The Texas Employment Verification form serves as an essential document that employers complete to confirm an employee's work history and earnings. This form is particularly important for individuals applying for state benefits, as it provides necessary proof of employment. To ensure your information is accurately reported, fill out the form by clicking the button below.
The Texas Employment Verification form serves a crucial role in the employment and benefits landscape of the state. Designed for employers, this form is used to verify the employment status and income of individuals applying for state benefits. It requires the employer to provide essential information, including the employee's name, Social Security number, and job details. The form also requests specifics such as the type of employment—whether full-time or part-time—and the employee's rate of pay. Employers are asked to confirm the employment status, detailing the average hours worked and any additional compensation, such as bonuses or overtime. Additionally, the form includes a section for employers to indicate if health insurance is available to the employee. This information is vital, as it not only assists in determining eligibility for benefits but may also impact tax credits for employers who hire individuals receiving state assistance. Completing the form accurately and returning it promptly is essential for both the employer and the employee. Should questions arise, assistance is readily available through various support channels, ensuring that the process remains smooth and accessible for all parties involved.
Name and Address
Date
Need help? Call 2-1-1 or 877-541-7905.
Fax: 877-447-2839
Mail:
Texas Health and Human Services Commission
P O BOX 149027
Austin, Texas 78714-9027
If you are deaf, hard of hearing, or speech impaired, call 7-1-1 or 800-735-2989. All numbers are free to call.
Case Name
Case No.
This form is for your employer. They need to fill out the form and return it by. You must agree to let them give facts about you.
Fill Out and Sign This Agreement
I,
(print your name) allow HHSC to give my Social Security number (SSN) to the employer listed on this form.
My SSN can be used to get facts about my employment. I also allow the employer listed on this form to give facts asked on this form to HHSC.
Signature
Employer – Your Help Is Needed
Employee or Former Employee
Social Security No.
We need proof that the following person is or was your employee.
Some employers might get tax refunds or tax credits for hiring people who get certain state benefits.
To learn more, go to TexasWorkforce.org/wotc or email the Texas Workforce Commission at [email protected].
Employer please follow these steps.
This person lives in a home in which someone is applying for state benefits. We need to know the amount of money this person makes or made from this job.
1.Please fill out the “Proof of Employment” form on the next page.
2.If a question doesn't apply, mark it with "N/A."
3.Return the form:
To send this back to us, you can either:
(a)give it to the employee listed above,
(b)mail it in the pre-paid envelope, or (c) fax it to 877-447-2839.
Form H1028 / 07-2022
Employment Verification
Form H1028
Page 2 / 07-2022-E
Proof of employment to be filled out by the employer.
Company or Employer
Address (Street, City, State, ZIP code)
Employee Name (as shown on your records)
Employee Address (Street, City, State, ZIP Code – as shown on your records)
Is (or was) this person employed by you?
If yes, what type of job?
Yes
No
Full Time
Part Time
Permanent
Temporary
If no: Stop here – sign and date the bottom of this form and return it.
If yes: Answer all the questions below. If a question doesn’t apply, write “N/A".
Rate of Pay
Per Day
Per Week
Per Month
Per Job
Per Hour
How Often Paid?
Average Hours Per Pay Period
Commissions Tips Bonuses
Overtime Pay
FICA or FIT Withheld
Profit Sharing or Pension Plan
Frequently
Rarely
Never
No If yes, current value?
Health insurance available?
If yes, employee is:
Name of Insurance Company
Not Enrolled
Enrolled with Family Member
Enrolled for Self Only
Date Hired
Date First Check Received
Average Hours Per Week
If Employee
is or was on Leave Without Pay:
Start Date:
End Date:
Do you expect any changes to the above information within the next few months? Yes No
If yes, explain:
On the chart below, list all wages received by this employee during the month(s) of:
Date Pay
Period Ended
Date Employee
Received Paycheck
Actual Hours
Gross
Pay
Other Pay*
(tips, commissions, bonuses)
EITC
Advance
Total Pretax
Contributions
*Please explain (in comments section below) when and how often tips, commissions, or bonuses are received. Comments
If this person is no longer in your employ.
Date Separated
Reason for Separation
Date Final Check Received
Gross Amount of Final Check
Employer – Read, Sign and Date
I confirm that this information is true and correct to the best of my knowledge:
Employer Signature
Title
Area Code and Phone No.
Filling out the Texas Employment Verification form is a straightforward process that requires accurate information about the employee. Once completed, the employer must return the form to the Texas Health and Human Services Commission. Follow these steps to ensure the form is filled out correctly.
After completing these steps, the employer can return the form by giving it to the employee, mailing it in the pre-paid envelope, or faxing it to the provided number. It’s important to ensure that all information is accurate to avoid delays in processing.
The Texas Employment Verification form is a document that employers fill out to confirm the employment status and income details of an employee or former employee. This form is often required when an individual is applying for state benefits, as it helps verify their eligibility based on their employment history.
This form must be completed by the employer of the individual seeking state benefits. The employee or former employee must also agree to allow their employer to share information about their employment. This consent is crucial for the verification process to proceed smoothly.
The employer needs to provide various details, including:
Completing these sections accurately is essential for the employee's benefit application.
The employee must fill out and sign a section of the form, allowing the Texas Health and Human Services Commission (HHSC) to share their Social Security number with the employer. This consent is necessary for the employer to provide the requested employment information.
If any question on the form does not apply to the employee, the employer should mark it as "N/A." This ensures that the form remains clear and concise, allowing for a quicker review process.
The completed Texas Employment Verification form can be returned in one of three ways:
Employers should choose the method that is most convenient for them while ensuring timely submission.
If the individual is no longer employed, the employer must indicate the separation date and the reason for separation on the form. This information is important for the state to understand the individual's current employment status.
If there are anticipated changes in the employment status or income details within the next few months, the employer should indicate this on the form and provide an explanation. This foresight can be helpful for the state in assessing the employee's benefit eligibility.
Employers are required to sign and date the form, confirming that the information provided is true and correct to the best of their knowledge. This signature serves as a declaration of the accuracy of the details submitted.
If you need help with the Texas Employment Verification form, you can call 2-1-1 or 877-541-7905 for assistance. If you are deaf, hard of hearing, or speech impaired, you can reach out via 7-1-1 or 800-735-2989. All of these numbers are free to call.
Incomplete Information: Failing to provide all required fields can lead to delays. Ensure every section is filled out completely.
Incorrect Employee Details: Using the wrong name or address for the employee can cause confusion. Double-check that the information matches your records.
Missing Signatures: Not signing the form is a common oversight. Both the employer and employee need to sign where indicated.
Incorrect Employment Status: Marking the wrong employment status (full-time vs. part-time) can affect benefits. Be accurate when selecting employment type.
Failure to Indicate N/A: If a question doesn’t apply, it’s important to mark it as "N/A." Leaving it blank can lead to assumptions.
Not Providing Pay Information: Omitting details about wages, pay frequency, or hours worked can hinder the verification process. Include all relevant pay details.
Not Following Submission Instructions: Ignoring the submission methods can delay processing. Make sure to fax, mail, or hand-deliver the form as instructed.
Ignoring Future Changes: If there are anticipated changes in employment status or pay, these should be noted. Failing to do so can lead to misunderstandings later.
The Texas Employment Verification form is a crucial document for individuals seeking state benefits. Employers complete this form to confirm an employee's work status and income details. Along with this form, several other documents are commonly used to support employment verification and related processes. Below is a list of these documents, each serving a unique purpose in the employment verification process.
Each of these documents plays a significant role in the employment verification process. They help establish an individual's work history, income, and overall eligibility for benefits. Having these documents readily available can streamline the verification process and ensure that all necessary information is accurately presented.
The Texas Employment Verification form is similar to the IRS Form W-2, which employers use to report an employee's annual wages and the taxes withheld from their paycheck. Both forms require information about the employee's earnings and employment status. The W-2 provides a summary of the employee's total compensation for the year, while the Texas Employment Verification form focuses on the current or past employment details, including pay rates and job type. Both documents serve as proof of employment and income for various purposes, such as applying for benefits or loans.
Another similar document is the Social Security Administration's Form SSA-89, which is used to authorize the release of an individual's Social Security number for verification purposes. Like the Texas Employment Verification form, it requires the individual's consent to share their personal information. Both forms aim to confirm employment status and income, although the SSA-89 specifically targets the verification of Social Security numbers, which can be crucial for employment and benefit applications.
The Employment Eligibility Verification form, commonly known as Form I-9, is also comparable. This form is required for all employees hired in the U.S. to verify their identity and eligibility to work. Similar to the Texas Employment Verification form, the I-9 requires information about the employee's job and employment status. Both forms are essential for ensuring compliance with employment laws and regulations, though the I-9 focuses more on citizenship and work authorization rather than income specifics.
Lastly, the Texas Workforce Commission's Wage Verification form shares similarities with the Texas Employment Verification form. This document is used to confirm an employee's wages for unemployment claims or other benefits. Both forms require detailed information about the employee's pay, hours worked, and employment status. While the Wage Verification form is often used in the context of unemployment benefits, the Texas Employment Verification form serves a broader purpose, including verifying income for state benefits and tax credits.
When filling out the Texas Employment Verification form, it’s essential to approach the task with care. Here’s a list of things you should and shouldn’t do to ensure the process goes smoothly.
By following these guidelines, you can help ensure that the employment verification process is efficient and effective. Remember, accurate information benefits both the employer and the employee.
The Texas Employment Verification form is often misunderstood. Below are eight common misconceptions about this form, along with clarifications for each.
Key Takeaways for Filling Out and Using the Texas Employment Verification Form