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In the state of Texas, the Employment Verification Form plays a crucial role in the process of applying for state benefits, ensuring that accurate employment information is provided to the Texas Health and Human Services Commission. This form, known as Form H1028, serves as a vital link between employers, employees, and the state, helping to determine eligibility for various benefits. With sections dedicated to both the employee's consent for the sharing of their personal and employment details and the employer's confirmation of employment status, wages, and benefits, this document is comprehensive. It covers all necessary information, including employment type, rate of pay, average hours worked, and available health insurance, among other details. Employers are instructed on how to complete and return the document, with accommodations made for those who are deaf, hard of hearing, or speech impaired, ensuring the form is accessible to all. Additionally, it highlights potential tax refunds or credits for employers under certain conditions, further encouraging accurate and prompt submission. This integral document not only facilitates a smoother verification process but also promotes transparency and compliance across the board.

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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 Attributes

Fact Details
Form Identification Form H1028, Employment Verification Form
Date of Issue 07-2022
Purpose of the Form To verify employment for individuals applying for state benefits in Texas
Required Actions for Employers Complete and return the form, providing details such as employment status, rate of pay, and hours worked
Contact Information for Assistance 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
Accessibility Options For individuals who are deaf, hard of hearing, or speech impaired: call 7-1-1 or 800-735-2989
Governing Law Managed under Texas State laws and regulations pertaining to employment verification for state benefits eligibility

How to Fill Out Texas Employment Verification

Filling out the Texas Employment Verification form is an important step that helps in determining eligibility for certain state benefits. It requires accurate information from both the employee and the employer. This process not only verifies employment but also includes details such as wages, type of employment, and benefits available. Here are detailed instructions to ensure a smooth and accurate completion of the form.

  1. For Employees:
    1. Print your name where it says "I, (print your name) allow HHSC.." to give your consent for the verification process.
    2. Provide your Social Security number (SSN) in the space provided to allow the Health and Human Services Commission (HHSC) and your employer to share and verify employment-related facts.
    3. Sign and date the form at the “Signature” and “Date” lines at the bottom of the agreement section to complete your part.
  2. For Employers:
    1. Begin by filling out the “Company or Employer Address” and “Employee Name and Address” sections with accurate information.
    2. Indicate the employment status of the person in question by marking "Yes" or "No" under the section asking if the person is (or was) employed by you. If “No”, sign, date, and return the form immediately.
    3. Fill in details about the type of job - whether it's full time, part time, permanent, or temporary.
    4. Provide the rate of pay along with the frequency, such as per day, week, month, job, or hour and how often the employee is paid.
    5. Indicate the average hours per pay period and add details regarding commissions, tips, bonuses, overtime pay, and any withholdings like FICA or FIT.
    6. Answer questions regarding profit sharing or pension plans, health insurance availability, and enrollment status. Provide the name of the insurance company if applicable.
    7. Fill in the “Date Hired”, “Date First Check Received”, and “Average Hours Per Week” fields with accurate dates and numbers.
    8. If the employee is or was on leave without pay, specify the start and end dates.
    9. Answer whether you expect any changes in the employment within the next few months. If "Yes", provide an explanation.
    10. On the provided chart, list all wages received by the employee during the specified months, including pay period end dates, paycheck receipt dates, actual hours, gross pay, other pay, EITC advance, and total pretax contributions.
    11. If applicable, provide reasons for separation, the separation date, date the final check was received, and the gross amount of the final check.
    12. Read the attestation at the end of the form, confirming that the information provided is true and correct to the best of your knowledge. Sign, date, and provide your title along with the area code and phone number.
    13. Lastly, return the completed form by giving it to the employee, mailing it in the pre-paid envelope provided, or faxing it to 877-447-2839 as instructed.

Once the form has been filled out and returned by the employer, it will be reviewed by the Texas Health and Human Services Commission. This verification plays a key role in the assessment of state benefit eligibility, so ensuring all information is accurate and complete is crucial for both employees and employers.

More About Texas Employment Verification

  1. What is the purpose of the Texas Employment Verification Form?

The Texas Employment Verification Form serves as a tool for employers to provide proof of employment for current or former employees. This information is typically requested when an individual is applying for state benefits. The verification includes details about the employee’s job status, wage rate, hours worked, and any benefits offered. Employers might also benefit from tax refunds or credits for hiring individuals who are receiving certain state benefits.

  1. Who needs to fill out the Texas Employment Verification Form?

This form should be completed by employers at the request of their current or former employees. The employees themselves are responsible for initiating the process, by agreeing to let their employer share their employment details with the Texas Health and Human Services Commission (HHSC).

  1. What steps must an employer take to complete the form?

An employer needs to accurately fill out the proof of employment section, which includes information like the employee's job status, pay rate, pay frequency, average hours worked per pay period, and any benefits provided. If a question is not applicable, it should be marked with "N/A." After completion, the form can be returned to the HHSC via mail, fax, or given directly back to the employee.

  1. How does an employer return the completed form?

Employers have three options for returning the completed form: handing it to the employee to return, mailing it back in a prepaid envelope provided, or faxing it to 877-447-2839.

  1. What happens if the employee is no longer employed?

If the employee is no longer working for the employer, the form should still be filled out with all available information, including the date of separation and reason for separation. The "No" option should be selected for current employment status, and the form should then be signed, dated, and returned.

  1. Is health insurance information necessary for the Employment Verification Form?

Yes, the form requires information regarding health insurance availability for the employee, including whether the employee is enrolled and the name of the insurance company. This detail helps the HHSC understand the full scope of the employee’s compensation and benefits.

  1. What if an employer expects changes to the employee's information in the near future?

Employers are asked to note any anticipated changes to the employee's employment status, wage rate, or benefits in the coming months on the form. This forward-looking information can be crucial for accurately assessing an individual’s eligibility for state benefits.

  1. Can employers receive benefits for completing the form?

While completing the form itself does not directly result in benefits for employers, they might be eligible for tax refunds or credits through programs like the Work Opportunity Tax Credit (WOTC) for hiring individuals who are receiving certain state benefits. Employers can learn more about their eligibility for such programs through the Texas Workforce Commission.

Common mistakes

Filling out the Texas Employment Verification form requires attention to detail and a thorough understanding of the instructions provided. Unfortunately, many people make mistakes during this process. Below are seven common errors that often occur when completing this form.

  1. Not providing complete information in the signature agreement section. Many individuals forget to print their name clearly or provide their Social Security number (SSN), both of which are crucial for processing the form.
  2. Employers failing to mark "N/A" for inapplicable questions. It's essential to indicate "N/A" where questions do not apply to the employee in question. Skipping this step can lead to confusion and delays in processing.
  3. Incorrect method of return. Some may overlook the specific instructions for returning the form, either by giving it to the employee, mailing it back in the provided pre-paid envelope, or faxing it to the designated number.
  4. Leaving the rate of pay section incomplete or vague. Employers need to specify the rate of pay clearly, choosing among per day, per week, per month, per job, or per hour, and accurately report how often the employee is paid.
  5. Omitting details about benefits. The section on benefits, including health insurance, profit sharing, or pension plans, is often filled out inaccurately or left incomplete. It's important to specify whether such benefits are available and if the employee is enrolled.
  6. Forgetting to provide information on leave without pay. If an employee has taken or is on leave without pay, this needs to be documented accurately, including the start and end dates of the leave.
  7. Not accurately reporting changes in employment. Employers sometimes neglect to mention expected changes to the employee's job situation within the coming months, which can affect eligibility for state benefits.

By avoiding these mistakes, you can ensure that the Texas Employment Verification form is completed accurately and efficiently, facilitating a smoother process for all parties involved.

Documents used along the form

When handling employment verification in Texas, it's crucial to be thorough and submit all necessary documentation. Alongside the Texas Employment Verification form, several other forms often play a vital role in various scenarios. Understanding each document's purpose can streamline processes and ensure compliance.

  • W-4 Form: This IRS form is used by employees to indicate their tax withholding preferences. It's essential for employers to determine the correct amount of federal income tax to withhold from an employee's paycheck.
  • I-9 Form: The Employment Eligibility Verification form is required by the U.S. Citizenship and Immigration Services. It verifies an employee's identity and eligibility to work in the United States, ensuring compliance with federal regulations.
  • Direct Deposit Authorization Form: This document allows an employee to authorize direct deposit of their paycheck into a specified bank account. It benefits both employers and employees by simplifying and securing the payment process.
  • State Tax Withholding Form: Similar to the W-4, but specific to state taxes. Not all states require this form, but it's necessary in those that do to ensure correct state income tax withholding.
  • Work Opportunity Tax Credit (WOTC) Form: Employers might be eligible for tax credits for hiring individuals from certain target groups who have consistently faced significant barriers to employment. This form is used to apply for the WOTC.
  • Employee Handbook Acknowledgment Form: This document is an employee's acknowledgment of receiving, reading, and understanding the company's handbook. It's crucial for communicating workplace policies, procedures, and expectations.

Gathering and managing these documents can be daunting, but each plays a critical role in verifying employment, ensuring compliance, and securing benefits for both the employer and the employee. Being proactive and organized with these documents can help smooth out the employment verification process and protect all parties involved.

Similar forms

  • Form I-9, Employment Eligibility Verification: Similar to the Texas Employment Verification form, the Form I-9 is used to verify the identity and legal authorization to work of all paid employees in the United States. Both forms are crucial for employers to comply with legal requirements, although the I-9 specifically focuses on proving that employees are legally allowed to work in the U.S.

  • W-4, Employee's Withholding Certificate: This form is filled out by employees to inform employers of their tax situation (e.g., filing status, number of dependents), which determines how much federal income tax to withhold from their paychecks. Like the Texas Employment Verification form, it requires personal information and is necessary for employment and tax purposes.

  • State New Hire Reporting Forms: Employers use state-specific new hire reporting forms to report newly hired or rehired employees to a state directory within a certain time frame after the date of hire. Similarly to the Texas Employment Verification form, these forms collect employee information for state benefits and compliance with state employment laws.

  • W-2, Wage and Tax Statement: The W-2 form is issued by employers to employees and the IRS at the end of the year, detailing an employee's annual wages and the amount of taxes withheld from their paycheck. Both this form and the Texas Employment Verification form provide documentation about the employee's earnings, though the W-2 is for tax recording purposes while the latter may be used for verifying employment for state benefits.

  • Work Opportunity Tax Credit (WOTC) Pre-screening Notice and Certification Request: This form is filled out by job applicants and employers to determine eligibility for a federal tax credit, encouraging the hiring of individuals with significant barriers to employment. Both the WOTC form and the Texas Employment Verification form involve the employer in processes that can benefit from hiring certain individuals, reflecting on financial aspects related to employment.

Dos and Don'ts

When handling the Texas Employment Verification form, it's important to approach the process with care and attention. Here are some guidelines to ensure the form is filled out accurately and submitted properly.

Things You Should Do

  • Ensure that the employee's name and Social Security Number (SSN) are accurately entered, as these are critical for the verification process.

  • Complete all sections of the form that are applicable. If certain questions do not apply to the employee’s situation, clearly mark these with "N/A" to indicate they are not applicable.

  • Verify all details, especially the employment dates, rate of pay, and job status (full-time, part-time, permanent, or temporary), to ensure they are correctly stated.

  • Double-check the accuracy of the insurance and benefits information, such as health insurance availability and enrollment status, as well as any pension plan contributions.

  • Sign and date the form as the employer to certify that the information provided is true and correct to the best of your knowledge.

Things You Shouldn't Do

  • Do not leave sections blank without clarification. If a question is not applicable, make sure to mark it with "N/A" instead of leaving it empty.

  • Avoid providing estimated or inaccurate information. All data should be based on employment records to ensure the accuracy of the verification.

  • Do not forget to list all forms of compensation, including bonuses, commissions, and tips, in the designated sections. Omitting these can lead to an incomplete understanding of the employee’s earnings.

  • Avoid delaying the submission of the form. Ensure it is filled out and returned promptly, either directly to the employee, via mail in the pre-paid envelope, or by faxing it to the provided number.

  • Do not ignore requests for additional information. If the Texas Health and Human Services Commission (HHSC) or the employee requests clarification or additional details, provide them in a timely manner.

Misconceptions

Understanding the Texas Employment Verification form can sometimes be confusing, with various misconceptions clouding its purpose and requirements. Below are seven common misunderstandings about this form and clarifications to each.

  • It's primarily for the benefit of the employer. In fact, the form serves to verify employment as part of an individual's application for state benefits. Its main purpose is to assist employees or former employees in their application process for state support.
  • Employers must fill out the form for every employee. Employers are only required to complete the form for individuals applying for certain state benefits and not for all of their employees.
  • The form is complicated and time-consuming to fill out. Although the form requires specific information, it is structured to be straightforward. Employers only need to provide relevant details about the employee's work status, type of job, and earnings.
  • Any missing information will result in automatic denial of the employee's benefits. While complete and accurate information is crucial, employers are encouraged to mark questions that do not apply with "N/A", and minor omissions can often be clarified or supplemented with additional documentation.
  • All sections of the form must be filled out for it to be valid. There is a section that requires completion only if the employee is still employed. If the individual is no longer with the company, the employer stops at a certain point, signs the document, and returns it as instructed.
  • Employers can only return the form by mail. Employers have multiple options for returning the completed form: they can give it to the employee to return, mail it using a pre-paid envelope, or fax it to the provided number, enhancing convenience and flexibility in the submission process.
  • Personal employee information, like the Social Security number, is at high risk of being misused. The form is designed with privacy in mind, allowing the Social Security number to be used specifically for verifying employment in the context of a state benefit application. This use is clearly stated in the part of the form where the employee grants permission for its use, ensuring a measure of security for personal information.

Correcting these misconceptions is important not only for employers who need to fill out the form but also for employees who are applying for state benefits. Understanding the purpose, requirements, and privacy protections of the Texas Employment Verification form can help streamline the process for all involved parties.

Key takeaways

Filling out and using the Texas Employment Verification form is a crucial step for employees and employers within the state, especially when it involves eligibility for certain state benefits. Here are key takeaways to keep in mind:

  • Authorization is Mandatory: Before any information can be shared, employees must authorize the Texas Health and Human Services Commission (HHSC) and their employer to exchange their employment and Social Security number (SSN) details. This is initiated by the employee signing the authorization agreement on the form.
  • Detailed Employer Input Required: Employers are tasked with providing comprehensive details about the employee’s job status, type of employment (full-time, part-time, permanent, temporary), pay rate, frequency of payment, and any benefits like health insurance. If certain inquiries are irrelevant, marking them with "N/A" is necessary rather than leaving them blank.
  • Focused on Accuracy and Completeness: It's imperative that all submitted information by the employer is thorough and accurate to ensure a smooth verification process. This entails filling out details about wages, including overtime, commissions, and any other compensations, as well as documenting any expected changes in the employee's employment status or pay in the near future.
  • Multiple Submission Options: The completed form can be returned to HHSC through various channels - directly by the employee, via mail using a pre-paid envelope, or through fax. This flexibility ensures that the verification process is not hindered by logistical issues.

Adhering to these guidelines will facilitate a smoother interaction with Texas Health and Human Services Commission for both employers and employees, making sure that the employment verification process supports those applying for state benefits effectively.

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