The Texas Employment Verification Form is a crucial document designed to validate an individual's employment status, earnings, and related information for eligibility determination in state benefit programs. Employers are tasked with completing this form to provide proof of employment, which may also impact their eligibility for certain tax benefits. Ready to ensure compliance and support your employees in accessing state benefits? Click the button below to fill out the Texas Employment Verification Form.
In the state of Texas, securing employment verification is a process handled with precision and care, courtesy of the Texas Employment Verification form (Form H1028). Designed to bridge communication between employers and the Texas Health and Human Services Commission (HHSC), this form ensures that individuals applying for state benefits can provide undeniable proof of employment or past employment. As a pivotal document, it captures a comprehensive array of details including the employer's and employee's information, employment status, rate of pay, and benefits, among others. Employers are urged to partake in this verification process, which not only aids in the determination of eligibility for state benefits but may also uncover potential tax benefits for the employer. With this form, applicants grant the HHSC permission to share their Social Security number (SSN) with their respective employers, enabling a smooth retrieval of employment facts. Instructions are clear: fill out, sign, and select a return method—by the employee, mail in a pre-paid envelope, or fax. The process emphasizes a collaborative effort, where employers are furnished with guidelines to complete and return the form, ensuring accuracy and compliance with state regulations. Such meticulous attention to detail provides a streamlined approach to verifying employment, thereby assisting in the qualification process for state benefits and facilitating a system of integrity and trust between employers, employees, and the HHSC.
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 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
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 an essential step for individuals seeking state benefits or for those whose circumstances require official documentation of employment status, wages, and benefits. By properly completing this form, employers assist their employees or former employees in navigating process requirements, ensuring accurate and timely verification. This guide will help clear any uncertainties surrounding how to properly fill out the Texas Employment Verification form, step by step.
Once this form is filled out correctly and submitted, it plays a crucial role in the verification process required for state benefits or other needs. It is essential for both employees and employers to pay close attention to the accuracy of the information provided to avoid delays or complications. Remember, help is always available through the provided contact numbers if you encounter any problems or have questions during the completion of this form.
The Texas Employment Verification Form, known as Form H1028, is a document used by the Texas Health and Human Services Commission (HHSC) to verify employment details of individuals applying for state benefits. Employers fill out this form to provide information about an employee or former employee's job status, income, and benefits.
This form is intended for employers to complete. It is provided to them by their current or former employees who are applying for state benefits. The employee gives consent for their employer to release employment and income information to the HHSC.
Employers have three options for submitting the completed form:
Employers are asked to provide detailed employment information including:
If an employer finds that a specific question on the form does not apply to their situation, they should mark that question with "N/A" (not applicable) instead of leaving it blank.
Yes, employers or employees needing assistance with the form can call 2-1-1 or 877-541-7905. For those who are deaf, hard of hearing, or speech impaired, assistance is available by calling 7-1-1 or 800-735-2989. All these numbers are free to call.
This form plays a crucial role in the process of determining eligibility for state benefits. By providing accurate and up-to-date information about an employee's income and benefits, employers help the HHSC make informed decisions about benefit applications. Additionally, some employers might qualify for tax refunds or credits by employing individuals receiving state benefits.
When completing the Texas Employment Verification form, people often make several mistakes that could delay or complicate the process. Here's a comprehensive list of common errors to avoid:
To avoid these mistakes:
By paying close attention to these areas, employers can help streamline the employment verification process and avoid unnecessary delays.
When processing or reviewing the Texas Employment Verification form, it's important to remember that this document often doesn't stand alone. It's part of a larger ecosystem of employment-related documentation, each serving its specific purpose to maintain clarity, legal compliance, and thorough records of an employment relationship. Below is a list of other documents that are frequently used alongside the Texas Employment Verification form:
Each document listed above plays a unique role in the employment process, from hiring through ongoing employment to compliance with legal obligations. Employers should ensure they manage these documents carefully, respecting privacy and accuracy to maintain a professional and secure work environment.
The Form I-9, Employment Eligibility Verification: This federal form, required by the U.S. Citizenship and Immigration Services, checks an employee's eligibility to work in the U.S., paralleling the Texas Employment Verification form's need to confirm employment status and details.
W-4 Form, Employee's Withholding Certificate: Used for tax filing purposes, the W-4 form helps employers withhold the correct federal income tax from employees' pay, which shares the similarity of requiring employees’ personal and employment information.
State New Hire Reporting Forms: These forms, required for new employees in states across the U.S., help state agencies collect and maintain data on new hires, similar to how the Texas Employment Verification form collects employment information for benefits eligibility purposes.
Employment Insurance (EI) Reporting Forms: In various regions, EI reporting forms collect information about employees' earnings and hours worked, akin to the detailed employment information collected by the Texas form.
Proof of Income Statement (Option C): This is a document provided by tax authorities that verify an individual's income, similar to the Texas form’s function of verifying employment and income for state benefit eligibility.
Direct Deposit Enrollment Forms: These forms gather an employee's bank details for payroll purposes, and like the Texas Employment Verification, they require personal and sensitive information.
Background Check Authorization Forms: Used by employers to perform background checks on prospective employees, these documents similarly require an individual's consent to gather and share personal information.
Health Insurance Enrollment Forms: Similar to the queries about health insurance availability and enrollment in the Texas Employment Verification form, health insurance forms collect detailed information on employees' coverage preferences.
Work Opportunity Tax Credit (WOTC) Forms: These federal forms, similar to the Texas form, are used to determine eligibility for tax credits when hiring individuals from certain groups, requiring detailed employment information.
When filling out the Texas Employment Verification form, it's crucial to handle the information accurately and thoroughly to ensure compliance with state guidelines. Below are tips to help you navigate the process effectively.
Do's:
Don'ts:
Following these guidelines can help streamline the process of filling out the Texas Employment Verification form, ensuring it's done accurately and in compliance with state requirements.
There are several misconceptions about the Texas Employment Verification Form that can lead to confusion for both employers and employees. Understanding the purpose and requirements of this form is vital for ensuring accurate and timely compliance with state regulations.
Understanding these common misconceptions can help streamline the process of verifying employment details for state benefits, ensuring that both employers and employees fulfill their roles without unnecessary complications.
Filling out and utilizing the Texas Employment Verification form is a crucial step for employers to assist employees or former employees who are applying for state benefits. Here are seven key takeaways to ensure the process is completed accurately and efficiently:
By understanding these key aspects, employers can help streamline the process for employees seeking state benefits, ensuring that all parties provide and receive accurate and useful information. Furthermore, participation in such verification may offer financial incentives for employers while also supporting employee welfare initiatives.
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