicant is an Ex-Felon.
Enter date of felony conviction (mm/dd/yyyy) and release date.
Federal conviction. State conviction: List applicable state.
Work Release Program
Check here if the job applicant is in a Work Release Program.
Designated Community Resident (DCR)
Check if the job applicant is at least age 18 but not age 40 on the hiring date, and resides in a Rural Renewal County (RRC) or an Empowerment Zone (EZ).
Enter job applicant's birthday (mm/dd/yyyy).
Vocational Rehabilitation Referral
The job applicant is a Vocational Rehabilitation (VR) Referral: check here.
Qualified Summer Youth Employee
The job applicant is a Qualified Summer Youth Employee: check here.
Enter the job applicant's birthday (mm/dd/yyyy).
Qualified Supplemental Nutrition Assistance Program (SNAP) Recipient
The job applicant is a Qualified SNAP (Food Stamps) Recipient: check here.
Enter job applicant's birthday (mm/dd/yyyy), the name of the primary benefits recipient, and the city and state(s) where benefits were received.
Qualified Supplemental Security Income (SSI) Recipient
If the job applicant received or is receiving Supplemental Security Income (SSI), check here.
Long-Term Family Assistance Recipient
If the job applicant is a Long-term Family Assistance (long-term TANF) recipient, check here.
Enter name of the primary benefits recipient, and the city and state(s) where benefits were received.
Qualified Long-Term Unemployment Recipient
If the job applicant is a qualified long-term unemployment recipient (LTUR), check here.
Enter city and state(s) where UI claim records / UI wage records were filed.
Sources used to document eligibility
Employers and SWAs use this box to list the sources used to verify target group eligibility.
Indicate in parentheses next to each document listed whether it is attached (A) or forthcoming (F).
Signature and date
"I certify that this information is true and correct to the best of my knowledge."
The form may be completed, on behalf of the job applicant, by: 1) the employer or employer's representative, 2) the applicant directly (if a minor, the parent or guardian must sign the form), or 3) a participating agency, and signed by the individual completing the form.
Signature Options: (a) Employer or their Authorized Representative, (b) SWA staff, (c) Participating Agency staff, or (d) Applicant (If applicant is minor, the parent or guardian must sign).
Box 24, Date: Enter the month, day and year when the form was completed.
More rules for ETA Form 9061
This form is required to be used, without modification, by all employers (or their representatives) seeking WOTC certification.
Read statements carefully, check any boxes that apply, and provide additional information where requested.
If your situation is different
Sources
[1] ETA Form 9061 (Rev. May 2023), Work Opportunity Tax Credit Individual Characteristics Form, U.S. Department of Labor (the Official source link on this page).