Tax Calendar Details

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.

QuestionAnswer
Form NameIrs Form 8850
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesirs form 8850, form 8850 rev 3 2016, 8850 form, form 8850 printable

Form Preview Example

Form 8850 (Rev. March 2016)

Department of the Treasury Internal Revenue Service

Pre-Screening Notice and Certification Request for

the Work Opportunity Credit

Information about Form 8850 and its separate instructions is at www.irs.gov/form8850.

OMB No. 1545-1500

Job applicant: Fill in the lines below and check any boxes that apply. Complete only this side.

Your name

 

Social security number

Street address where you live

City or town, state, and ZIP code

County

 

Telephone number

 

 

 

If you are under age 40, enter your date of birth (month, day, year)

1

2

3

4

5

6

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 3-month period during the past 15 months.

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 service-connected disability and you were discharged or released from active duty in the U.S. Armed Forces during the past year.

Check here if you are a veteran entitled to compensation for a service-connected disability and you were unemployed for a period or periods totaling at least 6 months during the past year.

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 18-month period beginning after August 5, 1997, ended during the past 2 years; or

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.

7

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.

Signature—All Applicants Must Sign

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

 

Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Cat. No. 22851L

Form 8850 (Rev. 3-2016)

Form 8850 (Rev. 3-2016)

 

 

 

 

Page 2

 

 

 

 

 

 

 

For Employer’s Use Only

 

 

Employer’s name

 

Telephone no.

EIN

 

 

 

 

 

 

Street address

City or town, state, and ZIP code

Person to contact, if different from above

 

Telephone no.

 

 

 

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) . . .

. . . . . . . . . . .

Date applicant:

 

 

 

 

 

 

 

 

 

Gave

 

Was

 

Was

 

Started

information

 

offered job

 

hired

 

job

 

 

 

 

 

 

 

 

 

 

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

Title

 

Date

 

 

Privacy Act and

criminal litigation, to the Department of

The time needed to complete and file

Labor for oversight of the certifications

this form will vary depending on

 

Paperwork Reduction

 

performed by the SWA, and to cities,

individual circumstances. The estimated

Act Notice

states, and the District of Columbia for

average time is:

 

 

 

use in administering their tax laws. We

 

 

 

 

 

Recordkeeping

. .

6 hr., 27 min.

Section references are to the Internal

may also disclose this information to

 

 

 

 

Revenue Code.

other countries under a tax treaty, to

Learning about the law

 

 

Section 51(d)(13) permits a prospective

federal and state agencies to enforce

or the form

.

. 24 min.

federal nontax criminal laws, or to

 

 

 

 

employer to request the applicant to

Preparing and sending this form

federal law enforcement and intelligence

complete this form and give it to the

to the SWA

.

. 31 min.

agencies to combat terrorism.

prospective employer. The information

 

 

 

 

 

If you have comments concerning the

will be used by the employer to

You are not required to provide the

accuracy of these time estimates or

complete the employer’s federal tax

information requested on a form that is

suggestions for making this form

return. Completion of this form is

subject to the Paperwork Reduction Act

simpler, we would be happy to hear from

voluntary and may assist members of

unless the form displays a valid OMB

you. You can send us comments from

targeted groups in securing employment.

control number. Books or records

www.irs.gov/formspubs. Click on “More

Routine uses of this form include giving

relating to a form or its instructions must

Information” and then on “Give us

it to the state workforce agency (SWA),

be retained as long as their contents

feedback.” Or you can send your

which will contact appropriate sources

may become material in the

comments to:

 

 

 

to confirm that the applicant is a

administration of any Internal Revenue

 

 

 

 

 

 

 

member of a targeted group. This form

law. Generally, tax returns and return

Internal Revenue Service

 

 

may also be given to the Internal

information are confidential, as required

Tax Forms and Publications

 

Revenue Service for administration of

by section 6103.

1111 Constitution Ave. NW, IR-6526

the Internal Revenue laws, to the

 

Washington, DC 20224

 

 

Department of Justice for civil and

 

Do not send this form to this address.

 

 

Instead, see When and Where To File in the separate instructions.

Form 8850 (Rev. 3-2016)

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