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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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This form indicates the frm was tentatively determined as eligible for a WOTC target group. Form has a specific day filing requirement. 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.

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

What is a Designated Employer Representative? The employer completes the top portion of the form, making sure all the blanks are completed.

How Does an Employer Apply for WOTC?

Form is required to apply for the WOTC. The job seeker or the employer must complete the following forms: 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: Job Service North Dakota.

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.


Obtain the current forms and their instructions: The employer has the new hire complete question 8 on the top of the form and answer the characteristics questions. Faxed or emailed forms cannot eya accepted and will result in a denial.

Carefully read the instructions for this form to learn about the target groups. Re-verification of target group eligibility and the date listed in Question 15 on Form may occur by Job Service North Dakota.

Complete ONE of the following required U.

WOTC – Forms and Publications

Auxiliary aids and services are available upon request to individuals with disabilities. The Work Opportunity Tax Credit WOTC is a Federal tax credit incentive that employers may receive for hiring individuals from certain target groups who have consistently faced significant barriers to employment.

Postal Service postmark or postage meter mail stamp dated no later than the 28th calendar day after the date the new hire began work. The employer and the job seeker must sign the Formunder penalty of perjury, attesting that the job seeker is a member of a target group. The amount 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.

Before mailing the forms to JSND, make sure they contain the required signatures, review them for completeness, and make copies for your records.

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:. Please do not include personal or contact information. The employer must hire the individual by the date indicated in Question 15 in order to possibly be qualified for a tax credit. 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.


WOTC Questions: What is a Conditional Certification from the State Workforce Agency?

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

If the 28th day falls on a Saturday, Sunday, or federal holiday, the next business day is considered the 28th filing day. The employer completes Part II of the form. Executive Office of Labor and Workforce Development. Give this form to the new hire and have him or her complete, sign, and date the front of the form.

For more information and additional filing options fax, email, onlinecontact the Department of Career Services at


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