Instructions For Form 8850 - Internal Revenue Service (Page 2 of 3) in pdf

•

You can get ETA Form 9061 from your local public

Performs services for the employer between May 1

employment service office or you can download it from

and September 15,

•

the ETA website at

Is age 16 but not yet age 18 on the hiring date (or if

later, on May 1),

•

Has never worked for the employer before, and

•

Lives within an empowerment zone, enterprise

Recordkeeping

community, or renewal community.

Keep copies of Forms 8850, any transmittal letters that

7. Food stamp recipient. An individual who:

you submit to your state WOTC coordinator, and

•

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

certification letters you receive from your WOTC

date, and

coordinator as long as they may be needed for the

•

Is a member of a family that —

administration of the Internal Revenue Code provisions

a. Has received food stamps for the 6-month period

relating to the work opportunity credit. Records that

ending on the hiring date or

support the credit usually must be kept for 3 years from

b. Is no longer eligible for such assistance under

the date any income tax return claiming the credit is due

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

or filed, whichever is later.

family received food stamps for at least 3 months of the

5-month period ending on the hiring date.

Hurricane Katrina employee. Form 8850 should

8. SSI recipient. An individual who is receiving

not be filed with the SWA for employees who

supplemental security income benefits under title XVI of

check only box 1 on Form 8850. Employers

CAUTION

the Social Security Act (including benefits of the type

should keep Form 8850 for their records. If a prior

described in section 1616 of the Social Security Act or

version of Form 8850 was sent to the SWA indicating the

section 212 of Public Law 93-66) for any month ending

employee is a Hurricane Katrina employee, the employer

within the 60-day period ending on the hiring date.

and employee should complete this version of Form 8850

9. Long-term family assistance recipient. An

for the employer to retain for its records. Do not attach

individual who is a member of a family that:

Form 8850 to a tax return.

•

Has received TANF payments for at least 18

consecutive months ending on the hiring date, or

Members of Targeted Groups

•

Receives TANF payments for any 18 months

A job applicant may be certified as a member of a

(whether or not consecutive) beginning after August 5,

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

1997, and the earliest 18-month period beginning after

following groups.

August 5, 1997, ended within the last 2 years, or

•

Stopped being eligible for TANF payments because

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

Federal or state law limits the maximum period such

member of a family receiving assistance under a state

assistance is payable and the individual is hired not more

plan approved under part A of title IV of the Social

than 2 years after such eligibility ended.

Security Act relating to Temporary Assistance for Needy

Families (TANF). The assistance must be received for

10. Hurricane Katrina employee. A Hurricane Katrina

employee is a person who, on August 28, 2005, had a

any 9 months during the 18-month period that ends on

main home in the core disaster area and, within a

the hiring date.

two-year period beginning on this date, is hired to

2. Qualified veteran. A veteran who is a member of a

perform services principally in the core disaster area.

family receiving assistance under the Food Stamp

program for at least a 3-month period during the

Gulf Opportunity (GO) Zone (Core Disaster Area).

15-month period ending on the hiring date. See section

The GO Zone (also called the core disaster area) covers

51(d)(3). To be considered a veteran, the applicant must:

the portion of the Hurricane Katrina disaster area

•

Have served on active duty (not including training) in

determined by the Federal Emergency Management

the Armed Forces of the United States for more than 180

Agency (FEMA) to be eligible for either individual only or

days or have been discharged or released from active

both individual and public assistance from the Federal

duty for a service-connected disability and

Government. The GO Zone covers the following areas in

•

Not have a period of active duty (not including

three states.

training) of more than 90 days that ended during the

a. Alabama. The counties of Baldwin, Choctaw,

60-day period ending on the hiring date.

Clarke, Greene, Hale, Marengo, Mobile, Pickens,

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

Sumter, Tuscaloosa, and Washington.

convicted of a felony under any Federal or state law, and

b. Louisiana. The parishes of Acadia, Ascension,

is hired not more than 1 year after the conviction or

Assumption, Calcasieu, Cameron, East Baton Rouge,

release from prison for that felony.

East Feliciana, Iberia, Iberville, Jefferson, Jefferson

4. High-risk youth. An individual who is at least 18

Davis, Lafayette, Lafourche, Livingston, Orleans,

but not yet 25 on the hiring date and lives within an

Plaquemines, Pointe Coupee, St. Bernard, St. Charles,

empowerment zone, enterprise community, or renewal

St. Helena, St. James, St. John the Baptist, St. Martin,

community.

St. Mary, St. Tammany, Tangipahoa, Terrebonne,

5. Vocational rehabilitation referral. An individual

Vermilion, Washington, West Baton Rouge, and West

who has a physical or mental disability resulting in a

Feliciana.

substantial handicap to employment and who was

c. Mississippi. The counties of Adams, Amite, Attala,

referred to the employer upon completion of (or while

Choctow, Claiborne, Clarke, Copiah, Covington, Forrest,

receiving) rehabilitation services by a rehabilitation

Franklin, George, Greene, Hancock, Harrison, Hinds,

agency approved by the state, an employment network

Holmes, Humphreys, Jackson, Jasper, Jefferson,

under the Ticket to Work program, or the Department of

Jefferson Davis, Jones, Kemper, Lamar, Lauderdale,

Veterans Affairs.

Lawrence, Leake, Lincoln, Lowndes, Madison, Marion,

6. Summer youth employee. An individual who:

Neshoba, Newton, Noxubee, Oktibbeha, Pearl River,

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Instructions For Form 8850 - Internal Revenue Service Page 2

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