TX HHS Form H1028. Employment Verification

Form H1028 is an official Texas Health and Human Services Commission (HHSC) document used to verify a person’s employment status, income, and work-related benefits. HHSC relies on this form when determining eligibility for state assistance programs such as SNAP, Medicaid, TANF, and other public benefits. The form must be completed by the employer, not the employee, and returned to HHSC by the specified deadline.

Although the form may look straightforward, it plays an important role in confirming whether an applicant qualifies for public assistance. It ensures that income is reported accurately and that the state has reliable employer-verified information.

Purpose and Function of the Form

The primary purpose of Form H1028 is to collect verified information about an applicant’s employment. HHSC uses this data to calculate earnings, confirm job status, and assess whether the applicant meets income and eligibility requirements for state benefits.

The form also allows employers to report special circumstances such as unpaid leave, job separation, variable wages, or expected future changes in income—all of which can significantly impact benefit eligibility.

Explanation of Key Sections

1. Applicant Consent Section

The form begins with a consent statement authorizing HHSC to share the applicant’s Social Security number with their employer. This consent is a legal requirement. Without it, the employer is not permitted to disclose employment details due to federal privacy rules.

• Common mistake: Applicants often forget to sign this section, causing delays.
• The signature authorizes both the employer and HHSC to exchange employment information.

2. Employer Identification Section

The employer must provide their company name and mailing address exactly as it appears in their official records. HHSC uses this to verify the legitimacy of the business providing the information.

3. Employee Verification Section

Here, the employer confirms whether the applicant is or was employed and identifies the type of employment (full-time, part-time, temporary, or permanent).

• If the applicant was never employed, the employer simply checks “No,” signs, and returns the form.
• If the applicant was employed, all remaining fields must be completed.

4. Wage and Compensation Details

This portion requests critical financial information, including rate of pay, frequency of payment, work hours, commissions, bonuses, overtime, and pre-tax contributions. HHSC uses this to calculate gross monthly income.

• Typical misunderstanding: Employers sometimes list net pay instead of gross pay. HHSC requires gross pay.
• Commission, tip, and bonus schedules should be described clearly in the comments section.

5. Employment Benefits Section

The employer reports whether the employee receives retirement benefits, profit-sharing, or health insurance. These details may affect eligibility for certain programs.

6. Work History and Expected Changes

Employers must state the hire date, first paycheck date, and average weekly hours. If the employee has been on leave without pay, start and end dates of the leave must be provided.

HHSC also asks employers to report any expected changes—such as a planned reduction in hours or an anticipated pay increase—because income may soon change.

7. Wage Reporting Table

The employer itemizes actual wages for specific months. This provides detailed, period-by-period proof of income used for eligibility calculations.

8. Separation Information

If the employee is no longer with the company, the employer must report the separation date, reason, final paycheck amount, and the date it was paid.

9. Employer Signature

The employer certifies that all reported information is truthful. HHSC may contact them to confirm details if something appears incomplete or inconsistent.

When the Form Is Required

• When an applicant is currently employed but did not provide sufficient pay stubs.
• When applicants have variable income such as hourly wages, tips, or commissions.
• When employment recently ended and proof of separation is needed.
• When HHSC detects inconsistencies in reported income.

When the Form Is Not Required

• If the applicant provides complete and recent pay stubs covering all required months.
• If the applicant is unemployed and HHSC already has proof of unemployment or job loss.
• If the employer does not exist or is no longer reachable—alternative verification may apply.

Who Can Complete the Form

Only an authorized representative of the employer—such as a payroll officer, supervisor, HR specialist, or business owner—may complete Form H1028. Employees may not fill it out themselves.

Documents Often Attached

• Recent pay stubs
• Employer letters explaining employment changes
• Termination notices
• Leave-of-absence documentation
• Insurance enrollment forms (if requested)

Practical Tips for Filling Out the Form

• Write “N/A” for questions that do not apply—do not leave blanks.
• Use gross wages, not take-home pay.
• Be precise about dates—hire date, first check, separation date.
• Include detailed comments when reporting tips, bonuses, or commissions.
• Return the form quickly to avoid delays in the employee’s benefits.

Examples of Real-Life Situations

• Example 1: A worker applies for SNAP but has inconsistent hours. HHSC uses this form to calculate an accurate average income.
• Example 2: A parent recently switched jobs and cannot provide enough pay stubs. The employer completes Form H1028 to verify current earnings.
• Example 3: An employee was laid off and needs proof of termination for Medicaid. The employer fills out the separation section.
• Example 4: A part-time worker earns tips, and HHSC requires employer confirmation of tip reporting frequency and amounts.

FAQ (Detailed)

• What is the purpose of Form H1028? It verifies employment and income for applicants seeking state benefits.
• Does the employee fill out the form? No. Only the employer can complete it. The employee only signs the consent authorization.
• Can pay stubs replace this form? Sometimes, if they fully cover the required time period.
• What if the employer refuses to complete the form? HHSC may seek other verification, but refusal can delay benefits.
• What if the employee worked multiple jobs? Each employer must complete a separate Form H1028.
• How fast does the employer need to respond? As quickly as possible—delays can affect the employee’s benefits approval.
• Does HHSC contact the employer? They might, especially if information appears incomplete.

Micro-FAQ (Short Answers for AI Overviews)

• Who completes Form H1028? The employer.
• Why is it needed? To verify income for state benefits.
• Who submits the form? Employer or employee, depending on the chosen method.
• Is employee consent required? Yes, they must sign the authorization.
• What pay information is required? Gross wages, hours, and any bonuses/tips.
• Does it include separation details? Yes, if employment ended.
• Where is it sent? Texas Health and Human Services Commission.
• Does it allow multiple months of wages? Yes, in the wage table.
• Is health insurance reported? Yes, if offered by the employer.
• Can the form be faxed? Yes, to 877-447-2839.

Related Forms

• Texas Form H1024 – Self-Employment Verification
• Texas Form H1836 – Medical Release
• Texas Form H1020 – Request for Information
• Texas Form H1010 – Application for Benefits

Form Details

• Form Name: Employment Verification (Proof of Employment)
• Form Number: H1028
• State Agency: Texas Health and Human Services Commission
• Edition Date: 07-2022
• Pages: 2