Texas Employment Verification Template Access Texas Employment Verification Editor Now

Texas Employment Verification Template

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.

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Table of Contents

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.

Form Preview

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.

 

 

 

 

 

 

 

 

 

 

 

 

Form Breakdown

Fact Name Description
Form Purpose The Texas Employment Verification Form (Form H1028) is used for verifying the employment status and income of individuals applying for state benefits.
Submission Options Employers can return the completed form via mail in a pre-paid envelope, fax to 877-447-2839, or give it to the employee to return.
Contact Information For assistance, individuals can call 2-1-1 or 877-541-7905, and those who are deaf, hard of hearing, or speech impaired can call 7-1-1 or 800-735-2989.
Governing Law This form is governed by the policies and regulations set forth by the Texas Health and Human Services Commission.

Guidelines on Filling in Texas Employment Verification

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.

  1. Begin by reading the instructions at the top of the form carefully. Understand that the form requires input from the employee giving consent and the employer providing the employment verification.
  2. In the section labeled "Fill Out and Sign This Agreement," the employee must print their name clearly, provide their Social Security number (SSN), and sign and date the form to give the necessary consents.
  3. Next, focus on the "Employer – Your Help Is Needed" section. Start with the employee or former employee's Social Security No. and proceed to fill in the proof of employment on the next page as directed.
  4. To complete the "Proof of Employment" form, provide the company or employer address (including street, city, state, and ZIP code) as requested.
  5. Fill in the employee's name and address exactly as it appears in your records.
  6. Answer whether the person is or was employed by you. If yes, specify the type of job (full time, part time, permanent, temporary).
  7. For applicable employees, fill in all subsequent questions regarding rate of pay, frequency of payment, benefits, and other compensations. If a particular question does not apply, remember to mark it with "N/A".
  8. Include the start and end dates if the employee is or was on leave without pay, and note any expected changes in employment within the next few months.
  9. In the chart provided, list all wages received by the employee during the specified month(s), including details such as date pay period ended, date employee received paycheck, actual hours, gross pay, other pay, and total pretax contributions.
  10. If the person is no longer employed with your company, provide the date separated, reason for separation, and gross amount of the final check.
  11. Lastly, the employer must read the declaration, confirm that the information provided is true and correct, and then sign and date the form. Don't forget to include your title, area code, and phone number.
  12. Return the completed form by giving it to the employee, mailing it in the pre-paid envelope, or faxing it to 877-447-2839.

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.

Learn More on Texas Employment Verification

What is the Texas Employment Verification 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.

Who needs to fill out this form?

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.

How can this form be submitted?

Employers have three options for submitting the completed form:

  • Hand it to the employee to submit.
  • Mail it using the pre-paid envelope provided.
  • Fax it to 877-447-2839.

What information is required from the employer?

Employers are asked to provide detailed employment information including:

  1. Employment status (current or former) and job type.
  2. Rate of pay and how often the employee is paid.
  3. Average hours worked per pay period.
  4. Benefits offered, such as health insurance, profit-sharing, or pension plans.
  5. Detailed wage information for the requested period.

What should be done if a question on the form does not apply?

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.

Is there any help available for completing this form?

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.

Why is this form important?

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.

Common mistakes

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:

  1. Not reading the instructions carefully before starting the form, leading to missed or incorrectly filled fields.
  2. Failing to print the employee's name exactly as it appears on their records, which could lead to confusion or processing delays.
  3. Skipping the section that requires the employee's consent for the employer to release their information, which is mandatory for the verification process.
  4. Omitting the employer’s contact information, including the correct mailing address, which is necessary for any follow-up communication.
  5. Marking fields with "N/A" improperly, or not at all, when certain questions do not apply to the employee's situation.
  6. Forgetting to specify the type of employment (e.g., Full Time, Part Time, Permanent, Temporary), which is crucial for determining eligibility for certain benefits.
  7. Inaccurately reporting the rate of pay or other compensation details, such as tips, commissions, and bonuses, that could affect benefits calculations.
  8. Leaving the sections on benefits, like health insurance and pension plans, blank instead of indicating whether they are available to the employee.
  9. Not providing complete information on leave without pay, if applicable, which can impact the accuracy of employment verification.
  10. Failure to sign and date the form at the bottom, which is a necessary step to validate the information provided.

To avoid these mistakes:

  • Double-check all entered information for accuracy.
  • Ensure that all applicable fields are filled out.
  • Consult with the employee on any unclear information to avoid discrepancies.
  • Review and update the employer's contact information to ensure it is current.

By paying close attention to these areas, employers can help streamline the employment verification process and avoid unnecessary delays.

Documents used along the form

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:

  • W-4 Form: This IRS document is completed by employees to inform employers how much tax to withhold from their paycheck. It's essential for tax compliance and ensuring employees are taxed correctly based on their status and allowances.
  • I-9 Form: Used for verifying the identity and legal authorization to work of all paid employees in the United States. This form is crucial for compliance with federal regulations and preventing unauthorized employment.
  • Employee's Withholding Certificate: Similar to the W-4, this state-specific form is for state tax withholding purposes, ensuring state income taxes are correctly deducted from employees' paychecks.
  • Direct Deposit Authorization Form: Enables employees to have their paychecks deposited directly into their bank accounts. This form ensures the correct bank account information is captured and authorizes the transaction.
  • Employee Handbook Acknowledgement Receipt: Upon receiving an employee handbook that outlines company policies and procedures, employees sign this receipt. It’s proof they have access to the company's policies.
  • Job Application Form: Filled out by applicants, this form collects information on candidates' background, qualifications, and work history, serving as a preliminary screening tool.
  • Background Check Authorization Form: This form is used to obtain consent from a job candidate or current employee to conduct a background check, typically a prerequisite for employment or certain job responsibilities.
  • Emergency Contact Form: Essential for all employees to fill out, this document gathers information on who to contact in case of an emergency, ensuring that the employer can respond effectively.

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.

Similar forms

  • 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.

Dos and Don'ts

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:

  • Read through the entire form first: Before starting, take the time to understand what information is needed. This ensures you gather all necessary details before beginning to fill it out.
  • Use black ink: To ensure legibility and that the form can be copied or scanned without issues, fill out the form using black ink unless otherwise specified.
  • Provide accurate information: Falsehoods or inaccuracies can lead to processing delays or legal issues. Confirm details such as employment dates and wages before submitting the form.
  • Mark "N/A" where appropriate: If a question does not apply to your situation, clearly mark it with "N/A" instead of leaving it blank. This clarifies that you didn't overlook the question.
  • Keep a copy for your records: After completing the form, make a copy for your personal records before submitting it. This can be helpful if there are any questions or issues later on.

Don'ts:

  • Don't rush: Take your time to fill out the form carefully. Mistakes can cause delays and may require you to fill out the form again.
  • Don't use correction fluid: If you make a mistake, it's better to start over on a new form than to use correction fluid, which can make the form look unprofessional or as if it's been tampered with.
  • Don't leave sections blank: Aside from sections that genuinely do not apply to your situation (which should be marked "N/A"), ensure you fill out every required field to avoid processing delays.
  • Don't forget to sign and date the form: Your signature validates the form. Forgetting to sign and date can result in the form being returned to you, leading to delays.
  • Don't underestimate the importance of accuracy: Even small mistakes can have big implications. Double-check all information, especially numbers and dates, for accuracy before submitting.

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.

Misconceptions

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.

  • Misconception 1: The Texas Employment Verification Form is mandatory for all employees. The truth is, this form is specifically required when an employee or their household member applies for state benefits and employment verification is needed as part of the eligibility determination process.
  • Misconception 2: Employers are the ones who initiate this form. Actually, it is typically the employee or their household member applying for benefits who must provide the form to their employer to complete, as it contains information necessary for the benefit application.
  • Misconception 3: Any employer can fill out the form regardless of receiving the notice. In practice, only employers who are requested by the Texas Health and Human Services Commission (HHSC) or their employees should complete the form.
  • Misconception 4: The form can be submitted in any format. The form needs to be returned either by giving it directly to the employee, mailing it in the pre-paid envelope provided, or faxing it to the specified number to ensure secure and proper submission.
  • Misconception 5: All sections of the form must be filled out. Employers are only required to answer applicable questions and should mark "N/A" for those that don’t apply.
  • Misconception 6: Personal information is optional. The employee’s Social Security Number (SSN) is mandatory for the form to be processed correctly, as it verifies the individual’s employment for benefits eligibility.
  • Misconception 7: Verifying employment affects the employer’s taxes. While the form is used for verifying eligibility for state benefits, it does not directly impact the employer’s taxes, although some might be eligible for tax refunds or credits for hiring certain individuals.
  • Misconception 8: The form is only for current employees. The form can and should be filled out for former employees as well if their employment period is relevant to the benefit application.
  • Misconception 9: Health insurance information is irrelevant. Providing details about health insurance availability and enrollment is crucial as it may impact the applicant’s eligibility for certain health-related state benefits.

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.

Key takeaways

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:

  1. All data must be provided directly by the employer, highlighting the importance of the employer's role in the verification process.
  2. The form serves dual purposes: verifying employment and potentially qualifying employers for tax credits or refunds through the Work Opportunity Tax Credit (WOTC) program.
  3. The form not only requests employment status (current or former) but also details such as type of employment, rate of pay, and benefits offered, which underscores the depth of information required to complete the verification process.
  4. This form requires the employee's consent to release their Social Security Number (SSN) and employment information, emphasizing the need for clear communication and authorization between the employer and employee.
  5. Employers are instructed to mark unrelated questions with "N/A," indicating that comprehensiveness and specificity are critical, even if some sections do not apply.
  6. The necessity to return the completed form via specific methods (handing it to the employee, mailing, or faxing) introduces flexibility in submission but also demands attention to proper and timely delivery.
  7. If the employee is no longer with the company, the employer must still fill out the form, providing details of the employment end date and reason for separation, which means employers must maintain accurate records for both current and former employees.

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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