Formulaire 8850 Instructions
Instructions pour le formulaire 8850, (Pour utilisation avec la révision de mars 2016 du formulaire 8850, Avis de pré-évaluation et demande de certification pour le crédit d'occasion de travail)
Rév. mars 2021
Formulaires associés
- Formulaire 8850 - Avis de pré-évaluation et demande de certification pour le crédit d'occasion de travail
Department of the Treasury
Internal Revenue Service
Instructions for Form 8850
(Rev. March 2021)
(For use with the March 2016 revision of Form 8850, Pre-Screening Notice and
Certification Request for the Work Opportunity Credit)
member of a targeted group (as defined later, under
General Instructions
Members of Targeted Groups), the employer completes the
rest of the form no later than the day the job offer is made.
Section references are to the Internal Revenue Code unless
otherwise noted.
Both the job applicant and the employer must sign Form
8850 no later than the date for submitting the form to the
SWA.
Future Developments
For the latest information about developments related to
Form 8850 and its instructions, such as legislation enacted
Instructions for Employer
When and Where To File
What's New
Don’t file Form 8850 with the IRS. Instead, you must submit it
to the SWA of the state in which your business is located
(where the employee works) generally no later than the 28th
calendar day after the date the individual begins working for
you.
The Taxpayer Certainty and Disaster Tax Relief Act of 2020
made the following changes.
The work opportunity credit has been extended to cover
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certain individuals who begin working for you after 2020 and
before 2026.
Submitting Form 8850 to the SWA is listed in Rev.
The empowerment zone designations expired at the end
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Proc. 2018-58 (section 15, item 12) as an act that
may be postponed for taxpayers affected by a
TIP
of 2020. However, the Act provides for an extension of the
designations to the end of 2025. To extend the designations,
state and local governments must amend their nominations
of the designated zones in order to move the termination
date to December 31, 2025. The IRS is working to provide
guidance on how to amend the nomination of an
federally declared disaster. For the latest disaster tax relief
If the credit expires and is retroactively extended, the
IRS may allow you more time to submit Form 8850
for an individual who began work while the credit was
TIP
empowerment zone to provide for a new termination date. Go
becomes available.
expired or for a reasonable time after it was extended. If more
time is allowed, we will provide details at IRS.gov/Form8850
and in revised Instructions for Form 8850.
Purpose of Form
Employers use Form 8850 to pre-screen and to make a
written request to the state workforce agency (SWA) of the
state in which their business is located (where the employee
works) to certify an individual as a member of a targeted
group for purposes of qualifying for the work opportunity
credit.
Although facsimile submission of Form 8850 is permitted,
not all states are equipped to accept a faxed copy of Form
8850. Contact your state WOTC coordinator as discussed
below and see Notice 2012-13 for details. Notice 2012-13,
2012-9 I.R.B. 421, is available at IRS.gov/irb/
Submitting Form 8850 to the SWA is but one step in the
process of qualifying for the work opportunity credit. The
state work opportunity tax credit (WOTC) coordinator for the
SWA must certify the job applicant is a member of a targeted
group. After starting work, the employee must meet the
minimum number-of-hours-worked requirement for the work
opportunity credit. Generally, an employer elects to take the
credit by filing Form 5884, Work Opportunity Credit.
However, a tax-exempt organization that hires a qualified
veteran must report the work opportunity credit on Form
5884-C, Work Opportunity Credit for Qualified Tax-Exempt
Organizations Hiring Qualified Veterans.
Although electronic submission of Form 8850 is permitted,
not all states are equipped to receive Form 8850
electronically. Contact your state WOTC coordinator as
discussed next and see Announcement 2002-44 and Notice
2012-13 for details. You can find Announcement 2002-44 on
page 809 of Internal Revenue Bulletin 2002-17 at
To get the name, address, phone and fax numbers, and
email address of the WOTC coordinator for your state, visit
the Department of Labor Employment and Training
Administration (ETA) website at www.dol.gov/agencies/eta/
You must receive the certification from the SWA
Never attach Form 8850 to a tax return or otherwise
before you can claim the related credit on Form 5884
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send it to the IRS, regardless of the employee's
CAUTION
or Form 5884-C.
!
CAUTION
targeted group. Form 8850 must be submitted to the
SWA of the state in which your business is located (where
the employee works).
Who Should Complete and Sign the
Form
The job applicant gives information to the employer on or
before the day a job offer is made. This information is entered
on Form 8850. If the employer believes the applicant is a
Feb 25, 2021
Cat. No. 24833J
Have served on active duty (not including training) in the
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Additional Requirements for
Certification
Armed Forces of the United States for more than 180 days or
have been discharged or released from active duty for a
service-connected disability, and
In addition to submitting Form 8850, you must complete and
send to your state WOTC coordinator either:
Not have a period of active duty (not including training) of
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more than 90 days that ended during the 60-day period
ending on the hiring date.
ETA Form 9062, Conditional Certification, if the job
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applicant received this form from a participating agency (for
example, the Jobs Corps); or
3. Qualified ex-felon. An ex-felon who has been
convicted of a felony under any federal or state statute, and
is hired not more than 1 year after the conviction or release
from prison for that felony.
4. Designated community resident. An individual who
is at least age 18 but not yet age 40 on the hiring date and
lives within an empowerment zone or rural renewal county
(defined later).
ETA Form 9061, Individual Characteristics Form (ICF), if
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the job applicant didn't receive a conditional certification; and
ETA Form 9175, Long-Term Unemployment Recipient
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Self-Attestation Form, if the job applicant is a qualified
long-term unemployment recipient.
You can get ETA Form 9061 and ETA Form 9175 from
your local public employment service office or you can
download it from the ETA website at
5. Vocational rehabilitation referral. An individual who
has a physical or mental disability resulting in a substantial
handicap to employment and who was referred to the
employer upon completion of (or while receiving)
Recordkeeping
rehabilitation services by a rehabilitation agency approved by
the state, an employment network under the Ticket to Work
program, or the Department of Veterans Affairs.
Keep copies of Forms 8850, any transmittal letters that you
submit to your state WOTC coordinator, and certification
letters you receive from your WOTC coordinator as long as
they may be needed for the administration of the provisions
relating to the work opportunity credit. Records that support
the credit usually must be kept for 3 years from the date any
income tax return claiming the credit is due or filed,
whichever is later.
6. Summer youth employee. An individual who:
Performs services for the employer between May 1 and
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September 15;
Is at least age 16 but not yet age 18 on the hiring date (or,
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if later, on May 1);
Has never worked for the employer before; and
Lives within an empowerment zone.
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Members of Targeted Groups
A job applicant may be certified as a member of a targeted
group if he or she is described in one of the following groups.
7. Recipient of SNAP benefits (food stamps). An
individual who:
1. Qualified IV-A recipient. An individual who is a
member of a family receiving assistance under a state plan
approved under part A of title IV of the Social Security Act
relating to Temporary Assistance for Needy Families (TANF).
The assistance must be received for any 9 months during the
18-month period ending on the hiring date.
Is at least age 18 but not yet age 40 on the hiring date, and
Is a member of a family that:
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a. Has received SNAP benefits for the 6-month period
ending on the hiring date; or
b. Is no longer eligible for such assistance under section
6(o) of the Food and Nutrition Act of 2008, but the family
received SNAP benefits for at least 3 months of the 5-month
period ending on the hiring date.
8. SSI recipient. An individual who is receiving
supplemental security income benefits under title XVI of the
Social Security Act (including benefits of the type described
in section 1616 of the Social Security Act or section 212 of
Public Law 93-66) for any month ending during the 60-day
period ending on the hiring date.
2. Qualified veteran. A veteran who is any of the
following.
A member of a family that has received Supplemental
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Nutrition Assistance Program (SNAP) benefits (food stamps)
for at least a 3-month period during the 15-month period
ending on the hiring date.
Unemployed for a period or periods totaling at least 4
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weeks (whether or not consecutive) but less than 6 months in
the 1-year period ending on the hiring date.
9. Long-term family assistance recipient. An
Unemployed for a period or periods totaling at least 6
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individual who is a member of a family that:
months (whether or not consecutive) in the 1-year period
ending on the hiring date.
Has received TANF payments for at least 18 consecutive
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months ending on the hiring date; or
Entitled to compensation for a service-connected disability
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Receives TANF payments for any 18 months (whether or
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and is hired not more than 1 year after being discharged or
released from active duty in the U.S. Armed Forces.
not consecutive) beginning after August 5, 1997, and the
earliest 18-month period beginning after August 5, 1997,
ended during the past 2 years; or
Entitled to compensation for a service-connected disability
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and was unemployed for a period or periods totaling at least
6 months (whether or not consecutive) in the 1-year period
ending on the hiring date.
Stopped being eligible for TANF payments because
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federal or state law limits the maximum period such
assistance is payable and the individual is hired not more
than 2 years after such eligibility ended.
Note. Requesting the information in box 4 or box 5 of Form
8850 is an exception to the Americans with Disabilities Act's
prohibition on pre-offer disability-related inquiries. The
purpose of this request is to support the hiring of certain
disabled veterans, which may entitle the employer to a larger
work opportunity credit than the hiring of other targeted group
members.
10. Qualified long-term unemployment recipient. An
individual who on the day before the individual begins work
for the employer, or, if earlier, the day the individual
completes Form 8850 as a pre-screening notice, is in a
period of unemployment that:
Is not less than 27 consecutive weeks, and
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To be considered a veteran, the applicant must:
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Instructions for Form 8850 (March 2021)
Includes a period (which may be less than 27 consecutive
Rio Grande Valley, TX (parts of Cameron, Hidalgo, Starr,
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weeks) in which the individual received unemployment
compensation under state or federal law.
and Willacy Counties)
Southernmost Illinois Delta, IL (parts of Alexander and
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Johnson Counties and all of Pulaski County)
Member of a Family
Southwest Georgia United, GA (part of Crisp County and
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all of Dooly County)
With respect to the qualified IV-A recipient, qualified veteran,
recipient of SNAP benefits (food stamps), and long-term
family assistance recipient, an individual whose family
receives assistance for the requisite period meets the family
assistance requirement of the applicable group if the
individual is included on the grant (and thus receives
assistance) for some portion of the specified period.
Rural Renewal Counties
A rural renewal county is a county in a rural area that lost
population during the 5-year periods 1990 through 1994 and
1995 through 1999. Rural renewal counties are listed below.
Alabama. The counties of Butler, Dallas, Macon, Perry,
Sumter, and Wilcox.
Empowerment Zones
Alaska. The census areas of Aleutians West,
The following paragraphs describe areas that were
designated empowerment zones. For the latest information
about empowerment zone designations, go to IRS.gov/
Wrangell-Petersburg, and Yukon-Koyukuk.
Arkansas. The counties of Arkansas, Chicot, Clay, Desha,
Jackson, Lafayette, Lee, Little River, Monroe, Nevada,
Ouachita, Phillips, Union, and Woodruff.
Urban areas. Parts of the following urban areas were
designated empowerment zones.
Colorado. The counties of Cheyenne, Kiowa, and San
Baltimore, MD
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Juan.
Boston, MA
Georgia. The counties of Randolph and Stewart.
Chicago, IL
Cincinnati, OH
Illinois. The counties of Alexander, Edwards, Franklin,
Gallatin, Greene, Hancock, Hardin, Jasper, Knox,
McDonough, Montgomery, Pulaski, Randolph, Richland,
Scott, Warren, Wayne, and White.
Cleveland, OH
Columbia/Sumter, SC
Columbus, OH
Cumberland County, NJ
Detroit, MI
Indiana. Perry County.
El Paso, TX
Iowa. The counties of Adair, Adams, Appanoose, Audubon,
Butler, Calhoun, Cass, Cherokee, Clay, Clayton, Emmet,
Floyd, Franklin, Fremont, Hancock, Humboldt, Ida, Keokuk,
Kossuth, Montgomery, Osceola, Palo Alto, Pocahontas,
Poweshiek, Sac, Taylor, Union, Wayne, Winnebago, and
Worth.
Kansas. The counties of Atchison, Barber, Barton, Brown,
Clay, Cloud, Comanche, Decatur, Edwards, Elk, Ellsworth,
Gove, Graham, Greeley, Greenwood, Harper, Hodgeman,
Jewell, Kiowa, Labette, Lane, Lincoln, Marshall, Mitchell,
Montgomery, Ness, Osborne, Phillips, Rawlins, Republic,
Rooks, Rush, Russell, Scott, Sheridan, Sherman, Smith,
Stafford, Trego, Wallace, Washington, Wichita, and
Woodson.
Fresno, CA
Gary/Hammond/East Chicago, IN
Huntington, WV/Ironton, OH
Jacksonville, FL
Knoxville, TN
Los Angeles, CA (city and county)
Miami/Dade County, FL
Minneapolis, MN
New Haven, CT
New York, NY
Norfolk/Portsmouth, VA
Oklahoma City, OK
Philadelphia, PA/Camden, NJ
Pulaski County, AR
San Antonio, TX
Kentucky. The counties of Bell, Caldwell, Floyd, Harlan,
Hickman, Leslie, Letcher, Pike, and Union.
Santa Ana, CA
St. Louis, MO/East St. Louis, IL
Syracuse, NY
Louisiana. The parishes of Bienville, Claiborne, Franklin,
Jackson, Morehouse, St. Mary, Tensas, Vernon, and
Webster.
Tucson, AZ
Yonkers, NY
Maine. The counties of Aroostook and Piscataquis.
Rural areas. Parts of the following rural areas were
Michigan. The counties of Gogebic, Marquette, and
designated empowerment zones.
Ontonagon.
Aroostook County, ME (part of Aroostook County)
Desert Communities, CA (part of Riverside County)
Griggs-Steele, ND (part of Griggs County and all of Steele
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Minnesota. The counties of Big Stone, Chippewa,
Cottonwood, Faribault, Jackson, Kittson, Koochiching, Lac
Qui Parle, Lincoln, Marshall, Martin, Murray, Norman,
Pipestone, Red Lake, Redwood, Renville, Stevens,
Traverse, Wilkin, and Yellow Medicine.
Mississippi. The counties of Adams, Coahoma,
Humphreys, Montgomery, Quitman, Sharkey, Tallahatchie,
and Washington.
County)
Kentucky Highlands, KY (part of Wayne County and all of
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Clinton and Jackson Counties)
Mid-Delta, MS (parts of Bolivar, Holmes, Humphreys,
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Leflore, Sunflower, and Washington Counties)
Middle Rio Grande FUTURO Communities, TX (parts of
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Dimmit, Maverick, Uvalde, and Zavala Counties)
Oglala Sioux Tribe, SD (parts of Jackson and Bennett
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Missouri. The counties of Atchison, Carroll, Chariton, Clark,
Counties and all of Shannon County)
Holt, Knox, Mississippi, New Madrid, Pemiscot, and Worth.
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Instructions for Form 8850 (March 2021)
Montana. The counties of Carter, Daniels, Dawson, Deer
Lodge, Fallon, Garfield, Hill, Liberty, McCone, Petroleum,
Phillips, Powder River, Prairie, Richland, Roosevelt,
Rosebud, Sheridan, Valley, and Wibaux.
Nebraska. The counties of Antelope, Banner, Boone, Box
Butte, Boyd, Burt, Cedar, Chase, Deuel, Dundy, Fillmore,
Franklin, Garden, Garfield, Greeley, Hayes, Hitchcock, Holt,
Jefferson, Johnson, Logan, Nance, Nemaha, Nuckolls,
Pawnee, Perkins, Red Willow, Richardson, Rock, Sheridan,
Sherman, Thayer, Thomas, Valley, Webster, and Wheeler.
Nevada. The counties of Esmeralda, Lander, and Mineral.
New Hampshire. Coos County.
New Mexico. The counties of Harding and Quay.
New York. The counties of Clinton and Montgomery.
Pennsylvania. The counties of Venango and Warren.
South Carolina. Marlboro County.
South Dakota. The counties of Aurora, Campbell, Clark,
Day, Deuel, Douglas, Faulk, Grant, Gregory, Haakon, Hand,
Harding, Hutchinson, Jones, Kingsbury, Marshall,
McPherson, Miner, Perkins, Potter, Sanborn, Spink, Tripp,
and Walworth.
Texas. The counties of Andrews, Bailey, Baylor, Borden,
Briscoe, Brooks, Castro, Cochran, Coleman, Collingsworth,
Cottle, Crane, Culberson, Deaf Smith, Dimmit, Eastland,
Fisher, Floyd, Foard, Gray, Hall, Hardeman, Haskell,
Hemphill, Hockley, Hutchinson, Kenedy, Kent, Knox, Lamb,
Martin, McCulloch, Morris, Nolan, Oldham, Reagan, Reeves,
Refugio, Roberts, Scurry, Stonewall, Terrell, Terry, Upton,
Ward, Wheeler, Wilbarger, Winkler, Yoakum, and Zavala.
North Dakota. The counties of Adams, Barnes, Benson,
Billings, Bottineau, Burke, Cavalier, Dickey, Divide, Dunn,
Eddy, Emmons, Foster, Golden Valley, Grant, Griggs,
Hettinger, Kidder, LaMoure, Logan, McHenry, McIntosh,
McKenzie, McLean, Mercer, Mountrail, Nelson, Oliver,
Pembina, Pierce, Ramsey, Ransom, Renville, Sargent,
Sheridan, Slope, Stark, Steele, Stutsman, Towner, Traill,
Walsh, Wells, and Williams.
Virginia. The counties of Buchanan, Dickenson, Highland,
and Lee, and the independent cities of Clifton Forge,
Covington, Norton, and Staunton.
West Virginia. The counties of Calhoun, Gilmer, Logan,
McDowell, Mercer, Mingo, Summers, Tucker, Webster,
Wetzel, and Wyoming.
Wyoming. The counties of Carbon and Niobrara.
Ohio. The counties of Crawford, Monroe, Paulding, Seneca,
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.
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Instructions for Form 8850 (March 2021)