The Irs Form 8850 is used to certify workers as eligible for the Work Opportunity Tax Credit. It must be completed and filed by the employer before any wages paid to the worker can be claimed for the credit. The form can be downloaded from the IRS website, and there is also a section on the website that provides instructions on how to complete it. The form must be signed by both the employer and employee, and it must include all of the required information.
You'll find information regarding the type of form you would like to fill out in the table. It will tell you just how long it may need to fill out irs form 8850, exactly what parts you will have to fill in and some additional specific details.
Question | Answer |
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Form Name | Irs Form 8850 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | irs form 8850, form 8850 rev 3 2016, 8850 form, form 8850 printable |
Form 8850 (Rev. March 2016)
Department of the Treasury Internal Revenue Service
the Work Opportunity Credit
▶Information about Form 8850 and its separate instructions is at www.irs.gov/form8850.
OMB No.
Job applicant: Fill in the lines below and check any boxes that apply. Complete only this side.
Your name |
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Social security number ▶ |
Street address where you live
City or town, state, and ZIP code
County |
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Telephone number |
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If you are under age 40, enter your date of birth (month, day, year)
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Check here if you received a conditional certification from the state workforce agency (SWA) or a participating local agency for the work opportunity credit.
Check here if any of the following statements apply to you.
•I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9 months during the past 18 months.
•I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least a
•I was referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program, or the Department of Veterans Affairs.
•I am at least age 18 but not age 40 or older and I am a member of a family that:
a.Received SNAP benefits (food stamps) for the past 6 months; or
b.Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is no longer eligible to receive them.
•During the past year, I was convicted of a felony or released from prison for a felony.
•I received supplemental security income (SSI) benefits for any month ending during the past 60 days.
•I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during the past year.
Check here if you are a veteran and you were unemployed for a period or periods totaling at least 6 months during the past year.
Check here if you are a veteran entitled to compensation for a
Check here if you are a veteran entitled to compensation for a
Check here if you are a member of a family that:
•Received TANF payments for at least the past 18 months; or
•Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest
•Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be made.
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Check here if you are in a period of unemployment that is at least 27 consecutive weeks and for all or part of that period you received unemployment compensation.
Under penalties of perjury, I declare that I gave the above information to the employer on or before the day I was offered a job, and it is, to the best of my knowledge, true, correct, and complete.
Job applicant’s signature ▶ |
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Date |
For Privacy Act and Paperwork Reduction Act Notice, see page 2. |
Cat. No. 22851L |
Form 8850 (Rev. |
Form 8850 (Rev. |
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Page 2 |
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For Employer’s Use Only |
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Employer’s name |
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Telephone no. |
EIN ▶ |
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Street address
City or town, state, and ZIP code
Person to contact, if different from above |
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Telephone no. |
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Street address
City or town, state, and ZIP code
If, based on the individual’s age and home address, he or she is a member of group 4 or 6 (as described under Members of
Targeted Groups in the separate instructions), enter that group number (4 or 6) . . . |
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Date applicant: |
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Gave |
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information |
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offered job |
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hired |
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job |
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Under penalties of perjury, I declare that the applicant provided the information on this form on or before the day a job was offered to the applicant and that the information I have furnished is, to the best of my knowledge, true, correct, and complete. Based on the information the job applicant furnished on page 1, I believe the individual is a member of a targeted group. I hereby request a certification that the individual is a member of a targeted group.
Employer’s signature ▶ |
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Privacy Act and |
criminal litigation, to the Department of |
The time needed to complete and file |
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Labor for oversight of the certifications |
this form will vary depending on |
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Paperwork Reduction |
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performed by the SWA, and to cities, |
individual circumstances. The estimated |
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Act Notice |
states, and the District of Columbia for |
average time is: |
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use in administering their tax laws. We |
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Recordkeeping |
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6 hr., 27 min. |
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Section references are to the Internal |
may also disclose this information to |
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Revenue Code. |
other countries under a tax treaty, to |
Learning about the law |
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Section 51(d)(13) permits a prospective |
federal and state agencies to enforce |
or the form |
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. 24 min. |
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federal nontax criminal laws, or to |
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employer to request the applicant to |
Preparing and sending this form |
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federal law enforcement and intelligence |
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complete this form and give it to the |
to the SWA |
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. 31 min. |
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agencies to combat terrorism. |
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prospective employer. The information |
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If you have comments concerning the |
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will be used by the employer to |
You are not required to provide the |
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accuracy of these time estimates or |
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complete the employer’s federal tax |
information requested on a form that is |
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suggestions for making this form |
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return. Completion of this form is |
subject to the Paperwork Reduction Act |
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simpler, we would be happy to hear from |
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voluntary and may assist members of |
unless the form displays a valid OMB |
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you. You can send us comments from |
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targeted groups in securing employment. |
control number. Books or records |
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www.irs.gov/formspubs. Click on “More |
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Routine uses of this form include giving |
relating to a form or its instructions must |
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Information” and then on “Give us |
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it to the state workforce agency (SWA), |
be retained as long as their contents |
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feedback.” Or you can send your |
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which will contact appropriate sources |
may become material in the |
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comments to: |
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to confirm that the applicant is a |
administration of any Internal Revenue |
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member of a targeted group. This form |
law. Generally, tax returns and return |
Internal Revenue Service |
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may also be given to the Internal |
information are confidential, as required |
Tax Forms and Publications |
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Revenue Service for administration of |
by section 6103. |
1111 Constitution Ave. NW, |
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the Internal Revenue laws, to the |
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Washington, DC 20224 |
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Department of Justice for civil and |
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Do not send this form to this address. |
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Instead, see When and Where To File in the separate instructions.
Form 8850 (Rev.