Eta Form 9154 PDF Details

Central to aiding employers in navigating the complexities of the Work Opportunity Tax Credit (WOTC) program, the Eta 9154 form serves a crucial function in the employment and training administration overseen by the U.S. Department of Labor. This Youth Self-Attestation Form (SAF), designated for completion by new hires -- who are the only parties authorized to fill it out --, is instrumental in the certification process required to ascertain eligibility for the federal tax credit intended to incentivize the employment of target groups facing significant barriers to employment. Essentially, the form captures vital information including the new hire's name, social security number, date of birth, and pertinent details regarding their educational and employment history. Critical statements a new hire must attest to relate to their educational attendance, diploma status, and recent employment history, aimed at confirming their eligibility within specific criteria set by the WOTC program. In submitting this information under the penalties of perjury, the form instills a legal obligation upon the new hire to provide accurate and truthful information, while also outlining privacy notices and public burden statements that shed light on the procedural aspects related to the form's submission and the overarching legislative framework dictating its requirements. It underscores the procedural necessity of submitting this form alongside Form ETA 9061 to State Workforce Agencies, thus playing a foundational role in streamlining the process for employers seeking to capitalize on the Work Opportunity Tax Credit.

QuestionAnswer
Form NameEta Form 9154
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesyouth self form, self attestation form sample, self attestation form, form self attestation

Form Preview Example

U.S. Department Labor

OMB Control No. 1205-0371

Employment and Training Administration

Expiration Date: November 30, 2011

YOUTH SELF-ATTESTATION FORM

Work Opportunity Tax Credit Program

Instructions: This Self-Attestation Form (SAF) is to be completed, signed, and dated by the new hire only. Employers or consultants submit this SAF to the State Workforce Agency with Form ETA 9061 for each certification request filed.

New Hire Name: ___________________________________________________________

Social Security Number: _________________ Date of Birth:_______________________

Employer Name: ___________________________________________________________

Employer Federal ID (EIN) Number: ___________________________________________

Please check all the statements that apply to you. Sign and date this form where indicated below.

In the past 6 months, I have not attended a secondary, technical or postsecondary school for more than an average of 10 hours per week, not counting periods during which the school is closed for scheduled vacations.

I do not have a High School Diploma or GED certificate.

I have a High-School diploma or GED certificate awarded more than 6 months ago and I have not attended or been admitted to a technical or post-secondary school. I also have not held a job (other than occasionally) since receiving my High-School diploma or GED certificate.

Under penalties of perjury, I declare that this information is true and correct to the best of my knowledge.

New Hire’s Signature: _______________________________________________Date_________

Privacy Act Notice:

The Internal Revenue Code of 1986, Section 51, as amended and its enacting legislation, P.L. 104-188, specify that the State Workforce Agencies are the "designated" agencies responsible for administering the WOTC certification procedures of this program. The information you have provided completing this form, including the Social Security Number, will be disclosed by your employer to the State Workforce Agency. Provision of this information is voluntary; however the information is required to determine your employer's eligibility for the federal tax credit.

Public Burden Statement:

Persons are not required to respond to this collection of information unless it displays a currently valid OM B control number. Respondents' obligation to complete this form is required to obtain or retain benefits (P.L. 111-5). Public reporting burden is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate to the U.S. Department of Labor, Division of Adult Services, Room S-4209, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0371). Please do not submit completed forms to this address.

ETA Form 9154 (Rev. May 2010)

How to Edit Eta Form 9154 Online for Free

Once you open the online editor for PDFs by FormsPal, you are able to complete or modify self attestation right here and now. The editor is continually improved by our team, receiving powerful features and growing to be greater. For anyone who is looking to begin, here's what it's going to take:

Step 1: Press the "Get Form" button above. It is going to open our tool so you could begin filling out your form.

Step 2: With this advanced PDF file editor, it's possible to accomplish more than simply fill in blank fields. Edit away and make your docs appear faultless with custom text added in, or fine-tune the file's original content to perfection - all comes with an ability to add any photos and sign the file off.

Be mindful while filling in this pdf. Make sure that every single blank field is done accurately.

1. Begin completing the self attestation with a selection of essential blank fields. Note all the required information and be sure not a single thing overlooked!

Filling in segment 1 in attestation self form

2. The third part is usually to fill in the next few blanks: Under penalties of perjury I, Privacy Act Notice The Internal, and ETA Form Rev May.

A way to fill out attestation self form portion 2

Be very attentive while completing Under penalties of perjury I and Privacy Act Notice The Internal, as this is the section where a lot of people make some mistakes.

Step 3: Just after taking one more look at the form fields you've filled out, press "Done" and you're good to go! After setting up a7-day free trial account at FormsPal, you will be able to download self attestation or send it through email at once. The form will also be available via your personal account menu with all your adjustments. At FormsPal.com, we do our utmost to be certain that your information is stored private.

Eta Form 9154 isn’t the one you’re looking for?

Related Documents