Instructions For Form 8850 (Rev. January 2012) printable pdf download

Department of the Treasury

Instructions for Form 8850

Internal Revenue Service

(Rev. January 2012)

Pre-Screening Notice and Certification Request for the Work Opportunity Credit

General Instructions

Instructions for Employer

Section references are to the Internal Revenue Code unless

otherwise noted.

When and Where To File

What’s New

Do not file Form 8850 with the Internal Revenue Service.

Instead, file it with your SWA no later than the 28th day after

For certain veterans who begin work after November 21,

the job applicant begins work for you (by June 19, 2012, for

2011, and before 2013, the qualified veteran targeted group

all qualified veterans who begin work after November 21,

has been expanded to cover veterans who were

2011, and before May 22, 2012).

unemployed for at least 4 weeks during the 1-year period

ending on the hiring date.

Although facsimile filing of Form 8850 is permitted, not all

The Hurricane Katrina employee targeted group expired

states are equipped to accept a faxed copy of Form 8850.

for individuals hired after August 27, 2009.

Contact your state WOTC coordinator as discussed below

and see Notice 2012-13 for details. Notice 2012-13 is

The unemployed veteran and disconnected youth

available at

targeted groups expired for individuals hired after 2010.

The empowerment zone designations were extended until

Although electronic filing of Form 8850 is permitted, at

the end of 2011.

the time these instructions were published, only the

following states are equipped to receive Form 8850

The renewal community designations expired at the end

electronically: Alabama, Arizona, Arkansas, Colorado,

of 2009.

Florida, Illinois, Kansas, Kentucky, Minnesota, New Jersey,

Some states may be equipped to accept a faxed copy of

Ohio, Pennsylvania, and South Carolina. See

Form 8850 and additional states are equipped to receive

Announcement 2002-44 and Notice 2012-13 for details. You

Form 8850 electronically.

can find Announcement 2002-44 on page 809 of Internal

The IRS has created a page on IRS.gov for information

Revenue Bulletin 2002-17 at

about Form 8850 and its instructions at

pub/irs-irbs/irb02-17.pdf.

form8850. Information about any future developments

affecting Form 8850 (such as legislation enacted after we

To get the name, address, phone and fax numbers, and

release it) will be posted on that page.

email address of the WOTC coordinator for your state, visit

the Department of Labor Employment and Training

Administration (ETA) website at

Purpose of Form

Employers use Form 8850 to pre-screen and to make a

written request to their state workforce agency (SWA) to

Never attach Form 8850 to a tax return or otherwise

certify an individual as a member of a targeted group for

send it to the IRS, regardless of the employee’s

purposes of qualifying for the work opportunity credit.

targeted group. Form 8850 should be filed with the

CAUTION

SWA.

Submitting Form 8850 to the SWA is but one step in the

process of qualifying for the work opportunity credit. The

Additional Requirements for

state work opportunity tax credit (WOTC) coordinator for the

SWA must certify the job applicant is a member of a

Certification

targeted group. After starting work, the employee must meet

In addition to filing Form 8850, you must complete and send

the minimum number-of-hours-worked requirement for the

to your state WOTC coordinator either:

work opportunity credit. Generally, an employer elects to

ETA Form 9062, Conditional Certification Form, if the job

take the credit by filing Form 5884, Work Opportunity Credit.

applicant received this form from a participating agency

However, a tax-exempt organization that hires a qualified

(e.g., the Jobs Corps), or

veteran should report the work opportunity credit on Form

ETA Form 9061, Individual Characteristics Form, if the job

5884-C, Work Opportunity Credit for Qualified Tax-Exempt

applicant did not receive a conditional certification.

Organizations Hiring Qualified Veterans.

You can get ETA Form 9061 from your local public

Who Should Complete and

employment service office or you can download it from the

ETA website at

Sign the Form

The job applicant gives information to the employer on or

before the day a job offer is made. This information is

Recordkeeping

entered on Form 8850. Based on the applicant’s

information, the employer determines whether or not he or

Keep copies of Forms 8850, any transmittal letters that you

she believes the applicant is a member of a targeted group

submit to your state WOTC coordinator, and certification

(as defined under Members of Targeted Groups). If the

letters you receive from your WOTC coordinator as long as

employer believes the applicant is a member of a targeted

they may be needed for the administration of the provisions

group, the employer completes the rest of the form no later

relating to the work opportunity credit. Records that support

than the day the job offer is made. Both the job applicant

the credit usually must be kept for 3 years from the date any

and the employer must sign Form 8850 no later than the

income tax return claiming the credit is due or filed,

date for submitting the form to the SWA.

whichever is later.

Feb 09, 2012

Cat. No. 24833J

Instructions For Form 8850 (Rev. January 2012)

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