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Understanding the Texas Employment Verification form is essential for both employees and employers, especially in the context of state benefits applications. This form serves a crucial purpose: it allows employers to provide necessary employment details about their current or former employees to the Texas Health and Human Services Commission (HHSC). Key elements of the form include the employee’s name and Social Security number, which the employee must consent to share. Employers are responsible for verifying employment status, job type, and salary details, including hours worked and pay frequency. The form also requests information about any benefits the employee may have, such as health insurance or retirement plans. By completing this form accurately and returning it promptly—either by mail, fax, or directly to the employee—employers can help facilitate the benefits application process. Additionally, the form includes a section for comments, allowing employers to clarify any unique circumstances regarding the employee’s work history. Overall, this verification process is not just a bureaucratic step; it can significantly impact the financial well-being of employees seeking assistance.

Preview - Texas Employment Verification Form

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

Date

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

Yes

No

Frequently

Rarely

Never

Yes

No

Yes

No If yes, current value?

Health insurance available?

If yes, employee is:

 

 

 

Name of Insurance Company

Yes

No

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

 

Date

Title

Area Code and Phone No.

 

 

 

 

 

 

 

 

 

 

 

 

Document Specifics

Fact Name Fact Details
Form Purpose This form verifies employment for individuals applying for state benefits.
Governing Law The Texas Employment Verification form is governed by Texas state law related to public assistance programs.
Employer Responsibility Employers must complete and return the form to verify employment status.
Contact Information For assistance, individuals can call 2-1-1 or 877-541-7905.
Employee Consent Employees must agree to allow their Social Security number to be shared with their employer.
Submission Methods Employers can return the form via mail, fax, or by giving it to the employee.
Proof of Employment Employers must provide proof of employment details, including rate of pay and job type.
Leave Without Pay The form requires information about any leave without pay for the employee.
Final Check Details If the employee is no longer employed, the employer must provide details about the final paycheck.

Texas Employment Verification: Usage Instruction

Completing the Texas Employment Verification form requires careful attention to detail. Once the form is filled out, it should be returned to the appropriate agency by the employer. This process ensures that the necessary employment information is accurately reported and can assist in various state benefit applications.

  1. Begin by entering your Name and Address at the top of the form.
  2. Fill in the Date on which you are completing the form.
  3. Provide the Case Name and Case Number in the designated fields.
  4. As the employee, print your name where indicated to allow the employer to share your information.
  5. Sign and date the agreement allowing the Texas Health and Human Services Commission (HHSC) to share your Social Security number (SSN) with the employer.
  6. Employers should fill out the Proof of Employment section, including their Company or Employer Address.
  7. Enter the Employee Name and Employee Address as it appears in their records.
  8. Indicate if the employee is or was employed by checking Yes or No.
  9. If employed, specify the type of job (Full Time, Part Time, Permanent, Temporary).
  10. Complete the Rate of Pay section, indicating how often the employee is paid.
  11. Fill in the Average Hours Per Pay Period and any additional compensation information such as commissions, tips, and bonuses.
  12. Indicate if health insurance is available and provide the name of the insurance company if applicable.
  13. Record the Date Hired and Date First Check Received.
  14. If the employee is or was on Leave Without Pay, provide the Start Date and End Date.
  15. Answer whether there are expected changes to the information in the coming months.
  16. Complete the wage chart for the specified month(s), detailing gross pay and any other payments received.
  17. If the employee is no longer with the company, provide the Date Separated, Reason for Separation, and Date Final Check Received.
  18. Finally, the employer must sign and date the form, confirming the accuracy of the provided information.

After completing these steps, the employer can return the form via the options provided: hand it to the employee, mail it in the pre-paid envelope, or fax it to the designated number. Ensure that all sections are filled out accurately to facilitate the verification process.

Learn More on Texas Employment Verification

What is the Texas Employment Verification form used for?

The Texas Employment Verification form is designed to provide essential information about an employee's work history. It is primarily used by employers to confirm the employment status and earnings of individuals who are applying for state benefits. This verification helps the Texas Health and Human Services Commission (HHSC) assess eligibility for various assistance programs.

Who needs to fill out the Employment Verification form?

The form must be completed by the employer of the individual seeking state benefits. It requires the employer to provide specific details about the employee's job status, earnings, and other relevant information. The employee must consent to this disclosure by signing the form.

How should the completed form be submitted?

Once the employer has filled out the form, they have several options for submission:

  1. Hand the completed form directly to the employee.
  2. Mail it using the pre-paid envelope provided.
  3. Fax it to the designated number, 877-447-2839.

All methods are acceptable, and the employer should choose the one that is most convenient.

What information is required from the employer on the form?

The employer must provide various details, including:

  • Company name and address
  • Employee's name and address
  • Employment status (full-time, part-time, temporary, etc.)
  • Rate of pay and how often the employee is paid
  • Average hours worked per pay period
  • Any additional compensation such as tips or bonuses
  • Health insurance availability
  • Reason for separation if the employee is no longer employed

This information is crucial for assessing the employee's eligibility for benefits.

What if a question on the form does not apply?

If a question on the Employment Verification form does not apply to the employee, the employer should indicate this by writing "N/A" in the appropriate space. This helps clarify that the question was considered but is not relevant to the employee's situation.

What happens if the employee is no longer employed?

If the individual is no longer with the employer, the employer must still complete the form. They should provide the date of separation and the reason for leaving. Additionally, the employer should indicate the date of the final paycheck and the gross amount received. This information is vital for the HHSC to determine the employee's eligibility for benefits.

Is there a contact number for assistance with the form?

Yes, individuals can call 2-1-1 or 877-541-7905 for assistance regarding the Employment Verification form. These numbers are free to call. For those who are deaf, hard of hearing, or speech impaired, the contact number is 7-1-1 or 800-735-2989.

Employers seeking information about potential tax refunds or credits for hiring individuals who receive state benefits can visit TexasWorkforce.org/wotc. Alternatively, they can email the Texas Workforce Commission at [email protected] for more detailed inquiries.

Common mistakes

When filling out the Texas Employment Verification form, people often make several common mistakes that can lead to delays or complications. Understanding these pitfalls can help ensure a smoother process.

One frequent error is failing to include accurate contact information for the employer. This information is essential for the Texas Health and Human Services Commission (HHSC) to reach out if they have questions. Missing or incorrect phone numbers can lead to unnecessary delays in processing the form.

Another mistake occurs when the employer does not clearly indicate whether the employee is currently employed. If the answer is "no," the employer should stop filling out the form at that point. However, some employers mistakenly continue, which can confuse the verification process.

Many people overlook the requirement to mark questions that do not apply with "N/A." This step is crucial, as leaving questions blank can lead to assumptions or requests for additional information. Clarity is key, and marking "N/A" helps streamline the review process.

Additionally, employers sometimes fail to provide the correct pay rate or frequency of payment. This information is vital for HHSC to assess the employee's eligibility for benefits. Inaccurate pay details can result in incorrect conclusions about the employee's financial situation.

Some individuals also neglect to document any special circumstances regarding the employee's pay, such as commissions or bonuses. These elements can significantly impact the overall income assessment, and omitting them can lead to an incomplete picture of the employee's earnings.

Another common oversight is not signing and dating the form. An unsigned form is considered incomplete, which can stall the entire verification process. Employers should ensure that all required signatures are obtained before submitting the form.

Furthermore, employers may fail to provide a reason for an employee's separation if applicable. This information can be important for HHSC's understanding of the employee's situation and can affect benefit eligibility.

Sometimes, the form is returned without the necessary documentation or additional comments that clarify the employee's pay structure. Providing detailed comments can help HHSC better understand the specifics of the employment situation, which aids in the verification process.

Lastly, employers might forget to check for any expected changes in the employee's status in the near future. If changes are anticipated, it is essential to note them on the form. This proactive communication can prevent misunderstandings later on.

By being aware of these common mistakes, employers can help ensure that the Texas Employment Verification form is completed accurately and efficiently, ultimately benefiting both the employee and the employer.

Documents used along the form

The Texas Employment Verification form is a crucial document used to confirm an individual's employment status and income, particularly for those applying for state benefits. Alongside this form, several other documents may be required to provide a comprehensive view of the individual's employment situation. Below is a list of commonly used forms and documents that often accompany the Texas Employment Verification form.

  • Proof of Employment Form: This form is typically filled out by the employer to verify the employment details of the employee. It includes information such as job title, employment status, and pay rate.
  • W-2 Form: This form reports an employee's annual wages and the amount of taxes withheld from their paycheck. It is essential for verifying income for tax purposes.
  • Pay Stubs: Recent pay stubs provide detailed information about an employee's earnings, deductions, and hours worked. They serve as proof of income and employment status.
  • Employment Offer Letter: This letter outlines the terms of employment, including job title, salary, and start date. It can help establish the initial employment agreement.
  • Tax Returns: Personal tax returns can provide a broader view of an individual’s income over the past year. They may be requested to verify income for benefit eligibility.
  • Social Security Card: This card verifies the individual's Social Security number, which is often required for employment verification and tax purposes.
  • Form 1099: For independent contractors, this form reports income received outside of traditional employment. It is necessary for verifying earnings for self-employed individuals.
  • Employment History Verification: This document details an individual's previous employment, including dates of employment and job titles. It is useful for providing a complete employment background.

Collectively, these documents provide a thorough understanding of an individual's employment history and financial situation. They are essential for ensuring that the Texas Employment Verification form is completed accurately and that all necessary information is available for state benefit applications.

Similar forms

The Texas Employment Verification form shares similarities with the IRS Form W-2. Both documents serve as official records of employment and earnings. The W-2 form is issued by employers to report an employee's annual wages and the taxes withheld. Similarly, the Texas Employment Verification form collects information about an employee's job status, pay rate, and hours worked. Both forms require the employer's signature, affirming the accuracy of the information provided. This ensures that the data can be relied upon for tax purposes or eligibility for state benefits.

Another document akin to the Texas Employment Verification form is the Form 1099-MISC. This form is used to report payments made to independent contractors or freelancers. Like the Texas Employment Verification form, the 1099-MISC requires detailed information about the individual’s earnings. Both documents aim to provide a clear picture of an individual's income, albeit for different types of employment relationships. Employers must fill out these forms accurately to comply with tax regulations and facilitate any necessary verification processes.

The Employment Eligibility Verification form, commonly known as Form I-9, is also similar. This form is required for all employees hired in the U.S. to confirm their identity and eligibility to work. Like the Texas Employment Verification form, the I-9 necessitates input from both the employer and employee. Both forms ensure that the employment records are accurate and compliant with federal and state laws. They play a crucial role in verifying employment status, although the I-9 focuses more on legal work status than on income specifics.

The Paystub is another document that resembles the Texas Employment Verification form. Paystubs provide a breakdown of an employee's earnings, deductions, and net pay for each pay period. While the Texas Employment Verification form is more focused on overall employment verification, paystubs provide detailed insights into an employee's financial compensation. Both documents can be used to verify employment and income when applying for loans or benefits, making them essential for financial documentation.

Lastly, the Unemployment Insurance Claim form has similarities with the Texas Employment Verification form. When individuals file for unemployment benefits, they often need to provide proof of their previous employment and earnings. This form requires information about the individual's last employer, job title, and duration of employment, similar to the Texas Employment Verification form. Both documents serve to validate employment history and earnings, which are critical for determining eligibility for benefits.

Dos and Don'ts

When filling out the Texas Employment Verification form, it’s important to follow certain guidelines to ensure the process goes smoothly. Here’s a list of things you should and shouldn’t do:

  • Do provide accurate and complete information about the employee.
  • Do sign and date the form to confirm the information is correct.
  • Do mark any questions that don’t apply with "N/A."
  • Do return the completed form promptly to avoid delays in processing.
  • Do include the employee’s correct Social Security number as authorized.
  • Don’t leave any required fields blank; this could lead to processing issues.
  • Don’t provide false or misleading information; this can have serious consequences.
  • Don’t forget to check for any changes in the employee’s status before submitting.
  • Don’t ignore the instructions for returning the form; choose the method that works best.
  • Don’t hesitate to reach out for help if you have questions about the form.

By following these guidelines, you can help ensure that the Texas Employment Verification form is filled out correctly and submitted on time.

Misconceptions

Misconceptions about the Texas Employment Verification form can lead to confusion for both employers and employees. Here are nine common misunderstandings:

  • The form is optional for employers. Some believe that completing the form is voluntary. In reality, employers are required to fill it out to verify employment when requested.
  • Only current employees need verification. Many think that only current employees require this form. However, it is also necessary for former employees applying for state benefits.
  • Employers can ignore questions that don’t apply. Some employers think they can skip questions that don’t pertain to their situation. Instead, they should mark those questions with "N/A" to indicate they were addressed.
  • The employee’s Social Security number is optional. There is a belief that the Social Security number is not needed. However, it is essential for verifying the employee's identity and employment status.
  • The form can be submitted at any time. Some assume that there are no deadlines. In fact, the form must be returned promptly to avoid delays in the employee’s benefits.
  • All employers are familiar with the form. It is a misconception that all employers know how to fill out the form. Many may need guidance on the required information.
  • Employers can provide false information without consequences. Some think they can fill out the form carelessly. Providing inaccurate information can lead to legal repercussions for the employer.
  • The form is only for state benefits. There is a belief that the form is exclusively for state benefits. In reality, it can also impact tax credits and refunds for employers.
  • Employees cannot see the completed form. Many assume they have no right to view the filled-out form. However, employees can request to see it if needed.

Understanding these misconceptions can help ensure that both employers and employees navigate the employment verification process smoothly.

Key takeaways

Filling out the Texas Employment Verification form is an important step for both employees and employers. Here are some key takeaways to ensure the process is completed correctly:

  • Employer Responsibility: The employer must fill out the form accurately and return it promptly. This form is essential for verifying an employee's work status.
  • Employee Consent: Employees must provide consent for their Social Security number to be shared with the employer. This agreement allows the employer to disclose necessary employment details.
  • Proof of Employment: Employers need to confirm whether the individual is or was employed, detailing the type of job and employment status (full-time, part-time, etc.).
  • Submission Options: Once completed, the form can be returned by giving it to the employee, mailing it in a pre-paid envelope, or faxing it to the designated number.
  • Accurate Information: Employers must ensure that all information provided, including pay rates and employment dates, is accurate. Any changes to employment status should be noted.

Following these guidelines will help ensure that the Texas Employment Verification form is filled out and used effectively, facilitating the application for state benefits.