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                                                                                             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      Both the job applicant and the employer must sign Form 
otherwise noted.                                                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
after they were published, go to IRS.gov/Form8850.
                                                                When and Where To File
What's New                                                      Don’t file Form 8850 with the IRS. Instead, you must submit it 
The Taxpayer Certainty and Disaster Tax Relief Act of 2020      to the SWA of the state in which your business is located 
made the following changes.                                     (where the employee works) generally no later than the 28th 
•  The work opportunity credit has been extended to cover       calendar day after the date the individual begins working for 
certain individuals who begin working for you after 2020 and    you.
before 2026.
•  The empowerment zone designations expired at the end                 Submitting Form 8850 to the SWA is listed in Rev. 
of 2020. However, the Act provides for an extension of the      TIP     Proc. 2018-58 (section 15, item 12) as an act that 
designations to the end of 2025. To extend the designations,            may be postponed for taxpayers affected by a 
state and local governments must amend their nominations        federally declared disaster. For the latest disaster tax relief 
of the designated zones in order to move the termination        guidance go to IRS.gov/Disaster.

date to December 31, 2025. The IRS is working to provide                If the credit expires and is retroactively extended, the 
guidance on how to amend the nomination of an                   TIP     IRS may allow you more time to submit Form 8850 
empowerment zone to provide for a new termination date. Go              for an individual who began work while the credit was 
to IRS.gov/Form8850 for updates on the guidance once it         expired or for a reasonable time after it was extended. If more 
becomes available.                                              time is allowed, we will provide details at IRS.gov/Form8850 
Purpose of Form                                                 and in revised Instructions for Form 8850.

Employers use Form 8850 to pre-screen and to make a             Although facsimile submission of Form 8850 is permitted, 
written request to the state workforce agency (SWA) of the      not all states are equipped to accept a faxed copy of Form 
state in which their business is located (where the employee    8850. Contact your state WOTC coordinator as discussed 
works) to certify an individual as a member of a targeted       below and see Notice 2012-13 for details. Notice 2012-13, 
group for purposes of qualifying for the work opportunity       2012-9 I.R.B. 421, is available at IRS.gov/irb/
credit.                                                         2012-09_IRB#NOT-2012-13.
   Submitting Form 8850 to the SWA is but one step in the       Although electronic submission of Form 8850 is permitted, 
process of qualifying for the work opportunity credit. The      not all states are equipped to receive Form 8850 
state work opportunity tax credit (WOTC) coordinator for the    electronically. Contact your state WOTC coordinator as 
SWA must certify the job applicant is a member of a targeted    discussed next and see Announcement 2002-44 and Notice 
group. After starting work, the employee must meet the          2012-13 for details. You can find Announcement 2002-44 on 
minimum number-of-hours-worked requirement for the work         page 809 of Internal Revenue Bulletin 2002-17 at 
opportunity credit. Generally, an employer elects to take the   IRS.gov/pub/irs-irbs/irb02-17.pdf.
credit by filing Form 5884, Work Opportunity Credit. 
However, a tax-exempt organization that hires a qualified       To get the name, address, phone and fax numbers, and 
veteran must report the work opportunity credit on Form         email address of the WOTC coordinator for your state, visit 
5884-C, Work Opportunity Credit for Qualified Tax-Exempt        the Department of Labor Employment and Training 
Organizations Hiring Qualified Veterans.                        Administration (ETA) website at www.dol.gov/agencies/eta/
                                                                wotc/contact/state-workforce-agencies.
        You must receive the certification from the SWA 
                                                                        Never attach Form 8850 to a tax return or otherwise 
CAUTION or Form 5884-C.
   !    before you can claim the related credit on Form 5884    !       send it to the IRS, regardless of the employee's 
                                                                CAUTION targeted group. Form 8850 must be submitted to the 
                                                                SWA of the state in which your business is located (where 
Who Should Complete and Sign the 
                                                                the employee works).
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

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Additional Requirements for                                           • Have served on active duty (not including training) in the 
                                                                      Armed Forces of the United States for more than 180 days or 
Certification                                                         have been discharged or released from active duty for a 
In addition to submitting Form 8850, you must complete and            service-connected disability, and
send to your state WOTC coordinator either:                           • Not have a period of active duty (not including training) of 
• ETA Form 9062, Conditional Certification, if the job                more than 90 days that ended during the 60-day period 
applicant received this form from a participating agency (for         ending on the hiring date.
example, the Jobs Corps); or                                            3.  Qualified ex-felon. An ex-felon who has been 
• ETA Form 9061, Individual Characteristics Form (ICF), if            convicted of a felony under any federal or state statute, and 
the job applicant didn't receive a conditional certification; and     is hired not more than 1 year after the conviction or release 
• ETA Form 9175, Long-Term Unemployment Recipient                     from prison for that felony.
Self-Attestation Form, if the job applicant is a qualified              4.  Designated community resident. An individual who 
long-term unemployment recipient.                                     is at least age 18 but not yet age 40 on the hiring date and 
  You can get ETA Form 9061 and ETA Form 9175 from                    lives within an empowerment zone or rural renewal county 
your local public employment service office or you can                (defined later).
download it from the ETA website at                                     5.  Vocational rehabilitation referral. An individual who 
www.doleta.gov/business/Incentives/opptax/how-to-file.                has a physical or mental disability resulting in a substantial 
                                                                      handicap to employment and who was referred to the 
Recordkeeping                                                         employer upon completion of (or while receiving) 
Keep copies of Forms 8850, any transmittal letters that you           rehabilitation services by a rehabilitation agency approved by 
submit to your state WOTC coordinator, and certification              the state, an employment network under the Ticket to Work 
letters you receive from your WOTC coordinator as long as             program, or the Department of Veterans Affairs.
they may be needed for the administration of the provisions             6.  Summer youth employee. An individual who:
relating to the work opportunity credit. Records that support         • Performs services for the employer between May 1 and 
the credit usually must be kept for 3 years from the date any         September 15;
income tax return claiming the credit is due or filed,                • Is at least age 16 but not yet age 18 on the hiring date (or, 
whichever is later.                                                   if later, on May 1);
                                                                      • Has never worked for the employer before; and
Members of Targeted Groups                                            • Lives within an empowerment zone.
A job applicant may be certified as a member of a targeted              7.  Recipient of SNAP benefits (food stamps). An 
group if he or she is described in one of the following groups.       individual who:
  1.  Qualified IV-A recipient. An individual who is a                • Is at least age 18 but not yet age 40 on the hiring date, and
member of a family receiving assistance under a state plan            • Is a member of a family that:
approved under part A of title IV of the Social Security Act            a. Has received SNAP benefits for the 6-month period 
relating to Temporary Assistance for Needy Families (TANF).           ending on the hiring date; or
The assistance must be received for any 9 months during the 
18-month period ending on the hiring date.                              b. Is no longer eligible for such assistance under section 
                                                                      6(o) of the Food and Nutrition Act of 2008, but the family 
  2.  Qualified veteran. A veteran who is any of the                  received SNAP benefits for at least 3 months of the 5-month 
following.                                                            period ending on the hiring date.
• A member of a family that has received Supplemental                   8.  SSI recipient. An individual who is receiving 
Nutrition Assistance Program (SNAP) benefits (food stamps)            supplemental security income benefits under title XVI of the 
for at least a 3-month period during the 15-month period              Social Security Act (including benefits of the type described 
ending on the hiring date.                                            in section 1616 of the Social Security Act or section 212 of 
• Unemployed for a period or periods totaling at least 4              Public Law 93-66) for any month ending during the 60-day 
weeks (whether or not consecutive) but less than 6 months in          period ending on the hiring date.
the 1-year period ending on the hiring date.
• Unemployed for a period or periods totaling at least 6                9.  Long-term family assistance recipient. An 
months (whether or not consecutive) in the 1-year period              individual who is a member of a family that:
ending on the hiring date.                                            • Has received TANF payments for at least 18 consecutive 
• Entitled to compensation for a service-connected disability         months ending on the hiring date; or
and is hired not more than 1 year after being discharged or           • Receives TANF payments for any 18 months (whether or 
released from active duty in the U.S. Armed Forces.                   not consecutive) beginning after August 5, 1997, and the 
• Entitled to compensation for a service-connected disability         earliest 18-month period beginning after August 5, 1997, 
and was unemployed for a period or periods totaling at least          ended during the past 2 years; or
6 months (whether or not consecutive) in the 1-year period            • Stopped being eligible for TANF payments because 
ending on the hiring date.                                            federal or state law limits the maximum period such 
Note. Requesting the information in box 4 or box 5 of Form            assistance is payable and the individual is hired not more 
8850 is an exception to the Americans with Disabilities Act's         than 2 years after such eligibility ended.
prohibition on pre-offer disability-related inquiries. The              10. Qualified long-term unemployment recipient. An 
purpose of this request is to support the hiring of certain           individual who on the day before the individual begins work 
disabled veterans, which may entitle the employer to a larger         for the employer, or, if earlier, the day the individual 
work opportunity credit than the hiring of other targeted group       completes Form 8850 as a pre-screening notice, is in a 
members.                                                              period of unemployment that:
  To be considered a veteran, the applicant must:                     • Is not less than 27 consecutive weeks, and

                                                                  -2-                     Instructions for Form 8850 (March 2021)

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• Includes a period (which may be less than 27 consecutive          • Rio Grande Valley, TX (parts of Cameron, Hidalgo, Starr, 
weeks) in which the individual received unemployment                and Willacy Counties)
compensation under state or federal law.                            • Southernmost Illinois Delta, IL (parts of Alexander and 
                                                                    Johnson Counties and all of Pulaski County)
Member of a Family                                                  • Southwest Georgia United, GA (part of Crisp County and 
With respect to the qualified IV-A recipient, qualified veteran,    all of Dooly County)
recipient of SNAP benefits (food stamps), and long-term 
family assistance recipient, an individual whose family             Rural Renewal Counties
receives assistance for the requisite period meets the family       A rural renewal county is a county in a rural area that lost 
assistance requirement of the applicable group if the               population during the 5-year periods 1990 through 1994 and 
individual is included on the grant (and thus receives              1995 through 1999. Rural renewal counties are listed below.
assistance) for some portion of the specified period.               Alabama.  The counties of Butler, Dallas, Macon, Perry, 
                                                                    Sumter, and Wilcox.
Empowerment Zones
The following paragraphs describe areas that were                   Alaska.   The census areas of Aleutians West, 
designated empowerment zones. For the latest information            Wrangell-Petersburg, and Yukon-Koyukuk.
about empowerment zone designations, go to IRS.gov/                 Arkansas.  The counties of Arkansas, Chicot, Clay, Desha, 
Form8850.                                                           Jackson, Lafayette, Lee, Little River, Monroe, Nevada, 
Urban areas.  Parts of the following urban areas were               Ouachita, Phillips, Union, and Woodruff.
designated empowerment zones.                                       Colorado. The counties of Cheyenne, Kiowa, and San 
• Baltimore, MD                                                     Juan.
• Boston, MA
• Chicago, IL                                                       Georgia.  The counties of Randolph and Stewart.
• Cincinnati, OH                                                    Illinois. The counties of Alexander, Edwards, Franklin, 
• Cleveland, OH                                                     Gallatin, Greene, Hancock, Hardin, Jasper, Knox, 
• Columbia/Sumter, SC                                               McDonough, Montgomery, Pulaski, Randolph, Richland, 
• Columbus, OH                                                      Scott, Warren, Wayne, and White.
• Cumberland County, NJ
• Detroit, MI                                                       Indiana.  Perry County.
• El Paso, TX                                                       Iowa. The counties of Adair, Adams, Appanoose, Audubon, 
• Fresno, CA                                                        Butler, Calhoun, Cass, Cherokee, Clay, Clayton, Emmet, 
• Gary/Hammond/East Chicago, IN                                     Floyd, Franklin, Fremont, Hancock, Humboldt, Ida, Keokuk, 
• Huntington, WV/Ironton, OH                                        Kossuth, Montgomery, Osceola, Palo Alto, Pocahontas, 
• Jacksonville, FL                                                  Poweshiek, Sac, Taylor, Union, Wayne, Winnebago, and 
• Knoxville, TN                                                     Worth.
• Los Angeles, CA (city and county)
                                                                    Kansas.   The counties of Atchison, Barber, Barton, Brown, 
• Miami/Dade County, FL
                                                                    Clay, Cloud, Comanche, Decatur, Edwards, Elk, Ellsworth, 
• Minneapolis, MN
                                                                    Gove, Graham, Greeley, Greenwood, Harper, Hodgeman, 
• New Haven, CT
                                                                    Jewell, Kiowa, Labette, Lane, Lincoln, Marshall, Mitchell, 
• New York, NY
                                                                    Montgomery, Ness, Osborne, Phillips, Rawlins, Republic, 
• Norfolk/Portsmouth, VA
                                                                    Rooks, Rush, Russell, Scott, Sheridan, Sherman, Smith, 
• Oklahoma City, OK
                                                                    Stafford, Trego, Wallace, Washington, Wichita, and 
• Philadelphia, PA/Camden, NJ
                                                                    Woodson.
• Pulaski County, AR
• San Antonio, TX                                                   Kentucky.  The counties of Bell, Caldwell, Floyd, Harlan, 
• Santa Ana, CA                                                     Hickman, Leslie, Letcher, Pike, and Union.
• St. Louis, MO/East St. Louis, IL                                  Louisiana. The parishes of Bienville, Claiborne, Franklin, 
• Syracuse, NY                                                      Jackson, Morehouse, St. Mary, Tensas, Vernon, and 
• Tucson, AZ                                                        Webster.
• Yonkers, NY
                                                                    Maine. The counties of Aroostook and Piscataquis.
Rural areas.  Parts of the following rural areas were 
designated empowerment zones.                                       Michigan. The counties of Gogebic, Marquette, and 
• Aroostook County, ME (part of Aroostook County)                   Ontonagon.
• 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, 
• Kentucky Highlands, KY (part of Wayne County and all of           Pipestone, Red Lake, Redwood, Renville, Stevens, 
Clinton and Jackson Counties)                                       Traverse, Wilkin, and Yellow Medicine.
• Mid-Delta, MS (parts of Bolivar, Holmes, Humphreys, 
Leflore, Sunflower, and Washington Counties)                        Mississippi. The counties of Adams, Coahoma, 
• Middle Rio Grande FUTURO Communities, TX (parts of                Humphreys, Montgomery, Quitman, Sharkey, Tallahatchie, 
Dimmit, Maverick, Uvalde, and Zavala Counties)                      and Washington.
• Oglala Sioux Tribe, SD (parts of Jackson and Bennett              Missouri. The counties of Atchison, Carroll, Chariton, Clark, 
Counties and all of Shannon County)                                 Holt, Knox, Mississippi, New Madrid, Pemiscot, and Worth.

Instructions for Form 8850 (March 2021)                          -3-

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Montana. The counties of Carter, Daniels, Dawson, Deer           Pennsylvania.  The counties of Venango and Warren.
Lodge, Fallon, Garfield, Hill, Liberty, McCone, Petroleum, 
                                                                 South Carolina. Marlboro County.
Phillips, Powder River, Prairie, Richland, Roosevelt, 
Rosebud, Sheridan, Valley, and Wibaux.                           South Dakota.  The counties of Aurora, Campbell, Clark, 
                                                                 Day, Deuel, Douglas, Faulk, Grant, Gregory, Haakon, Hand, 
Nebraska. The counties of Antelope, Banner, Boone, Box 
                                                                 Harding, Hutchinson, Jones, Kingsbury, Marshall, 
Butte, Boyd, Burt, Cedar, Chase, Deuel, Dundy, Fillmore, 
                                                                 McPherson, Miner, Perkins, Potter, Sanborn, Spink, Tripp, 
Franklin, Garden, Garfield, Greeley, Hayes, Hitchcock, Holt, 
                                                                 and Walworth.
Jefferson, Johnson, Logan, Nance, Nemaha, Nuckolls, 
Pawnee, Perkins, Red Willow, Richardson, Rock, Sheridan,         Texas. The counties of Andrews, Bailey, Baylor, Borden, 
Sherman, Thayer, Thomas, Valley, Webster, and Wheeler.           Briscoe, Brooks, Castro, Cochran, Coleman, Collingsworth, 
                                                                 Cottle, Crane, Culberson, Deaf Smith, Dimmit, Eastland, 
Nevada. The counties of Esmeralda, Lander, and Mineral.
                                                                 Fisher, Floyd, Foard, Gray, Hall, Hardeman, Haskell, 
New Hampshire. Coos County.                                      Hemphill, Hockley, Hutchinson, Kenedy, Kent, Knox, Lamb, 
                                                                 Martin, McCulloch, Morris, Nolan, Oldham, Reagan, Reeves, 
New Mexico.  The counties of Harding and Quay.
                                                                 Refugio, Roberts, Scurry, Stonewall, Terrell, Terry, Upton, 
New York. The counties of Clinton and Montgomery.                Ward, Wheeler, Wilbarger, Winkler, Yoakum, and Zavala.
North Dakota. The counties of Adams, Barnes, Benson,             Virginia. The counties of Buchanan, Dickenson, Highland, 
Billings, Bottineau, Burke, Cavalier, Dickey, Divide, Dunn,      and Lee, and the independent cities of Clifton Forge, 
Eddy, Emmons, Foster, Golden Valley, Grant, Griggs,              Covington, Norton, and Staunton.
Hettinger, Kidder, LaMoure, Logan, McHenry, McIntosh, 
                                                                 West Virginia. The counties of Calhoun, Gilmer, Logan, 
McKenzie, McLean, Mercer, Mountrail, Nelson, Oliver, 
                                                                 McDowell, Mercer, Mingo, Summers, Tucker, Webster, 
Pembina, Pierce, Ramsey, Ransom, Renville, Sargent, 
                                                                 Wetzel, and Wyoming.
Sheridan, Slope, Stark, Steele, Stutsman, Towner, Traill, 
Walsh, Wells, and Williams.                                      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.

                                                             -4-                 Instructions for Form 8850 (March 2021)