Free Texas Employment Verification Form in PDF

Free Texas Employment Verification Form in PDF

The Texas Employment Verification form, also known as Form H1028, is a critical document required by the Texas Health and Human Services Commission. It's designed for employers to verify the employment status and income information of individuals applying for state benefits. Employers fill it out to provide essential details regarding the employment and compensation of current or former employees, which can influence the applicants' eligibility for state support programs.

Filling out the Texas Employment Verification form accurately is vital for ensuring that the state can properly assess an individual's eligibility for benefits. Click the button below to complete the form.

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The Texas Employment Verification form, a crucial document in the process of applying for state benefits, serves multiple purposes and requires attention from both the employee and the employer detailed within. This form not only acts as a verification tool confirming an individual's employment status, income, and personal details such as their Social Security Number (SSN), but it also plays a role in the eligibility and calculation of state benefits. Employers are encouraged to provide comprehensive information regarding the employee's job type, payment details, and benefits, which could ultimately affect tax refunds or credits for the employer through programs like the Work Opportunity Tax Credit. The form, comprising specific instructions for completion and return, encompasses essential data points like employment type, payment frequency, health insurance availability, and detailed income information. It must be filled out accurately and returned through prescribed methods. This system underscores the collaboration between employees, employers, and the Texas Health and Human Services Commission, aiming to facilitate a smooth process for those applying for assistance. Contact details are provided for support, catering to individuals with varying needs, ensuring the form's accessibility and the straightforward completion process, thereby streamlining the verification process for all parties involved.

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 wotc@twc.state.tx.us.

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 Specs

Fact Name Description
Form Number and Revision Date Form H1028 / 07-2022
Form Title Employment Verification Form
Intended User This form is for employers to fill out regarding employees or former employees.
Assistance Contact Information To get help, call 2-1-1 or 877-541-7905. For fax, use 877-447-2839. Mail can be directed to Texas Health and Human Services Commission, P O BOX 149027, Austin, Texas 78714-9027.
Accessibility Options For individuals who are deaf, hard of hearing, or speech impaired, call 7-1-1 or 800-735-2989. All numbers are free to call.
Purpose The form is used to verify employment information for someone applying for state benefits, potentially impacting tax refunds or credits for the employer.
Processing Instructions Employers are instructed to fill out the Proof of Employment, mark non-applicable questions with "N/A", and return the form via a given method: to the employee, by mail, or by fax.
Confidentiality Agreement An employee must consent to let HHSC share their Social Security number (SSN) with the employer and allow the employer to give HHSC needed information.
Submission Options The completed form can be given to the employee, mailed in a pre-paid envelope, or faxed to 877-447-2839.

Instructions on Writing Texas Employment Verification

Knowing how to accurately complete the Texas Employment Verification form is a crucial step for employees navigating the process of applying for state benefits in Texas. Whether you're applying for the first time or updating your information, the form serves as a bridge between your employment history and the potential benefits you may qualify for. Here are the simplified steps to follow, designed to make sure you provide all the necessary information without any hiccups.

  1. Start with your Name and Address at the top of the form. Make sure these details match your official identification documents.
  2. Enter the Date on which you are filling out the form to ensure it reflects the most current information.
  3. In the section labeled "Fill Out and Sign This Agreement," clearly print your name where it says "I, (print your name)." This acknowledges your permission for the Texas Health and Human Services Commission (HHSC) and your employer to share your employment data.
  4. Provide your Social Security Number (SSN) in the designated space, which is necessary for the HHSC to verify your employment status.
  5. Sign and date the form under the agreement section to validate the permissions granted for information sharing.
  6. Hand the form to your employer or former employer with the request to fill out the "Proof of Employment" section.
  7. Remind the employer to follow the instructions on the form, including filling out every question about your employment. If a question is not applicable, they should mark it as "N/A."
  8. The employer should then choose one of the three return methods indicated: giving it back to the employee, mailing it using the pre-paid envelope, or faxing it to 877-447-2839.
  9. Once the employer has completed their part, ensure they sign and date the bottom of the form.

With the correct and thorough completion of each section, the form stands ready to be submitted back to the Texas Health and Human Services Commission. Doing this promptly ensures a smoother verification process, potentially leading to quicker decision-making regarding the state benefits application. Remember, accurate and honest employment verification is not just a requirement but a step toward securing the necessary assistance you may need.

Understanding Texas Employment Verification

What is the purpose of the Texas Employment Verification form?

The Texas Employment Verification form is designed to verify the employment status and income details of individuals applying for state benefits in Texas. Employers are required to fill out this form to provide proof of employment, including information about wages, job type, and benefits for their current or former employees. This information is necessary for the Texas Health and Human Services Commission to determine eligibility for state benefits.

How does an employer submit the Texas Employment Verification form?

An employer can submit the Texas Employment Verification form in three ways: by giving it directly to the employee to return, mailing it in a pre-paid envelope provided, or faxing it to 877-447-2839. Employers should ensure that the form is complete and accurate before submission.

What should an employer do if some questions on the form do not apply?

If certain questions on the Texas Employment Verification form do not apply to the situation of the employee or former employee, employers should mark these questions with "N/A" (not applicable). This indicates that the question has been reviewed but is not relevant for the completion of the form.

Is it mandatory for an employer to provide an employee's Social Security number on this form?

Yes, it is mandatory for an employer to provide the employee's Social Security number (SSN) on this form. The employee's SSN is used by the Texas Health and Human Services Commission (HHSC) to efficiently process and verify employment details for the purpose of determining eligibility for state benefits.

What information is required about the rate of pay and hours worked?

The form requires detailed information about the employee's rate of pay, including whether it is calculated per day, week, month, job, or hour. It also asks for the average hours worked per pay period. This information helps in understanding the employee's employment status and income level.

What should be done if the employee is no longer employed?

If the individual is no longer employed by the company, the employer should indicate this on the form by answering "No" to the employment question, then sign and date the bottom of the form before returning it. They should also provide details regarding the date of separation, reason for separation, and gross amount of the final check received, if applicable.

How does an employer report changes in employment or income that are expected to occur soon?

If an employer anticipates any changes to the employment or income information provided on the form within the next few months, they should select "Yes" where the form asks about expected changes and provide an explanation in the space provided. This helps ensure that the Texas Health and Human Services Commission has the most current information regarding the applicant’s employment status.

Common mistakes

One common mistake is not correctly filling out the personal details at the beginning of the Texas Employment Verification form. It is crucial to accurately input the name, address, and date at the top of the form. Failing to do so can delay the processing of the form or result in it being sent back for corrections.

Another error is when employers overlook the instruction to mark questions that don't apply as "N/A". Instead of leaving a question blank, writing "N/A" clarifies that the question was read but was not applicable. This small step helps to prevent any misunderstandings or delays in the process.

Employers often make the mistake of providing incomplete information regarding employment, such as the rate of pay and the average hours per pay period. It's important to fill out this section fully, as it gives a clear picture of the employee's earnings, which is essential for accurately assessing benefits eligibility.

Failing to sign and date the bottom of the form is another frequent oversight. The employer's signature verifies that the provided information is accurate to the best of their knowledge. Without this confirmation, the form is considered incomplete and cannot be processed.

Some employers may neglect to provide details on additional earnings such as commissions, tips, bonuses, or overtime pay. Given that these can significantly affect the employee's total income, it's vital to include complete data about any extra compensation.

Lastly, not updating or indicating expected changes in employment within the next few months is a mistake. If there are anticipated changes to the employee's job status, hours, pay, or other relevant details, noting these on the form can help ensure that the information remains accurate and current.

Documents used along the form

When navigating the intricacies of employment in Texas, the Employment Verification Form is just the beginning. It's crucial for employers and employees alike to be familiar with the complementary documents that support a seamless employment process. These documents not only enhance the understanding of one's employment status but also ensure compliance with various legal and regulatory requirements.

  • W-4 Form (Employee's Withholding Certificate): Essential for new hires, this form dictates how much federal income tax is withheld from an employee's paycheck.
  • I-9 Form (Employment Eligibility Verification): This document is mandatory for every employee in the U.S. It verifies the employee’s identity and their legal authorization to work in the country.
  • Direct Deposit Authorization Form: Used by employees to authorize direct deposit of paychecks into their bank account, specifying the account details.
  • State Tax Withholding Form: Similar to the W-4 but for state taxes, it's not required in Texas, which does not have state income tax. However, it's relevant for employees in states that do.
  • Non-Disclosure Agreement (NDA): Often used to protect sensitive company information, it prevents employees from sharing proprietary knowledge outside the company.
  • Employee Handbook Acknowledgment Form: This form confirms that an employee has received and understands the company's handbook and policies.
  • Emergency Contact Form: Collects important contact information for use in case of an emergency involving an employee.
  • Job Description Form: Outlines the duties, responsibilities, and qualifications for a position. It sets clear expectations between employer and employee.
  • Employee Performance Review Form: Used periodically throughout an employee's tenure, this form assesses and documents job performance and development needs.

Together, these documents create a comprehensive framework for employment, providing clarity and legal safeguards for both employers and employees. Understanding and utilizing these forms ensure that the employment process is not only compliant with state and federal guidelines but also supports a transparent and effective workplace environment.

Similar forms

The Texas Employment Verification form shares similarities with the I-9 Employment Eligibility Verification form used by employers across the United States to verify an employee's identity and legal authorization to work. Both forms require employers to confirm specific details about an employee's employment status and eligibility. However, while the I-9 focuses on legal work authorization and requires documentation proof, the Texas form is more oriented towards verifying employment for state benefit eligibility with a focus on the employee's income details.

Another document similar to the Texas Employment Verification form is the W-4 Form, also known as the Employee's Withholding Certificate. Both forms are used to collect important information from employees. The W-4 is primarily for determining the amount of federal income tax to withhold from an employee's paycheck, while the Texas form verifies employment and income for state benefits purposes. Nevertheless, each serves to officially gather employee information for regulatory compliance and financial assessment.

The Employee Verification Letter often required for purposes such as loan applications, housing, and more, similarly includes some of the information found on the Texas Employment Verification form. These letters typically confirm an employee's position, salary, and employment status. While the verification letter might be more customizable to the requestor's needs, both serve to confirm essential employment and income information about an employee.

The Request for Social Security Earnings Information form, while serving a different primary purpose, also parallels the Texas Employment Verification form in its use to verify income information. This Social Security form requests detailed earnings records, which can be used for various purposes, including verifying eligibility for certain benefits. Both forms facilitate access to an individual's income information, albeit from different sources and for varying reasons.

Additionally, the Texas Workforce Commission Unemployment Benefit Services claim form, required for individuals applying for unemployment benefits, shares similarities with the Texas Employment Verification form. Both require information regarding an individual’s employment history, earnings, and reasons for separation when applicable. The key difference lies in their end purposes: one is to verify employment for state benefits eligibility, while the other is to apply for unemployment benefits directly.

The Wage Verification Form, commonly used by financial institutions or government agencies, also echoes the purpose and structure of the Texas Employment Verification form. It's designed to verify an individual’s employment status and income for loan applications, public assistance eligibility, or other financial reasons. Both documents require employers to furnish detailed income information, employee status, and personal identifiers, facilitating the verification of financial standing for various applications.

Lastly, the proof of employment or income letters provided by employers upon request shares a similar goal with the Texas Employment Verification form. These letters are often personalized but generally include key information such as employment status, income levels, and job tenure. They are used in a variety of personal and professional verification processes, underscoring the importance of accurately reflecting an individual's employment scenario. Like the Texas form, they play a crucial role in processes that require validated employment and income information.

Dos and Don'ts

When filling out the Texas Employment Verification form, it is crucial to provide accurate and complete information to ensure a smooth process. Here is a list of dos and don'ts to guide you:

Do:
  • Read the instructions carefully before you start filling out the form to make sure you understand what is required.
  • Use black or blue ink when completing the form by hand to ensure the information is legible and can be scanned properly, if necessary.
  • Verify all the information you provide, especially numbers and dates, to prevent any misunderstandings or delays.
  • Mark "N/A" for questions that do not apply to your situation to indicate that you have read the question but it is not relevant.
  • Provide complete contact information, including area codes and zip codes, to facilitate smooth communication.
Don't:
  • Rush through the form without double-checking each section for accuracy and completeness.
  • Leave sections blank if they apply to your situation; instead, provide the requested details or write "N/A" if the question does not apply.
  • Guess on dates or figures; take the time to look up the correct information to avoid the need for corrections later.
  • Forget to sign and date the form where indicated, as an unsigned form may not be processed, leading to delays.

Following these guidelines can help ensure that your Texas Employment Verification form is filled out properly and processed without unnecessary delays.

Misconceptions

Many misconceptions surround the Texas Employment Verification form, affecting both employers and employees. Understanding these common errors can help in accurately completing and submitting the form, ensuring compliance with state requirements.

  • It's only for current employees: The verification form applies to both current and former employees. It's crucial for determining eligibility for certain state benefits and for employers to possibly qualify for tax credits.

  • Only large companies need to submit it: Regardless of size, any employer that has employed an individual applying for state benefits must complete the form. This requirement spans across all business sizes and sectors.

  • Personal information isn’t secure: The Texas Health and Human Services Commission (HHSC) takes the privacy of personal information seriously. Only authorized personnel can access the Social Security number (SSN) and employment details provided.

  • Employers must complete every section: If certain sections of the form do not apply, employers are instructed to mark these as "N/A." This ensures that only relevant information is provided, simplifying the process.

  • The form is complicated to send: Employers have multiple, straightforward options for returning the form, including handing it to the employee, mailing it back using a pre-paid envelope, or faxing it to the provided number.

  • There's no benefit to employers: Filling out the form can benefit employers by making them eligible for tax refunds or credits through programs like the Work Opportunity Tax Credit (WOTC), provided they meet certain criteria.

  • It's only necessary for full-time employees: The form must be filled out for employees regardless of their status - full-time, part-time, permanent, or temporary - as long as they are applying for state benefits.

  • Health insurance details aren’t important: The form asks whether health insurance is available to the employee and their enrollment status. This information is vital for assessing the full scope of the employee's compensation and benefits.

  • Employers must calculate and report the employee's earnings: While it's true that the form requests detailed earnings information, it also provides a straightforward chart to list wages, tips, commissions, and other pay for the specified period, along with a section to explain the payment frequency and terms of variable earnings.

Dispelling these misconceptions is essential for accurately handling the Texas Employment Verification form. By understanding the requirements and benefits of this form, employers can better comply with state regulations while potentially gaining financial incentives, and employees can ensure their eligibility for state benefits is accurately assessed.

Key takeaways

When dealing with the Texas Employment Verification form, it is crucial to pay attention to specific details and procedural steps to ensure the information is accurately conveyed. Here are key takeaways to keep in mind:

  • The form must be filled out by the employer to verify the employment status of an individual applying for state benefits. This process helps to validate the applicant's income information which is critical for determining their eligibility for certain benefits.
  • Accuracy is paramount when completing the form. Incorrect or incomplete information could delay the processing of state benefits for the employee. Employers should double-check all entries, especially the employee's Social Security Number (SSN), to avoid any mistakes.
  • The form provides space for detailing the type of employment (full-time, part-time, permanent, or temporary), pay rate, frequency of payment, and other compensation such as commissions, tips, and bonuses. It is important for employers to fill out these sections thoroughly to give a complete picture of the employee's earnings.
  • If certain questions on the form are not applicable, employers should mark these with "N/A" rather than leaving them blank. This indicates that the question was reviewed but did not apply to the situation, which helps in maintaining the integrity of the completed form.
  • The completed form can be returned to the Texas Health and Human Services Commission by the employee, mailed in a pre-paid envelope, or faxed to the number provided. This flexibility in submission methods helps facilitate the timely processing of the form.

In summary, the Texas Employment Verification form is an essential document for employees applying for state benefits. By ensuring the form is filled out accurately and completely, employers can assist their employees in potentially securing the benefits they need. Additionally, it's a good practice for employers to familiarize themselves with the submission process and deadlines to avoid any unnecessary delays.

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