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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The form that is submitted to Job Service North Dakota must contain the original signatures of the new hire and the employer.

The job seeker or the employer must complete the following forms:. If the 28th day falls on a Saturday, Sunday, or federal holiday, the next business day is considered the 28th filing day.

Complete ONE of the following required U. What is a Designated Employer Representative? Postal Service postmark or postage meter mail stamp dated no later than the 28th calendar day after the date the new hire began work.

WOTC – Forms and Publications

For 9026 information and additional filing options fax, email, onlinecontact the Department of Career Services at Should an employer realize after they have mailed Form to Job Service North Dakota that the form is missing original signatures, the employer can 902 a second form that contains original signatures.

If you need a response, please locate the contact information elsewhere on this page or in the footer. We use your feedback to help us improve this site but we are not able to respond directly. Employers can obtain copies of IRS by visiting www. Re-verification of target group eligibility and the date listed in Question 15 on Form may occur by Job Service North Dakota.


Application Process The first step is pre-screening to determine eligibility. The employer makes sure the individual has signed the form.

Please do not include personal or contact information. 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. Faxed or emailed forms cannot be accepted and will result in a denial. Job Service North Dakota. The Work Opportunity Tax Credit WOTC is a Federal tax credit incentive that employers may receive for hiring individuals from certain target forn who have consistently faced significant barriers to employment.

Give this form to torm new hire and have him or her complete, sign, and date the front of the form. Either the new hire or employer may sign and date the form.

Work Opportunity Tax Credit Program (WOTC) Overview |

The main objective of this program is to enable the targeted employees to gradually move from economic dependency into self-sufficiency as forn earn a steady income and become contributing taxpayers, while participating employers are compensated by being able to reduce their federal income tax liability. If you need to mail Form separately to meet the day filing requirement, write on the form that other documents are being mailed separately.


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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 completes Part II of the form.

WOTC – Forms and Publications

If the new hire is under age 18 on the hire date, a parent or guardian must sign and date the form. The first step is pre-screening to determine eligibility. Additionally, there are situations when an employer will receive a Notice of Denial from Job Service because Form was missing original signatures. The employer completes the top portion of the form, making sure all the blanks are completed.

How Does an Employer Apply for WOTC?

Executive Office of Labor and Workforce Development. 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 job seeker or the employer must complete the following forms: Amount of the Credit 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.

The mailing envelope must contain a U. For more details on WOTC benefit amounts, go to www.