Instructions For Form 8850 - 2006 (Page 2 of 3) in pdf

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Is a member of a family that had income on an

Additional Requirements for

annual basis of 70% or less of the Bureau of Labor

Certification

Statistics lower living standard during the 6 months

immediately preceding the earlier of the month the

In addition to filing Form 8850, you must complete and

income determination occurs or the month in which the

send to your state’s WOTC coordinator either:

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hiring date occurs.

ETA Form 9062, Conditional Certification Form, if the

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

job applicant received this form from a participating

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

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

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empowerment zone, enterprise community, or renewal

ETA Form 9061, Individual Characteristics Form, if the

community.

job applicant did not receive a conditional certification.

5. Vocational rehabilitation referral. An individual

You can get ETA Form 9061 from your local public

who has a physical or mental disability resulting in a

employment service office or you can download it from

substantial handicap to employment and who was

the ETA web site at

referred to the employer upon completion of (or while

receiving) rehabilitation services by a rehabilitation

Recordkeeping

agency approved by the state, an employment network

Keep copies of Forms 8850, along with any transmittal

under the Ticket to Work program, or the Department of

letters that you submit to your SESA, as long as they

Veterans Affairs.

may be needed for the administration of the Internal

6. Summer youth employee. An individual who:

Revenue Code provisions relating to the work opportunity

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Performs services for the employer between May 1

credit and the welfare-to-work credit. Records that

and September 15,

support these credits usually must be kept for 3 years

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

from the date any income tax return claiming the credits

later, on May 1),

is due or filed, whichever is later.

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Has never worked for the employer before, and

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Hurricane Katrina employee. Form 8850 should

Lives within an empowerment zone, enterprise

not be filed with the state SESA for employees

community, or renewal community.

who only check box 1 on Form 8850. Employers

CAUTION

7. Food stamp recipient. An individual who:

should keep Form 8850 for their records. If a prior

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Is at least age 18 but not yet age 25 on the hiring

version of Form 8850 was sent to the state SESA

date, and

indicating the employee is a Hurricane Katrina employee,

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Is a member of a family that —

the employer and employee should complete this version

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

of Form 8850 for the employer to retain for its records.

ending on the hiring date or

Do not attach Form 8850 to a tax return.

b. Is no longer eligible for such assistance under

Members of Targeted Groups

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

family received food stamps for at least 3 months of the

A job applicant may be certified as a member of a

5-month period ending on the hiring date.

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

8. SSI recipient. An individual who is receiving

following groups.

supplemental security income benefits under title XVI of

1. Qualified IV-A recipient. A member of a family

the Social Security Act (including benefits of the type

receiving assistance under a state plan approved under

described in section 1616 of the Social Security Act or

part A of title IV of the Social Security Act relating to

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

Temporary Assistance for Needy Families (TANF). The

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

assistance must be received for any 9 months during the

9. Hurricane Katrina employee. A Hurricane Katrina

18-month period that ends on the hiring date.

employee is:

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

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A person who, on August 28, 2005, had a main

family receiving assistance under the Food Stamp

home in the core disaster area and, within a two-year

program for at least a 3-month period during the

period beginning on this date, is hired to perform services

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

principally in the core disaster area; or

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

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A person who, on August 28, 2005, had a main

Have served on active duty (not including training) in

home in the core disaster area, was displaced from the

the Armed Forces of the United States for more than 180

main home as a result of Hurricane Katrina, and was

days or have been discharged or released from active

hired during the period beginning on August 28, 2005,

duty for a service-connected disability and

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and ending on December 31, 2005, for a job located

Not have a period of active duty (not including

outside the core disaster area.

training) of more than 90 days that ended during the

60-day period ending on the hiring date.

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

3. Qualified ex-felon. An ex-felon who:

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

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Has been convicted of a felony under any Federal

the portion of the Hurricane Katrina disaster area

or state law,

determined by the Federal Emergency Management

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Is hired not more than 1 year after the conviction or

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

release from prison for that felony, and

both individual and public assistance from the Federal

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Instructions For Form 8850 - 2006 Page 2

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