Instructions For Form 8850 (Rev. January 2012) (Page 2 of 3) in pdf

Members of Targeted Groups

a. Has received SNAP benefits for the 6-month period

ending on the hiring date, or

A job applicant may be certified as a member of a targeted

b. Is no longer eligible for such assistance under section

group if he or she is described in one of the following

6(o) of the Food Stamp Act of 1977, but the family received

groups.

SNAP benefits for at least 3 months of the 5-month period

1. Qualified IV-A recipient. An individual who is a

ending on the hiring date.

member of a family receiving assistance under a state plan

8. SSI recipient. An individual who is receiving

approved under part A of title IV of the Social Security Act

supplemental security income benefits under title XVI of the

relating to Temporary Assistance for Needy Families

Social Security Act (including benefits of the type described

(TANF). The assistance must be received for any 9 months

in section 1616 of the Social Security Act or section 212 of

during the 18-month period ending on the hiring date.

Public Law 93-66) for any month ending during the 60-day

2. Qualified veteran. A veteran who is any of the

period ending on the hiring date.

following.

9. Long-term family assistance recipient. An

A member of a family receiving assistance under the

individual who is a member of a family that:

Supplemental Nutrition Assistance Program (SNAP) (food

Has received TANF payments for at least 18

stamps) for at least a 3-month period during the 15-month

consecutive months ending on the hiring date, or

period ending on the hiring date.

Receives TANF payments for any 18 months (whether

Unemployed for a period or periods totaling at least 4

or not consecutive) beginning after August 5, 1997, and the

weeks (whether or not consecutive) but less than 6 months

earliest 18-month period beginning after August 5, 1997,

in the 1-year period ending on the hiring date.

ended during the past 2 years, or

Unemployed for a period or periods totaling at least 6

Stopped being eligible for TANF payments because

months (whether or not consecutive) in the 1-year period

federal or state law limits the maximum period such

ending on the hiring date.

assistance is payable and the individual is hired not more

than 2 years after such eligibility ended.

Entitled to compensation for a service-connected

disability and is hired not more than 1 year after being

discharged or released from active duty in the U.S. Armed

Member of a Family

Forces.

With respect to the qualified IV-A recipient, qualified veteran,

Entitled to compensation for a service-connected

recipient of SNAP benefits (food stamps), and long-term

disability and was unemployed for a period or periods

family assistance recipient, an individual whose family

totaling at least 6 months (whether or not consecutive) in the

receives assistance for the requisite period meets the family

1-year period ending on the hiring date.

assistance requirement of the applicable group if the

Note. Requesting the information in box 4 or box 5 of Form

individual is included on the grant (and thus receives

8850 is an exception to the Americans with Disabilities Act’s

assistance) for some portion of the specified period.

prohibition on pre-offer disability-related inquiries. The

purpose of this request is to support the hiring of certain

Empowerment Zones

disabled veterans, which will entitle the employer to a larger

The following paragraphs describe current designations of

work opportunity credit than the hiring of other targeted

empowerment zones. The designations will generally remain

group members.

in effect until the end of 2011.

To be considered a veteran, the applicant must:

Urban areas. Parts of the following urban areas are

Have served on active duty (not including training) in

empowerment zones. You can find out if your business or

the Armed Forces of the United States for more than 180

an employee’s residence is located within an urban

days or have been discharged or released from active duty

empowerment zone by using the EZ/RC Address Locator at

for a service-connected disability, and

or by calling 1-800-998-9999.

Not have a period of active duty (not including training)

Pulaski County, AR

of more than 90 days that ended during the 60-day period

Tucson, AZ

ending on the hiring date.

Fresno, CA

3. Qualified ex-felon. An ex-felon who has been

Los Angeles, CA (city and county)

convicted of a felony under any federal or state law, and is

Santa Ana, CA

hired not more than 1 year after the conviction or release

New Haven, CT

from prison for that felony.

Jacksonville, FL

4. Designated community resident. An individual who

Miami/Dade County, FL

is at least age 18 but not yet age 40 on the hiring date and

Chicago, IL

lives within an empowerment zone or rural renewal county

Gary/Hammond/East Chicago, IN

(defined later).

Boston, MA

5. Vocational rehabilitation referral. An individual who

Baltimore, MD

has a physical or mental disability resulting in a substantial

Detroit, MI

handicap to employment and who was referred to the

Minneapolis, MN

employer upon completion of (or while receiving)

St. Louis, MO/East St. Louis, IL

rehabilitation services by a rehabilitation agency approved

Cumberland County, NJ

by the state, an employment network under the Ticket to

New York, NY

Work program, or the Department of Veterans Affairs.

Syracuse, NY

6. Summer youth employee. An individual who:

Yonkers, NY

Performs services for the employer between May 1 and

Cincinnati, OH

September 15,

Cleveland, OH

Is at least age 16 but not yet age 18 on the hiring date

Columbus, OH

(or if later, on May 1),

Oklahoma City, OK

Has never worked for the employer before, and

Philadelphia, PA/Camden, NJ

Lives within an empowerment zone.

Columbia/Sumter, SC

7. Recipient of SNAP benefits (food stamps). An

Knoxville, TN

individual who:

El Paso, TX

Is at least age 18 but not yet age 40 on the hiring date,

San Antonio, TX

and

Norfolk/Portsmouth, VA

Is a member of a family that:

Huntington, WV/Ironton, OH

-2-

Instructions For Form 8850 (Rev. January 2012) Page 2

Related Articles

Related forms

Related Categories