TX HHS Form 3049. Employment Verification

The TX HHS Form 3049, Employment Verification, helps determine the eligibility of a household applying for health care assistance from various programs. This form is typically completed by an employer to verify the employment status of an individual who is receiving or has received benefits.

This form requires employers to provide accurate and complete information about their employees, including their name, address, and employment status. The employer must indicate whether the employee was permanently or temporarily employed and whether FICA (Federal Insurance Contributions Act) or FIT (Federal Income Tax) was withheld. The form also includes a section for the employee's signature and date.

To complete this form, employers should provide the requested information and follow the instructions provided. If any questions do not apply, they should mark them as "N/A." Once completed, the form can be given to the employee, mailed in the provided envelope, or faxed to the number listed above. The deadline for submitting the form is specified on the document.

• The TX HHS Form 3049 is used to verify employment status of individuals receiving health care assistance from various programs.
• The form requires employers to provide accurate and complete information about their employees, including name, address, and employment status.