TX HHS Form 3084. Employment Verification

The TX HHS Form 3084, Employment Verification, is a crucial document used to verify an individual's employment status for health care assistance purposes. This form helps determine eligibility for the County Indigent Health Care Program (CIHCP) by gathering information about the individual's earnings.

This form should be completed and submitted when an individual or their household is applying for health care assistance from the CIHCP. As an employer, you are required to provide complete and accurate information about your employee's employment status, including their Social Security number. The form consists of two pages: the first page contains general information about the employee or individual, while the second page requests detailed employment verification.

The key features of this form include the requirement for employers to provide information about their employees' earnings and employment status. The form also emphasizes the importance of accuracy and completeness in providing this information. Additionally, the form mentions that if a question does not apply, it should be marked as N/A. The completed form should be submitted to the relevant authorities by the specified deadline.