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)

Department of the Treasury

Internal Revenue Service

General Instructions

Section references are to the Internal Revenue Code unless 

otherwise noted.

Future Developments

For the latest information about developments related to 

Form 8850 and its instructions, such as legislation enacted 

after they were published, go to IRS.gov/Form8850.

What's New

The Taxpayer Certainty and Disaster Tax Relief Act of 2020 

made the following changes.

• The work opportunity credit has been extended to cover 

certain individuals who begin working for you after 2020 and 

before 2026.

• The empowerment zone designations expired at the end 

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 

empowerment zone to provide for a new termination date. Go 

to IRS.gov/Form8850 for updates on the guidance once it 

becomes available.

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.

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.

You must receive the certification from the SWA 

before you can claim the related credit on Form 5884 

or Form 5884-C.

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 

CAUTION

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member of a targeted group (as defined later, under 

Members of Targeted Groups), the employer completes the 

rest of the form no later than the day the job offer is made. 

Both the job applicant and the employer must sign Form 

8850 no later than the date for submitting the form to the 

SWA.

Instructions for Employer

When and Where To File

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.

Submitting Form 8850 to the SWA is listed in Rev. 

Proc. 2018-58 (section 15, item 12) as an act that 

may be postponed for taxpayers affected by a 

federally declared disaster. For the latest disaster tax relief 

guidance go to IRS.gov/Disaster.

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 

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.

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/

2012-09_IRB#NOT-2012-13.

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 

IRS.gov/pub/irs-irbs/irb02-17.pdf.

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/

wotc/contact/state-workforce-agencies.

Never attach Form 8850 to a tax return or otherwise 

send it to the IRS, regardless of the employee's 

targeted group. Form 8850 must be submitted to the 

SWA of the state in which your business is located (where 

the employee works).

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Feb 25, 2021 Cat. No. 24833J
Additional Requirements for 

Certification

In addition to submitting Form 8850, you must complete and 

send to your state WOTC coordinator either:

• ETA Form 9062, Conditional Certification, if the job 

applicant received this form from a participating agency (for 

example, the Jobs Corps); or

• ETA Form 9061, Individual Characteristics Form (ICF), if 

the job applicant didn't receive a conditional certification; and

• ETA Form 9175, Long-Term Unemployment Recipient 

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

www.doleta.gov/business/Incentives/opptax/how-to-file.

Recordkeeping

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.

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.

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.

2. Qualified veteran. A veteran who is any of the 

following.

• A member of a family that has received Supplemental 

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 

weeks (whether or not consecutive) but less than 6 months in 

the 1-year period ending on the hiring date.

• 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.

• Entitled to compensation for a service-connected disability 

and is hired not more than 1 year after being discharged or 

released from active duty in the U.S. Armed Forces.

• Entitled to compensation for a service-connected disability 

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.

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.

To be considered a veteran, the applicant must:

• Have served on active duty (not including training) in the 

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

• Not have a period of active duty (not including training) of 

more than 90 days that ended during the 60-day period 

ending on the hiring date.

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).

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) 

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.

6. Summer youth employee. An individual who:

• Performs services for the employer between May 1 and 

September 15;

• Is at least age 16 but not yet age 18 on the hiring date (or, 

if later, on May 1);

• Has never worked for the employer before; and

• Lives within an empowerment zone.

7. Recipient of SNAP benefits (food stamps). An 

individual who:

• Is at least age 18 but not yet age 40 on the hiring date, and

• Is a member of a family that:

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.

9. Long-term family assistance recipient. An 

individual who is a member of a family that:

• Has received TANF payments for at least 18 consecutive 

months ending on the hiring date; or

• Receives TANF payments for any 18 months (whether or 

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

• Stopped being eligible for TANF payments because 

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.

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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• Includes a period (which may be less than 27 consecutive 

weeks) in which the individual received unemployment 

compensation under state or federal law.

Member of a Family

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.

Empowerment Zones

The following paragraphs describe areas that were 

designated empowerment zones. For the latest information 

about empowerment zone designations, go to IRS.gov/

Form8850.

Urban areas. Parts of the following urban areas were 

designated empowerment zones.

• Baltimore, MD

• Boston, MA

• Chicago, IL

• Cincinnati, OH

• Cleveland, OH

• Columbia/Sumter, SC

• Columbus, OH

• Cumberland County, NJ

• Detroit, MI

• El Paso, TX

• 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

• Santa Ana, CA

• St. Louis, MO/East St. Louis, IL

• Syracuse, NY

• Tucson, AZ

• Yonkers, NY

Rural areas. Parts of the following rural areas were 

designated empowerment zones.

• 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 

County)

• Kentucky Highlands, KY (part of Wayne County and all of 

Clinton and Jackson Counties)

• Mid-Delta, MS (parts of Bolivar, Holmes, Humphreys, 

Leflore, Sunflower, and Washington Counties)

• Middle Rio Grande FUTURO Communities, TX (parts of 

Dimmit, Maverick, Uvalde, and Zavala Counties)

• Oglala Sioux Tribe, SD (parts of Jackson and Bennett 

Counties and all of Shannon County)

• Rio Grande Valley, TX (parts of Cameron, Hidalgo, Starr, 

and Willacy Counties)

• Southernmost Illinois Delta, IL (parts of Alexander and 

Johnson Counties and all of Pulaski County)

• Southwest Georgia United, GA (part of Crisp County and 

all of Dooly County)

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.

Alaska. The census areas of Aleutians West, 

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.

Colorado. The counties of Cheyenne, Kiowa, and San 

Juan.

Georgia. The counties of Randolph and Stewart.

Illinois. The counties of Alexander, Edwards, Franklin, 

Gallatin, Greene, Hancock, Hardin, Jasper, Knox, 

McDonough, Montgomery, Pulaski, Randolph, Richland, 

Scott, Warren, Wayne, and White.

Indiana. Perry County.

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.

Kentucky. The counties of Bell, Caldwell, Floyd, Harlan, 

Hickman, Leslie, Letcher, Pike, and Union.

Louisiana. The parishes of Bienville, Claiborne, Franklin, 

Jackson, Morehouse, St. Mary, Tensas, Vernon, and 

Webster.

Maine. The counties of Aroostook and Piscataquis.

Michigan. The counties of Gogebic, Marquette, and 

Ontonagon.

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.

Missouri. The counties of Atchison, Carroll, Chariton, Clark, 

Holt, Knox, Mississippi, New Madrid, Pemiscot, and Worth.

Instructions for Form 8850 (March 2021) -3-
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.

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.

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.

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.

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.

-4- Instructions for Form 8850 (March 2021)