Instructions for IRS Form 8850 - Pre-screening Notice and Certification Request for the Work Opportunity Credit

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Instructions for Form 8850
Department of the Treasury
Internal Revenue Service
(Rev. March 2016)
Pre-Screening Notice and Certification Request for the Work Opportunity Credit
sign Form 8850 no later than the date for submitting the form
General Instructions
to the SWA.
Section references are to the Internal Revenue Code unless
If the job applicant began working for the employer on or
otherwise noted.
after January 1, 2015, and on or before May 31, 2016, Form
Future Developments
8850 can be completed and signed as described above at
any time as long as it is completed, signed, and submitted to
For the latest information about developments related to
the SWA by June 29, 2016.
Form 8850 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/form8850.
Instructions for Employer
What's New
When and Where To File
The Protecting Americans from Tax Hikes Act of 2015 made
the following changes.
Do not file Form 8850 with the Internal Revenue Service.
The work opportunity credit has been extended to cover
Instead, you must generally submit it to the SWA of the state
certain individuals who began working for you after
in which your business is located (where the employee
December 31, 2014, and before January 1, 2020. For
works) no later than the 28th calendar day after the date the
information about transitional relief, see
Who Should
member of a targeted group begins working for you.
Complete and Sign the Form
and
When and Where To
File.
However, for members of targeted groups who began
Empowerment zone designations have been extended to
working for you on or after January 1, 2015 (January 1, 2016,
cover 2015 and 2016. For details, see
Empowerment
Zones.
for qualified long-term unemployment recipients), and on or
A new targeted group has been added for qualified
before May 31, 2016, you have until June 29, 2016, to submit
long-term unemployment recipients who begin work after
Form 8850 to the SWA.
2015. For details, see
Members of Targeted
Groups.
Although facsimile filing of Form 8850 is permitted, not all
Purpose of Form
states are equipped to accept a faxed copy of Form 8850.
Contact your state WOTC coordinator as discussed below
Employers use Form 8850 to pre-screen and to make a
and see Notice 2012-13 for details. Notice 2012-13, 2012-9
written request to the state workforce agency (SWA) of the
I.R.B. 421, is available at
state in which their business is located (where the employee
www.irs.gov/irb/2012-09_IRB/ar07.html.
works) to certify an individual as a member of a targeted
group for purposes of qualifying for the work opportunity
Although electronic filing of Form 8850 is permitted, not all
credit.
states are equipped to receive Form 8850 electronically.
Submitting Form 8850 to the SWA is but one step in the
Contact your state WOTC coordinator as discussed next and
process of qualifying for the work opportunity credit. The
see Announcement 2002-44 and Notice 2012-13 for details.
state work opportunity tax credit (WOTC) coordinator for the
You can find Announcement 2002-44 on page 809 of Internal
SWA must certify the job applicant is a member of a targeted
Revenue Bulletin 2002-17 at
group. After starting work, the employee must meet the
www.irs.gov/pub/irs-irbs/irb02-17.pdf.
minimum number-of-hours-worked requirement for the work
To get the name, address, phone and fax numbers, and
opportunity credit. Generally, an employer elects to take the
email address of the WOTC coordinator for your state, visit
credit by filing Form 5884, Work Opportunity Credit.
the Department of Labor Employment and Training
However, a tax-exempt organization that hires a qualified
Administration (ETA) website at
veteran should report the work opportunity credit on Form
www.doleta.gov/business/Incentives/opptax.
5884-C, Work Opportunity Credit for Qualified Tax-Exempt
Organizations Hiring Qualified Veterans.
Never attach Form 8850 to a tax return or otherwise
send it to the IRS, regardless of the employee's
You must receive the certification from the SWA
!
targeted group. Form 8850 must be submitted to
before you can claim the related credit on Form
!
CAUTION
the SWA of the state in which your business is located
5884 or Form 5884-C.
CAUTION
(where the employee works).
Who Should Complete and Sign the
Additional Requirements for
Form
Certification
If the job applicant will begin working for the employer after
In addition to filing Form 8850, you must complete and send
May 31, 2016, the job applicant gives information to the
to your state WOTC coordinator either:
employer on or before the day a job offer is made. This
ETA Form 9062, Conditional Certification Form, if the job
information is entered on Form 8850. If the employer believes
the applicant is a member of a targeted group (as defined
applicant received this form from a participating agency (for
example, the Jobs Corps); or
under
Members of Targeted
Groups), the employer
completes the rest of the form no later than the day the job
ETA Form 9061, Individual Characteristics Form, if the job
offer is made. Both the job applicant and the employer must
applicant did not receive a conditional certification. Additional
Mar 18, 2016
Cat. No. 24833J
Instructions for Form 8850
Department of the Treasury
Internal Revenue Service
(Rev. March 2016)
Pre-Screening Notice and Certification Request for the Work Opportunity Credit
sign Form 8850 no later than the date for submitting the form
General Instructions
to the SWA.
Section references are to the Internal Revenue Code unless
If the job applicant began working for the employer on or
otherwise noted.
after January 1, 2015, and on or before May 31, 2016, Form
Future Developments
8850 can be completed and signed as described above at
any time as long as it is completed, signed, and submitted to
For the latest information about developments related to
the SWA by June 29, 2016.
Form 8850 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/form8850.
Instructions for Employer
What's New
When and Where To File
The Protecting Americans from Tax Hikes Act of 2015 made
the following changes.
Do not file Form 8850 with the Internal Revenue Service.
The work opportunity credit has been extended to cover
Instead, you must generally submit it to the SWA of the state
certain individuals who began working for you after
in which your business is located (where the employee
December 31, 2014, and before January 1, 2020. For
works) no later than the 28th calendar day after the date the
information about transitional relief, see
Who Should
member of a targeted group begins working for you.
Complete and Sign the Form
and
When and Where To
File.
However, for members of targeted groups who began
Empowerment zone designations have been extended to
working for you on or after January 1, 2015 (January 1, 2016,
cover 2015 and 2016. For details, see
Empowerment
Zones.
for qualified long-term unemployment recipients), and on or
A new targeted group has been added for qualified
before May 31, 2016, you have until June 29, 2016, to submit
long-term unemployment recipients who begin work after
Form 8850 to the SWA.
2015. For details, see
Members of Targeted
Groups.
Although facsimile filing of Form 8850 is permitted, not all
Purpose of Form
states are equipped to accept a faxed copy of Form 8850.
Contact your state WOTC coordinator as discussed below
Employers use Form 8850 to pre-screen and to make a
and see Notice 2012-13 for details. Notice 2012-13, 2012-9
written request to the state workforce agency (SWA) of the
I.R.B. 421, is available at
state in which their business is located (where the employee
www.irs.gov/irb/2012-09_IRB/ar07.html.
works) to certify an individual as a member of a targeted
group for purposes of qualifying for the work opportunity
Although electronic filing of Form 8850 is permitted, not all
credit.
states are equipped to receive Form 8850 electronically.
Submitting Form 8850 to the SWA is but one step in the
Contact your state WOTC coordinator as discussed next and
process of qualifying for the work opportunity credit. The
see Announcement 2002-44 and Notice 2012-13 for details.
state work opportunity tax credit (WOTC) coordinator for the
You can find Announcement 2002-44 on page 809 of Internal
SWA must certify the job applicant is a member of a targeted
Revenue Bulletin 2002-17 at
group. After starting work, the employee must meet the
www.irs.gov/pub/irs-irbs/irb02-17.pdf.
minimum number-of-hours-worked requirement for the work
To get the name, address, phone and fax numbers, and
opportunity credit. Generally, an employer elects to take the
email address of the WOTC coordinator for your state, visit
credit by filing Form 5884, Work Opportunity Credit.
the Department of Labor Employment and Training
However, a tax-exempt organization that hires a qualified
Administration (ETA) website at
veteran should report the work opportunity credit on Form
www.doleta.gov/business/Incentives/opptax.
5884-C, Work Opportunity Credit for Qualified Tax-Exempt
Organizations Hiring Qualified Veterans.
Never attach Form 8850 to a tax return or otherwise
send it to the IRS, regardless of the employee's
You must receive the certification from the SWA
!
targeted group. Form 8850 must be submitted to
before you can claim the related credit on Form
!
CAUTION
the SWA of the state in which your business is located
5884 or Form 5884-C.
CAUTION
(where the employee works).
Who Should Complete and Sign the
Additional Requirements for
Form
Certification
If the job applicant will begin working for the employer after
In addition to filing Form 8850, you must complete and send
May 31, 2016, the job applicant gives information to the
to your state WOTC coordinator either:
employer on or before the day a job offer is made. This
ETA Form 9062, Conditional Certification Form, if the job
information is entered on Form 8850. If the employer believes
the applicant is a member of a targeted group (as defined
applicant received this form from a participating agency (for
example, the Jobs Corps); or
under
Members of Targeted
Groups), the employer
completes the rest of the form no later than the day the job
ETA Form 9061, Individual Characteristics Form, if the job
offer is made. Both the job applicant and the employer must
applicant did not receive a conditional certification. Additional
Mar 18, 2016
Cat. No. 24833J
information may be required for qualified long-term
hired not more than 1 year after the conviction or release
unemployment recipients.
from prison for that felony.
4. Designated community resident. An individual who
You can get ETA Form 9061 from your local public
is at least age 18 but not yet age 40 on the hiring date and
employment service office or you can download it from the
lives within an empowerment zone or rural renewal county
ETA website at
(defined later).
www.doleta.gov/business/Incentives/opptax.
5. Vocational rehabilitation referral. An individual who
Recordkeeping
has a physical or mental disability resulting in a substantial
handicap to employment and who was referred to the
Keep copies of Forms 8850, any transmittal letters that you
employer upon completion of (or while receiving)
submit to your state WOTC coordinator, and certification
rehabilitation services by a rehabilitation agency approved by
letters you receive from your WOTC coordinator as long as
the state, an employment network under the Ticket to Work
they may be needed for the administration of the provisions
program, or the Department of Veterans Affairs.
relating to the work opportunity credit. Records that support
the credit usually must be kept for 3 years from the date any
6. Summer youth employee. An individual who:
income tax return claiming the credit is due or filed,
Performs services for the employer between May 1 and
whichever is later.
September 15;
Members of Targeted Groups
Is at least age 16 but not yet age 18 on the hiring date (or if
later, on May 1);
A job applicant may be certified as a member of a targeted
Has never worked for the employer before; and
group if he or she is described in one of the following groups.
Lives within an empowerment zone.
1. Qualified IV-A recipient. An individual who is a
7. Recipient of SNAP benefits (food stamps). An
member of a family receiving assistance under a state plan
individual who:
approved under part A of title IV of the Social Security Act
Is at least age 18 but not yet age 40 on the hiring date, and
relating to Temporary Assistance for Needy Families (TANF).
Is a member of a family that:
The assistance must be received for any 9 months during the
a. Has received SNAP benefits for the 6-month period
18-month period ending on the hiring date.
ending on the hiring date; or
2. Qualified veteran. A veteran who is any of the
b. Is no longer eligible for such assistance under section
following.
6(o) of the Food Stamp Act of 1977, but the family received
A member of a family that has received Supplemental
SNAP benefits for at least 3 months of the 5-month period
Nutrition Assistance Program (SNAP) benefits (food stamps)
ending on the hiring date.
for at least a 3-month period during the 15-month period
8. SSI recipient. An individual who is receiving
ending on the hiring date.
supplemental security income benefits under title XVI of the
Unemployed for a period or periods totaling at least 4
Social Security Act (including benefits of the type described
weeks (whether or not consecutive) but less than 6 months in
in section 1616 of the Social Security Act or section 212 of
the 1-year period ending on the hiring date.
Public Law 93-66) for any month ending during the 60-day
Unemployed for a period or periods totaling at least 6
period ending on the hiring date.
months (whether or not consecutive) in the 1-year period
9. Long-term family assistance recipient. An
ending on the hiring date.
individual who is a member of a family that:
Entitled to compensation for a service-connected disability
Has received TANF payments for at least 18 consecutive
and is hired not more than 1 year after being discharged or
months ending on the hiring date; or
released from active duty in the U.S. Armed Forces.
Receives TANF payments for any 18 months (whether or
Entitled to compensation for a service-connected disability
not consecutive) beginning after August 5, 1997, and the
and was unemployed for a period or periods totaling at least
earliest 18-month period beginning after August 5, 1997,
6 months (whether or not consecutive) in the 1-year period
ended during the past 2 years; or
ending on the hiring date.
Stopped being eligible for TANF payments because
Note. Requesting the information in box 4 or box 5 of Form
federal or state law limits the maximum period such
8850 is an exception to the Americans with Disabilities Act's
assistance is payable and the individual is hired not more
prohibition on pre-offer disability-related inquiries. The
than 2 years after such eligibility ended.
purpose of this request is to support the hiring of certain
10. Qualified long-term unemployment recipient. An
disabled veterans, which will entitle the employer to a larger
individual hired after 2015 who on the day before the
work opportunity credit than the hiring of other targeted group
individual begins work for the employer, or, if earlier, the day
members.
the individual completes Form 8850 as a prescreening
To be considered a veteran, the applicant must:
notice, is in a period of unemployment that:
Have served on active duty (not including training) in the
Is not less than 27 consecutive weeks, and
Armed Forces of the United States for more than 180 days or
Includes a period (which may be less than 27 consecutive
have been discharged or released from active duty for a
weeks) in which the individual received unemployment
service-connected disability, and
compensation under state or federal law.
Not have a period of active duty (not including training) of
Member of a Family
more than 90 days that ended during the 60-day period
ending on the hiring date.
With respect to the qualified IV-A recipient, qualified veteran,
3. Qualified ex-felon. An ex-felon who has been
recipient of SNAP benefits (food stamps), and long-term
convicted of a felony under any federal or state law, and is
family assistance recipient, an individual whose family
receives assistance for the requisite period meets the family
-2-
Instructions for Form 8850 (March 2016)
assistance requirement of the applicable group if the
Southernmost Illinois Delta, IL (parts of Alexander and
individual is included on the grant (and thus receives
Johnson Counties and all of Pulaski County)
assistance) for some portion of the specified period.
Southwest Georgia United, GA (part of Crisp County and
all of Dooly County)
Empowerment Zones
Rural Renewal Counties
The following paragraphs describe areas that were
designated empowerment zones. For the latest information
A rural renewal county is a county in a rural area that lost
about empowerment zone designations, go to
www.irs.gov/
population during the 5-year periods 1990 through 1994 and
form8850.
1995 through 1999. Rural renewal counties are listed below.
Urban areas. Parts of the following urban areas were
Alabama. The counties of Butler, Dallas, Macon, Perry,
designated empowerment zones. You can find out if your
Sumter, and Wilcox.
business or an employee's residence is located within an
Alaska. The census areas of Aleutians West,
urban empowerment zone by using the EZ/RC Address
Wrangell-Petersburg, and Yukon-Koyukuk.
Locator at www.hud.gov/crlocator.
Arkansas. The counties of Arkansas, Chicot, Clay, Desha,
Baltimore, MD
Jackson, Lafayette, Lee, Little River, Monroe, Nevada,
Boston, MA
Ouachita, Phillips, Union, and Woodruff.
Chicago, IL
Cincinnati, OH
Colorado. The counties of Cheyenne, Kiowa, and San
Cleveland, OH
Juan.
Columbia/Sumter, SC
Georgia. The counties of Randolph and Stewart.
Columbus, OH
Cumberland County, NJ
Illinois. The counties of Alexander, Edwards, Franklin,
Gallatin, Greene, Hancock, Hardin, Jasper, Knox,
Detroit, MI
McDonough, Montgomery, Pulaski, Randolph, Richland,
El Paso, TX
Scott, Warren, Wayne, and White.
Fresno, CA
Gary/Hammond/East Chicago, IN
Indiana. Perry County.
Huntington, WV/Ironton, OH
Iowa. The counties of Adair, Adams, Appanoose, Audubon,
Jacksonville, FL
Butler, Calhoun, Cass, Cherokee, Clay, Clayton, Emmet,
Knoxville, TN
Floyd, Franklin, Fremont, Hancock, Humboldt, Ida, Keokuk,
Los Angeles, CA (city and county)
Kossuth, Montgomery, Osceola, Palo Alto, Pocahontas,
Miami/Dade County, FL
Poweshiek, Sac, Taylor, Union, Wayne, Winnebago, and
Minneapolis, MN
Worth.
New Haven, CT
Kansas. The counties of Atchison, Barber, Barton, Brown,
New York, NY
Clay, Cloud, Comanche, Decatur, Edwards, Elk, Ellsworth,
Norfolk/Portsmouth, VA
Gove, Graham, Greeley, Greenwood, Harper, Hodgeman,
Oklahoma City, OK
Jewell, Kiowa, Labette, Lane, Lincoln, Marshall, Mitchell,
Philadelphia, PA/Camden, NJ
Montgomery, Ness, Osborne, Phillips, Rawlins, Republic,
Pulaski County, AR
Rooks, Rush, Russell, Scott, Sheridan, Sherman, Smith,
San Antonio, TX
Stafford, Trego, Wallace, Washington, Wichita, and
Santa Ana, CA
Woodson.
St. Louis, MO/East St. Louis, IL
Kentucky. The counties of Bell, Caldwell, Floyd, Harlan,
Syracuse, NY
Hickman, Leslie, Letcher, Pike, and Union.
Tucson, AZ
Yonkers, NY
Louisiana. The parishes of Bienville, Claiborne, Franklin,
Jackson, Morehouse, St. Mary, Tensas, Vernon, and
Rural areas. Parts of the following rural areas were
Webster.
designated empowerment zones. You can find out if your
business or an employee's residence is located within a rural
Maine. The counties of Aroostook and Piscataquis.
empowerment zone by using the EZ/RC Address Locator at
Michigan. The counties of Gogebic, Marquette, and
www.hud.gov/crlocator.
Ontonagon.
Aroostook County, ME (part of Aroostook County)
Desert Communities, CA (part of Riverside County)
Minnesota. The counties of Big Stone, Chippewa,
Griggs-Steele, ND (part of Griggs County and all of Steele
Cottonwood, Faribault, Jackson, Kittson, Koochiching, Lac
County)
Qui Parle, Lincoln, Marshall, Martin, Murray, Norman,
Pipestone, Red Lake, Redwood, Renville, Stevens,
Kentucky Highlands, KY (part of Wayne County and all of
Traverse, Wilkin, and Yellow Medicine.
Clinton and Jackson Counties)
Mid-Delta, MS (parts of Bolivar, Holmes, Humphreys,
Mississippi. The counties of Adams, Coahoma,
Leflore, Sunflower, and Washington Counties)
Humphreys, Montgomery, Quitman, Sharkey, Tallahatchie,
Middle Rio Grande FUTURO Communities, TX (parts of
and Washington.
Dimmit, Maverick, Uvalde, and Zavala Counties)
Missouri. The counties of Atchison, Carroll, Chariton, Clark,
Oglala Sioux Tribe, SD (parts of Jackson and Bennett
Holt, Knox, Mississippi, New Madrid, Pemiscot, and Worth.
Counties and all of Shannon County)
Rio Grande Valley, TX (parts of Cameron, Hidalgo, Starr,
Montana. The counties of Carter, Daniels, Dawson, Deer
and Willacy Counties)
Lodge, Fallon, Garfield, Hill, Liberty, McCone, Petroleum,
-3-
Instructions for Form 8850 (March 2016)
Phillips, Powder River, Prairie, Richland, Roosevelt,
Pennsylvania. The counties of Venango and Warren.
Rosebud, Sheridan, Valley, and Wibaux.
South Carolina. Marlboro County.
Nebraska. The counties of Antelope, Banner, Boone, Box
South Dakota. The counties of Aurora, Campbell, Clark,
Butte, Boyd, Burt, Cedar, Chase, Deuel, Dundy, Fillmore,
Day, Deuel, Douglas, Faulk, Grant, Gregory, Haakon, Hand,
Franklin, Garden, Garfield, Greeley, Hayes, Hitchcock, Holt,
Harding, Hutchinson, Jones, Kingsbury, Marshall,
Jefferson, Johnson, Logan, Nance, Nemaha, Nuckolls,
McPherson, Miner, Perkins, Potter, Sanborn, Spink, Tripp,
Pawnee, Perkins, Red Willow, Richardson, Rock, Sheridan,
and Walworth.
Sherman, Thayer, Thomas, Valley, Webster, and Wheeler.
Texas. The counties of Andrews, Bailey, Baylor, Borden,
Nevada. The counties of Esmeralda, Lander, and Mineral.
Briscoe, Brooks, Castro, Cochran, Coleman, Collingsworth,
New Hampshire. Coos County.
Cottle, Crane, Culberson, Deaf Smith, Dimmit, Eastland,
Fisher, Floyd, Foard, Gray, Hall, Hardeman, Haskell,
New Mexico. The counties of Harding and Quay.
Hemphill, Hockley, Hutchinson, Kenedy, Kent, Knox, Lamb,
New York. The counties of Clinton and Montgomery.
Martin, McCulloch, Morris, Nolan, Oldham, Reagan, Reeves,
Refugio, Roberts, Scurry, Stonewall, Terrell, Terry, Upton,
North Dakota. The counties of Adams, Barnes, Benson,
Ward, Wheeler, Wilbarger, Winkler, Yoakum, and Zavala.
Billings, Bottineau, Burke, Cavalier, Dickey, Divide, Dunn,
Eddy, Emmons, Foster, Golden Valley, Grant, Griggs,
Virginia. The counties of Buchanan, Dickenson, Highland,
Hettinger, Kidder, LaMoure, Logan, McHenry, McIntosh,
and Lee, and the independent cities of Clifton Forge,
McKenzie, McLean, Mercer, Mountrail, Nelson, Oliver,
Covington, Norton, and Staunton.
Pembina, Pierce, Ramsey, Ransom, Renville, Sargent,
West Virginia. The counties of Calhoun, Gilmer, Logan,
Sheridan, Slope, Stark, Steele, Stutsman, Towner, Traill,
McDowell, Mercer, Mingo, Summers, Tucker, Webster,
Walsh, Wells, and Williams.
Wetzel, and Wyoming.
Ohio. The counties of Crawford, Monroe, Paulding, Seneca,
Wyoming. The counties of Carbon and Niobrara.
and Van Wert.
Oklahoma. The counties of Alfalfa, Beaver, Cimarron,
Custer, Dewey, Ellis, Grant, Greer, Harmon, Harper, Kiowa,
Major, Roger Mills, Seminole, Tillman, and Woodward.
-4-
Instructions for Form 8850 (March 2016)

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