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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Auxiliary aids and services are available upon request to individuals with disabilities.

Either the rorm hire or employer may sign and date the form. Faxed 0962 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. This form indicates the individual was tentatively determined as eligible for a WOTC target group.

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: Skip to main content. Carefully read the instructions for this form to learn about the target groups.

Feedback Did you find what you were looking for on this webpage? What is a Designated Employer Representative? Obtain the current forms and their instructions: Amount of the Credit The 906 of the tax credit is based on a percentage of qualified wages paid to the new employee for the first year of employment only with the exception of the long term TANF recipient. The employer has the new hire complete question 8 on the top of the form and answer the characteristics questions.

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 employer makes sure the individual has signed the form. Form is required to apply for the WOTC. If these are not in place or if signature areas are left blank, Form must be denied.

Postal Service postmark or postage meter mail stamp dated no later than the 28th calendar day after the date the new hire began work. Re-verification of target group eligibility and the date listed in Question 15 on Form may occur by Job Service North Dakota. Should an employer realize after they have mailed Form to Job Service North Dakota that the form is missing original signatures, the employer can resubmit a second form that contains original signatures.


The mailing envelope must contain a U. Job Service North Dakota. Employers make the hiring decision, and there is no limit to the number of new hires who can qualify the employer for the tax savings, but individuals must be identified as members of one of these targeted groups before a job offer is made.

Both the percentage and the cap on qualifying wages gorm based on which target group the new employee falls into.

Work Opportunity Tax Credit Program (WOTC) Overview |

If you need to mail Form separately to meet the day filing requirement, write on the form that other documents are being mailed separately.

The 902 form must meet the day filing requirement in order for it to be considered timely and in order for Job Service to consider it for processing.

Application Process The first step is pre-screening to determine eligibility. If the new hire is under age 18 on the hire date, a parent or guardian must sign from date the form. The main objective of this program is to enable the targeted employees to gradually move from economic dependency into self-sufficiency as they earn a steady income and become contributing taxpayers, while participating employers are compensated by being able to reduce their federal income tax liability.

For more details on WOTC benefit amounts, go to www. The job seeker or the employer must complete the following forms: If this requirement is not met, Form must be denied. Form has a specific day filing requirement. Before mailing the forms to JSND, make sure they contain the required signatures, review them for completeness, and make copies for your records.

WOTC – Forms and Publications

Department of Labor forms, as appropriate: The employer and the job seeker must sign the Formunder penalty of perjury, attesting that the job seeker is a member of a dorm group. Employers can obtain copies of IRS by visiting www. The first step is pre-screening to determine eligibility. Please do not include personal or contact information.


We use your feedback to help us improve this site but we are not able to respond directly. For more information and additional filing options fax, email, onlinecontact the Department of Career Services at Mail all required forms and documentation together.

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. Give this form to the new hire and have him or her complete, sign, and date the front of the form. The employer completes Part II of the form. Additionally, there are situations when an employer will receive a Notice of Denial from Job Service because Form was missing original signatures.

Complete ONE of the following required U. Executive Office of Labor and Workforce Development. The employer should review this form for any “yes” responses indicated by the new hire and then obtain the required documentation from the new hire to substantiate those responses. If you need a response, please locate the contact information elsewhere on this page or in the footer.

The employer completes the top portion of the form, making sure all the blanks are completed.

Work Opportunity Tax Credit Program (WOTC) Overview

The job seeker or the employer must complete the following forms:. 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. The form that is submitted to Job Service North Dakota must contain the original signatures of the new hire and the employer. If the 28th day falls on a Saturday, Sunday, wta federal holiday, the next business day is considered the 28th filing day.