Download Texas Employment Verification Template Fill Out Your Document

Download Texas Employment Verification Template

The Texas Employment Verification Form, a crucial document managed by the Texas Health and Human Services Commission, is designed for employers to confirm an employee's or former employee's employment status, earnings, and other job-related information. This form plays a significant role for individuals applying for state benefits, as it can influence eligibility and the level of assistance provided. Employers complete and return it, thus facilitating the verification process for various state assistance programs.

To ensure a smooth verification process and aid in the timely provision of state benefits, fill out the Texas Employment Verification form today by clicking the button below.

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In Texas, navigating the complexities of employment verification can seem daunting for both employers and employees alike. However, the Texas Employment Verification Form plays a crucial role in this process, serving as a bridge between employees, their employers, and the Texas Health and Human Services Commission. Primarily, this document is designed to authenticate the employment status and earnings of individuals applying for or receiving state benefits, thereby ensuring the accuracy and integrity of the information provided to the state. To facilitate this, the form requires comprehensive details about the employee in question, including their social security number, employment status (whether current or former), and the nature of their job. Employers are tasked with verifying these details, which may include the rate of pay, type of employment (e.g., full-time, part-time, temporary, or permanent), and any additional income like commissions, tips, or bonuses. Additionally, the form explores the availability of health insurance and participation in profit-sharing or pension plans, underlining the state's commitment to a thorough review process. Information about the employee's earnings, including gross pay and other pay, is meticulously outlined for a specific period, highlighting the form's role in ensuring that state benefits are accurately allocated based on verifiable employment data. The inclusion of support options—such as contact numbers for assistance and instructions for the form’s submission—underscores the state’s dedication to accessibility and user guidance throughout the verification process.

Document Example

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 Information

Fact Number Fact Detail
1 The Texas Employment Verification Form (Form H1028) is used to verify employment and income information for individuals applying for state benefits.
2 Employers are required to fill out the form with details such as employee's job status, rate of pay, and employment period.
3 The form allows for the reporting of various types of earnings including wages, tips, commissions, bonuses, and overtime pay.
4 Additionally, the form inquires about employee benefits like health insurance and profit sharing or pension plans.
5 The completed form can be returned to the Texas Health and Human Services Commission via mail, fax, or by handing it to the employee.
6 Governing law(s) for this form include regulations related to state benefits eligibility and employment verification processes in Texas.

How to Use Texas Employment Verification

Filling out the Texas Employment Verification form is a crucial step for employees undergoing processes that require them to prove their employment status or income in the State of Texas. This document serves as a formal verification from the employer about the employee's work and is often needed for various state benefits applications. Ensuring accuracy and completeness while filling out this form is necessary to avoid delays or issues with your application. Here's a simple guide to help you through the process.

  1. Start with providing personal information:
    • Print your name where specified.
    • Enter your Social Security Number (SSN).
    • Sign and date the agreement section to allow the Health and Human Services Commission (HHSC) and your employer to share and receive information about your employment.
  2. Hand the form to your employer to complete the next parts:
    • They should begin with verifying your employment status by answering whether you are or were employed with them.
    • Next, they must fill in your job type (Full Time, Part Time, Permanent, Temporary).
  3. If employed, your employer should complete all subsequent sections, as follows:
    • Provide the company or employer address in full.
    • Specify your employment details including rate of pay, frequency of pay, average hours per pay period, and any additional income such as commissions, tips, bonuses, etc.
    • Detail offered benefits, including health insurance options and any profit sharing or pension plans, indicating the current value if applicable.
    • Report on the employment duration including the date hired, date of first check, average hours per week, and if applicable, details regarding leave without pay.
    • Anticipate any changes to the above information in the next few months and explain if necessary.
    • List all wages received by the employee during the specific month(s) requested, including gross pay and any other pay like tips or bonuses.
  4. Completion by the employer:
    • If no longer employed, they should provide the separation date, reason for separation, date, and gross amount of the final check received.
    • The employer must read the declaration, confirm the accuracy of the information provided by signing, dating, and including their title, area code, and phone number.
  5. Return the form: The employer has multiple options for returning the completed form:
    • Hand it back to the employee.
    • Mail it using the pre-paid envelope provided.
    • Fax it to 877-447-2839.
    It is the employee's responsibility to ensure the form has been returned by the employer to the appropriate agency by the given deadline.

After the form is completed and submitted, the Texas Health and Human Services Commission will process the information for the specific benefits or services you're applying for. The completion of this verification step is crucial for the continued progression of your application. Make sure to keep a copy of the completed form for your records and follow up as necessary to ensure that your application proceeds smoothly.

Listed Questions and Answers

What is the Texas Employment Verification Form?

The Texas Employment Verification Form, also known as Form H1028, is a document used by employers in the state of Texas to verify the employment status and income of individuals who are applying for or receiving state benefits. This form is required by the Texas Health and Human Services Commission (HHSC) to help determine the eligibility of applicants for various state-supported aid programs.

Who needs to fill out this form?

This form is intended for employers. It should be completed by them to provide necessary information about an employee's or former employee's employment status, income, and other related details as part of the employee's application for state benefits.

An employee gives their consent by filling out and signing the agreement section of the form. This section requires the employee to print their name, provide their Social Security number (SSN), and sign the document. By doing this, the employee allows the HHSC to share their SSN with their employer and permits the employer to release their employment and income information to the HHSC.

What steps should the employer follow to complete the form?

  1. Fill out the "Proof of Employment" section with detailed information about the employee's job status, wages, benefits, and other employment-related data.
  2. If any question does not apply, mark it with "N/A" for not applicable.
  3. Return the completed form to the HHSC by giving it to the employee, mailing it in the pre-paid envelope provided, or faxing it to the number 877-447-2839.

What happens if the person is not currently employed by the employer?

If the individual in question is no longer employed by the employer, the employer should indicate "No" to the question of current employment, sign and date the bottom of the form, and return it without answering the further questions. They should also provide the date of separation and reason for separation if applicable.

Can employers get any benefits for providing this information?

Yes. Some employers might be eligible for tax refunds or credits for hiring individuals who receive certain state benefits. Employers can learn more about these potential benefits by visiting TexasWorkforce.org/wotc or contacting the Texas Workforce Commission via email at wotc@twc.state.tx.us.

Is health insurance information required on the form?

Yes. The form asks employers to specify whether health insurance is available to the employee, if the employee is enrolled in a plan, and what type of enrollment it is (e.g., self-only, family member, not enrolled). If health insurance is available, the employer must also provide the name of the insurance company.

What if there are expected changes to the provided information?

If the employer anticipates any changes to the employment or income information provided within the next few months, this should be indicated on the form with a "Yes" response to the relevant question. The employer is also asked to explain what changes are expected.

Common mistakes

When filling out the Texas Employment Verification form, it’s crucial to avoid common mistakes that can delay processing. Below are nine common errors:

  1. Not providing the employee's Social Security Number (SSN) or inaccurately filling it out. The SSN is critical for verifying employment and obtaining information about the employee.
  2. Failing to mark questions that do not apply with "N/A." This omission can cause confusion and lead to unnecessary follow-ups.
  3. Omitting the signature and date on the agreement section where the employee authorizes the release of their employment information. This authorization is essential for the process.
  4. Incorrectly filling out the employer’s address or providing incomplete address details. A complete address ensures that communication between the Texas Health and Human Services Commission and the employer is seamless.
  5. Forgetting to list the employment status of the individual (full-time, part-time, permanent, temporary), which is required to determine the benefits the person may be eligible for.
  6. Leaving out details of the rate of pay, how often the employee is paid, and the average hours per pay period. These details are crucial for calculating income and benefits.
  7. Neglecting to provide information on other forms of compensation such as commissions, tips, bonuses, and overtime pay. This comprehensive income information is necessary for a full evaluation.
  8. Omitting or inaccurately providing information about available health insurance options for the employee, which can be relevant for certain types of state benefits.
  9. Incomplete information regarding the date of hire, rate of pay, and if the employee is or was on leave without pay. This information is vital for understanding the employee's current employment situation.

Below are additional tips to ensure accuracy and completeness:

  • Double-check all entries for accuracy before submitting the form.
  • Ensure that any changes in employment within the next few months are clearly explained, as fluctuations can affect benefits.
  • Use the comments section to provide details on how often and when tips, commissions, or bonuses are received, for a comprehensive income perspective.

Avoiding these mistakes not only expedites the process but ensures that employees receive the correct benefits in a timely manner.

Documents used along the form

When processing employment verification in Texas, it's important to consider the broader context of employment and human resources documentation. The Texas Employment Verification Form provides critical employment history and income information. However, several other forms and documents play essential roles in ensuring that both employers and employees meet their legal and procedural obligations. These documents support various aspects of employment, from hiring to potential termination, and help facilitate compliance with state and federal regulations.

  • I-9 Form (Employment Eligibility Verification): Employers use this form to verify the identity and employment authorization of individuals hired for employment in the United States. It is a mandatory form for all U.S. employers.
  • W-4 Form (Employee's Withholding Certificate): This IRS form is completed by employees to indicate their tax withholding preferences. Employers use it to withhold the correct federal income tax from employees' paychecks.
  • W-9 Form (Request for Taxpayer Identification Number and Certification): Freelancers and contractors typically use this form to provide their Taxpayer Identification Number (TIN) to the entity they are doing business with, allowing the employer to report income paid to the IRS.
  • Direct Deposit Authorization Form: This form allows employees to request direct deposit of their paychecks into their bank accounts, specifying the account and routing numbers.
  • Employee Handbook Acknowledgement Receipt: This document is signed by employees to acknowledge they have received, read, and understood the company’s employee handbook. It's crucial for setting expectations and ensuring compliance with company policies.
  • Performance Review Form: Used to evaluate an employee’s job performance, this form typically covers various competencies and goals, offering both employers and employees a structured feedback mechanism.
  • Non-Disclosure Agreement (NDA): An NDA is a legal contract between an employer and an employee to keep specific information confidential, protecting proprietary information and trade secrets.
  • Employee Separation Form: This document is filled out when an employee leaves the company, voluntarily or involuntarily, detailing the reasons for separation and finalizing necessary procedures like return of property.
  • COBRA Election Notice: For employers subject to the Consolidated Omnibus Budget Reconciliation Act (COBRA), this notice gives qualifying former employees the right to continue their group health benefits under the company’s health plan for a limited period.

Together with the Texas Employment Verification Form, these documents contribute to a comprehensive employment records package. They help manage the employment lifecycle, from onboarding to departure, ensuring both regulatory compliance and a clear communication pathway between employers and employees. Knowing and using these forms appropriately not only protects the organization but also supports the rights and responsibilities of its workforce.

Similar forms

The Form I-9, Employment Eligibility Verification, required by the U.S. Citizenship and Immigration Services (USCIS), bears strong resemblance to the Texas Employment Verification form in its objective to verify an individual's employment eligibility in the United States. Both forms necessitate the provision of personal identification and employment details, albeit for different end goals: the Form I-9 for verifying the legal status of employees to work in the U.S., and the Texas form primarily for determining eligibility for state benefits or tax credits for employers.

A W-4 form, used by employers to determine the correct amount of federal income tax to withhold from employees' paychecks, shares similarities with the Texas Employment Verification form in the sense that both require employee information and are integral to financial and employment verification processes. The key difference lies in their primary usage: the W-4 focuses on tax withholding preferences, while the Texas form focuses on verifying employment for state benefit eligibility.

The verification process in the Texas Employment Verification form also parallels the procedures required by the Request for Verification of Employment (VOE) form used in mortgage lending. A VOE form substantiates an applicant's employment status and income, which lenders need to assess loan suitability and risk, similar to how the Texas form verifies employment for state benefits or tax credits.

The Employee’s Withholding Certificate for Local Taxes, often required in certain jurisdictions for local tax withholding, and the Texas Employment Verification form serve similar administrative functions in gathering employee identity and employment details. While the focus of the local withholding certificate is on local tax implications, both documents are pivotal in ensuring the correct management of employment-related fiscal responsibilities.

Another document akin to the Texas Employment Verification form is the Employer's Quarterly Federal Tax Return, known as Form 941, which employers use to report income taxes, social security tax, or Medicare tax withheld from employee's paychecks. Both forms are essential for tax reporting and compliance, although the Texas form specifically aids in verifying employment for employees applying for state benefits, rather than fulfilling federal tax obligations.

The Unemployment Insurance (UI) Wage Verification form, essential for verifying wages for UI benefits claims, mirrors the functionality of the Texas Employment Verification form. Both are crucial in determining an individual's financial eligibility for certain benefits, yet they cater to different types of benefits, with one focusing on unemployment benefits and the other on state benefits like food or healthcare assistance.

Similarly, the Proof of Income Statement (Option "C" Print) from the Canada Revenue Agency, which verifies an individual's income for a variety of purposes, shares the function of confirming employment and income details like the Texas Employment Verification form. Though one is specific to Canadian residents for a broad array of verification purposes and the other serves residents of Texas for state benefits, both streamline the verification of employment and financial status.

Last, the Direct Deposit Enrollment Forms that many employers use for setting up electronic paycheck deposits also require detailed employee identification and banking information, somewhat similar to the Texas Employment Verification form. While primarily for facilitating salary payments, both forms necessitate employer verification of employee details, underscoring the importance of accuracy in personal and employment information across administrative purposes.

Dos and Don'ts

When filling out the Texas Employment Verification form, accuracy, and attentiveness to detail are paramount. In the context of ensuring that all parties are accurately represented, and legal obligations are met satisfactorily, certain practices should be followed diligently, while others should be avoided. Below are systematic guidelines that highlight these practices:

Do's:

  • Ensure that all requested information is complete and accurate. Specifically, double-check the employee's Social Security Number (SSN) for correctness, as it is critical for validating employment and personal identity.
  • Use "N/A" (not applicable) for any question that does not apply to the employee in question. This indicates that you have seen the question and confirmed that it does not pertain to the situation, rather than accidentally skipping it.
  • Provide detailed responses to questions regarding pay rate, type of employment (full-time, part-time, permanent, temporary), and benefits available. This comprehensive information is essential for accurate assessment and processing.
  • Before you send the form back, whether it is through fax, mail, or handed back to the employee, verify that all the sections of the form have been filled out and reviewed for accuracy. Moreover, ensure that the form bears your signature and the date, certifying the veracity of the information provided.

Don'ts:

  • Do not leave any fields blank unless they are explicitly not applicable to the employee's situation. An empty field can lead to misinterpretation, processing delays, or the assumption of incomplete documentation.
  • Avoid guessing or estimating information. If there are uncertainties about specific data, consult payroll records or human resources documents to provide accurate figures. This is particularly relevant for detailing the employee's earnings, including overtime, bonuses, or tips.
  • Do not overlook the provision of additional information when applicable, such as explanations for bonuses, commissions, or other pay that might be irregular. Failing to explain such entries thoroughly can lead to confusion and require clarification, thereby delaying the process.
  • Refrain from withholding information regarding changes in employment status, such as an anticipated leave of absence, change in work hours, or employment termination. Transparency is crucial for ensuring that the provided information reflects the employee's most current employment situation.

Misconceptions

When it comes to the Texas Employment Verification form, there are several misconceptions that can lead to misunderstandings for both employers and employees. Let's clear up some of these misconceptions to ensure you're fully informed.

  1. Only Texas-based employees need to be verified: This form is relevant for any employee working in Texas, regardless of their state of residency. Employers must verify employment for any individual employed within the state.

  2. It's optional for employers: Completing the Texas Employment Verification form is not optional. When requested, employers are required to fill it out to comply with state benefit program requirements.

  3. The form is complex and time-consuming: While the form requires detailed information, it is structured in a straightforward manner. Employers should find it relatively easy to complete if they have their employment records organized.

  4. Employers must know the employee's Social Security Number (SSN) by heart: While the form does ask for the employee's SSN, employers typically reference their records rather than recalling this information from memory.

  5. The form only benefits employees: The form can also benefit employers, as it can help them qualify for tax refunds or credits for hiring individuals receiving certain state benefits.

  6. All questions must be answered fully: If a question is not applicable, employers can simply mark it with "N/A" (not applicable). The form is designed to accommodate varying employment situations.

  7. Employers can keep the information private: By signing the form, employers agree to share the specified information with the Texas Health and Human Services Commission (HHSC). Privacy is maintained within the boundaries of the law, but relevant employment information must be disclosed.

  8. It's a one-time verification: Employers might need to complete the form multiple times if they hire several employees who are applying for state benefits or if re-verification is requested by the state.

  9. Any method of return is acceptable: The form clearly outlines acceptable methods of return, including mailing it in the pre-paid envelope provided or faxing it to the specified number. Handing it to the employee is also an option, but the form must reach HHSC in one of the approved ways to be processed correctly.

Understanding these key points about the Texas Employment Verification form ensures that both employers and employees can navigate the process with confidence, fulfilling legal obligations while supporting eligibility for state benefit programs.

Key takeaways

Understanding the Texas Employment Verification Form is crucial for both employers and employees engaged in the employment verification process. Here are seven key takeaways to ensure the process is handled accurately and efficiently:

  • It's mandatory for employees to consent to the release of their employment information. This is done by signing the agreement section of the form, which authorizes the Health and Human Services Commission (HHSC) to obtain their Social Security Number (SSN) and employment details from their employer.
  • Employers play a critical role in the verification process. They are required to accurately fill out the form, providing details such as employment status, rate of pay, and any benefits associated with the position like health insurance or profit-sharing plans.
  • Accuracy is paramount when completing the form. Both general and financial information must be filled out correctly to avoid delays or issues with the application for state benefits.
  • For questions that do not apply to the employee's situation, employers should mark these with "N/A" to indicate that the question is not applicable, ensuring that every part of the form is addressed.
  • The form offers multiple avenues for submission, including handing it directly to the employee, mailing it using a pre-paid envelope provided, or faxing it to the specified number. This flexibility ensures that the form can be returned in a timely and convenient manner.
  • This verification can benefit employers as well, particularly since some may qualify for tax refunds or credits for hiring individuals receiving certain state benefits. Employers are encouraged to learn more about these potential advantages.
  • The form requires detailed employment proof; it includes sections for listing wages received during specific months, along with other types of pay like tips, commissions, and bonuses. This comprehensive approach helps ensure that the state has a full picture of the employee's earnings for benefit determination.

By following these guidelines, both employers and employees can navigate the Texas Employment Verification process more smoothly, ensuring that all parties fulfill their obligations and contribute to an accurate assessment of state benefit eligibility.

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