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AH XSL/XML Fileid: … ns/I8850/202004/A/XML/Cycle08/source (Init. & Date) _______

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Department of the Treasury
Internal Revenue Service
Instructions for Form 8850

(Rev. April 2020)
(For use with the March 2016 revision of Form 8850, Pre-Screening Notice and
Certification Request for the Work Opportunity Credit)

Members of Targeted Groups), the employer completes the
General Instructions rest of the form no later than the day the job offer is made.
Both the job applicant and the employer must sign Form
Section references are to the Internal Revenue Code unless 8850 no later than the date for submitting the form to the
otherwise noted. SWA.
Future Developments
For the latest information about developments related to Instructions for Employer
Form 8850 and its instructions, such as legislation enacted
after they were published, go to IRS.gov/Form8850. When and Where To File
Don’t file Form 8850 with the IRS. Instead, you must submit it
What's New to the SWA of the state in which your business is located
The Taxpayer Certainty and Disaster Tax Relief Act of 2019 (where the employee works) generally no later than the 28th
made the following changes. calendar day after the date the individual begins working for
• The work opportunity credit has been extended to cover you. However, submitting Form 8850 to the SWA is listed in
certain individuals who begin working for you in 2020. Rev. Proc. 2018-58 (section 15, item 12) as an act that may
• The empowerment zone designations expired at the end be postponed for taxpayers affected by a federally declared
of 2017. However, the Act provides for an extension of the disaster. Notice 2020-23, citing the COVID-19 emergency
designations to the end of 2020. To extend the designations, declaration, allows all employers to submit Form 8850 to the
state and local governments must amend their nominations SWA by July 15, 2020, if the 28th calendar day falls on or
of the designated zones in order to move the termination after April 1, 2020, and before July 15, 2020. Any extensions
date to December 31, 2020. The IRS is working to provide of the July 15 date will be posted at IRS.gov/Form8850.
guidance on how to amend the nomination of an
empowerment zone to provide for a new termination date. Go If the credit expires and is retroactively extended, the
to IRS.gov/Form8850 for updates on the guidance once it TIP IRS may allow you more time to submit Form 8850
becomes available. for an individual who began work while the credit was
expired or for a reasonable time after it was extended. If more
Purpose of Form time is allowed, we will provide details at IRS.gov/Form8850
and in revised Instructions for Form 8850.
Employers use Form 8850 to pre-screen and to make a
written request to the state workforce agency (SWA) of the
Although facsimile submission of Form 8850 is permitted,
state in which their business is located (where the employee
not all states are equipped to accept a faxed copy of Form
works) to certify an individual as a member of a targeted
8850. Contact your state WOTC coordinator as discussed
group for purposes of qualifying for the work opportunity
below and see Notice 2012-13 for details. Notice 2012-13,
credit.
2012-9 I.R.B. 421, is available at IRS.gov/irb/
Submitting Form 8850 to the SWA is but one step in the 2012-09_IRB#NOT-2012-13.
process of qualifying for the work opportunity credit. The Although electronic submission of Form 8850 is permitted,
state work opportunity tax credit (WOTC) coordinator for the not all states are equipped to receive Form 8850
SWA must certify the job applicant is a member of a targeted electronically. Contact your state WOTC coordinator as
group. After starting work, the employee must meet the discussed next and see Announcement 2002-44 and Notice
minimum number-of-hours-worked requirement for the work 2012-13 for details. You can find Announcement 2002-44 on
opportunity credit. Generally, an employer elects to take the page 809 of Internal Revenue Bulletin 2002-17 at
credit by filing Form 5884, Work Opportunity Credit. IRS.gov/pub/irs-irbs/irb02-17.pdf.
However, a tax-exempt organization that hires a qualified
veteran must report the work opportunity credit on Form To get the name, address, phone and fax numbers, and
5884-C, Work Opportunity Credit for Qualified Tax-Exempt email address of the WOTC coordinator for your state, visit
Organizations Hiring Qualified Veterans. the Department of Labor Employment and Training
Administration (ETA) website at www.dol.gov/agencies/eta/
You must receive the certification from the SWA wotc/contact/state-workforce-agencies.
! before you can claim the related credit on Form 5884
CAUTION or Form 5884-C. Never attach Form 8850 to a tax return or otherwise
send it to the IRS, regardless of the employee's
Who Should Complete and Sign the CAUTION! targeted group. Form 8850 must be submitted to the
SWA of the state in which your business is located (where
Form the employee works).
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
member of a targeted group (as defined later, under

Apr 30, 2020 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 hired after 2015 who on the day before the
disabled veterans, which may entitle the employer to a larger individual begins work for the employer, or, if earlier, the day
work opportunity credit than the hiring of other targeted group the individual completes Form 8850 as a pre-screening
members. notice, is in a period of unemployment that:
To be considered a veteran, the applicant must: • Is not less than 27 consecutive weeks, and

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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 (April 2020)                          -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 (April 2020)

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