Instructions For Form 8850 (Rev. June 2007) (Page 2 of 4) in pdf

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the ETA website at

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

later, on May 1),

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Has never worked for the employer before, and

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Lives within an empowerment zone or renewal

Recordkeeping

community.

Keep copies of Forms 8850, any transmittal letters that

7. Food stamp recipient. An individual who:

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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

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coordinator as long as they may be needed for the

Is a member of a family that —

administration of the provisions relating to the work

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

opportunity credit. Records that support the credit usually

ending on the hiring date or

must be kept for 3 years from the date any income tax

b. Is no longer eligible for such assistance under

return claiming the credit is due or filed, whichever is

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

later.

family received food stamps for at least 3 months of the

5-month period ending on the hiring date.

Members of Targeted Groups

8. SSI recipient. An individual who is receiving

supplemental security income benefits under title XVI of

A job applicant may be certified as a member of a

the Social Security Act (including benefits of the type

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

described in section 1616 of the Social Security Act or

following groups.

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

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

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

member of a family receiving assistance under a state

9. Long-term family assistance recipient. An

plan approved under part A of title IV of the Social

individual who is a member of a family that:

Security Act relating to Temporary Assistance for Needy

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Has received TANF payments for at least 18

Families (TANF). The assistance must be received for

consecutive months ending on the hiring date, or

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

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Receives TANF payments for any 18 months

the hiring date.

(whether or not consecutive) beginning after August 5,

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

1997, and the earliest 18-month period beginning after

following.

August 5, 1997, ended during the past 2 years, or

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A member of a family receiving assistance under the

Stopped being eligible for TANF payments because

Food Stamp program for at least a 3-month period during

federal or state law limits the maximum period such

the 15-month period ending on the hiring date.

assistance is payable and the individual is hired not more

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Entitled to compensation for a service-connected

than 2 years after such eligibility ended.

disability and is hired not more than 1 year after being

10. Hurricane Katrina employee. A Hurricane Katrina

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

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

Armed Forces.

main home in the Gulf Opportunity (GO) Zone (core

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Entitled to compensation for a service-connected

disaster area) and, during a two-year period beginning on

disability and was unemployed for a period or periods

this date, is hired to perform services principally in the

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

GO Zone. Certification does not apply to this group.

the 1-year period ending on the hiring date.

To be considered a veteran, the applicant must:

Member of a Family

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Have served on active duty (not including training) in

With respect to the qualified IV-A recipient, qualified

the Armed Forces of the United States for more than 180

veteran, food stamp recipient, and long-term family

days or have been discharged or released from active

assistance recipient, an individual whose family receives

duty for a service-connected disability, and

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assistance for the requisite period meets the family

Not have a period of active duty (not including

assistance requirement of the applicable group if the

training) of more than 90 days that ended during the

individual is included on the grant (and thus receives

60-day period ending on the hiring date.

assistance) for some portion of the specified period.

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

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

Gulf Opportunity (GO) Zone (Core

is hired not more than 1 year after the conviction or

release from prison for that felony.

Disaster Area)

4. Designated community resident. An individual

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

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

the portion of the Hurricane Katrina disaster area

date and lives within an empowerment zone, renewal

determined by the Federal Emergency Management

community, or rural renewal county (defined later).

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

5. Vocational rehabilitation referral. An individual

both individual and public assistance from the Federal

who has a physical or mental disability resulting in a

Government. The GO Zone covers the following areas in

substantial handicap to employment and who was

three states.

referred to the employer upon completion of (or while

Alabama. The counties of Baldwin, Choctaw, Clarke,

receiving) rehabilitation services by a rehabilitation

Greene, Hale, Marengo, Mobile, Pickens, Sumter,

agency approved by the state, an employment network

Tuscaloosa, and Washington.

under the Ticket to Work program, or the Department of

Veterans Affairs.

Louisiana. The parishes of Acadia, Ascension,

6. Summer youth employee. An individual who:

Assumption, Calcasieu, Cameron, East Baton Rouge,

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Performs services for the employer between May 1

East Feliciana, Iberia, Iberville, Jefferson, Jefferson

and September 15,

Davis, Lafayette, Lafourche, Livingston, Orleans,

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Instructions For Form 8850 (Rev. June 2007) Page 2

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