Texas Form H1049, the Client’s Statement of Self-Employment Income, is a one-page document the Texas Health and Human Services Commission uses to collect two months of income and expense details from self-employed applicants for SNAP, TANF, and Medicaid when tax returns or formal business records don’t reflect your current earnings.1Texas Health and Human Services. Form H1049, Client’s Statement of Self-Employment Income You answer five questions, sign it, and send it to HHSC by upload, fax, mail, or in person.
When HHSC Asks for Form H1049
HHSC uses this form as a self-reported alternative when accurate tax or business records are not available to document your self-employment income.1Texas Health and Human Services. Form H1049, Client’s Statement of Self-Employment Income Common situations: you started a business and haven’t filed taxes yet, your income has shifted since your last return, or you do informal work like lawn care, cleaning, or freelance gigs with no employer issuing a W-2. A caseworker may ask for it during an initial application, a redetermination, or when your circumstances change.
The form is a client statement, not a replacement for every form of verification. The Texas Works Handbook lists business records, receipts, checks, and tax records as acceptable verification for self-employment income and hours worked.2Texas Health and Human Services. A-1880, Verification Requirements If you have any of those, submit them with the form. A caseworker who can match your statement against receipts or bank records is less likely to come back asking for more.
What to Gather Before You Start
The form covers the past two months of self-employment activity, or your most recent payments if you don’t get paid every month.3Texas Health and Human Services. Texas HHS Form H1049 Client’s Statement of Self-Employment Income Before you sit down, pull together:
- Payment records of any kind: Venmo or Cash App history, invoices, handwritten logs, or notes showing the date, who paid you, and how much.
- Receipts for costs tied to earning that income: supplies, materials, equipment rental, fuel for work travel, advertising, and similar outlays.
- An estimate of your weekly work hours. The form asks for a number, so decide on a typical week before you start writing.
Filling Out the Five Questions
The form is five numbered questions followed by a signature block.3Texas Health and Human Services. Texas HHS Form H1049 Client’s Statement of Self-Employment Income
Questions 1 Through 3
Question 1 asks for the name of the person earning the self-employment income. If you’re filling this out for another household member, enter their name, not yours. Question 2 asks what type of work earns the money. Write a short, plain description: “house cleaning,” “mowing lawns,” “selling tamales at the flea market,” or “auto repair.” Question 3 asks how many hours you work each week. Give an honest estimate; if your hours vary, use a typical week.
Question 4: The Income Table
This is the core of the form. The table has three columns: Date, Who paid this money, and Amount paid. Enter each payment you received from self-employment over the past two months, one per row. List the date you received it, who paid you (a customer’s name, “cash customers,” or a platform like Etsy), and the dollar amount. Total the column at the bottom.
Report what actually happened during those two months, even if income swings heavily. Federal SNAP rules require self-employment income to be averaged over the period it’s intended to cover, and your caseworker handles that math.4eCFR. 7 CFR 273.11 – Action on Households With Special Circumstances Your job is to report the real numbers. If your business recently had a large increase or decrease, tell your caseworker, because the regulation lets them base the calculation on anticipated future earnings when prior income doesn’t reflect your current situation.
Question 5: The Expense Table
This table has the same three columns: Date, Type of expense, and Amount paid. List every business cost you paid during the same two-month window. Common entries include supplies, materials, fuel for work-related travel, equipment rental, advertising, and insurance premiums. Total the column at the bottom.
Texas allows actual self-employment expenses as deductions from gross income for SNAP purposes.5Cornell Law Institute. 1 Texas Admin. Code 372.410 – Allowable Deductions From Income You itemize real costs rather than claim a flat percentage. Listing expenses you didn’t pay is the fastest route to a fraud finding. Forgetting legitimate costs means your net income looks higher than it is, which can reduce your benefits.
The Signature Block
Below the expense table, you sign and date. The attestation reads: “By signing below, I agree that: The answers on this form are true and complete to the best of my knowledge. If they aren’t, I know I might: (1) be charged with a crime, and (2) have to repay benefits.”3Texas Health and Human Services. Texas HHS Form H1049 Client’s Statement of Self-Employment Income A second line is reserved for anyone who helped you complete the form. If a friend, family member, or community worker assisted, they sign and date that line. Leaving the primary signature blank will stall your application.
Which Expenses Count on Question 5
Not every cost of running a business is a deductible expense for SNAP purposes. Federal regulations separate costs that produce income from personal expenses already accounted for by SNAP’s standard earned-income deduction.4eCFR. 7 CFR 273.11 – Action on Households With Special Circumstances
Allowable business expenses include:
- Wages paid to employees or subcontractors (not yourself).
- Raw materials, stock, seed, fertilizer, or goods you resell.
- Principal and interest on purchases of income-producing equipment, machinery, or real estate.
- Insurance premiums and property taxes paid on income-producing assets.
- Rent for workspace, utilities for a business location, advertising, and repairs.
Costs that are not deductible include:
- Depreciation, which is an accounting concept rather than an out-of-pocket cost.
- Net losses from prior periods. You can’t carry forward a bad month.
- Federal, state, and local income taxes.
- Money set aside for savings or retirement.
- Personal commuting to and from your work site. Work-related travel during the day, such as driving between job sites, is allowed.
When in doubt, ask whether the expense exists solely because of the business. If you’d pay it anyway, it probably doesn’t belong on question 5.
How to Submit the Form
You have four ways to get Form H1049 to HHSC:
- Online upload through YourTexasBenefits.com or the Your Texas Benefits mobile app. From your case summary, tap “Upload a file,” pick the file type, take a photo of the completed form or choose one from your gallery, and send. The limit is 30 MB per upload, roughly 20 photos, and you’ll get an on-screen confirmation.3Texas Health and Human Services. Texas HHS Form H1049 Client’s Statement of Self-Employment Income
- Fax to 877-447-2839.6Texas Health and Human Services. Benefits Application Next Steps
- Mail to HHSC, P.O. Box 149027, Austin, TX 78714-9027.6Texas Health and Human Services. Benefits Application Next Steps
- In person at your local HHSC benefits office. Find the nearest location through the Services Office Locator on the HHS website.7Texas Health and Human Services. Contact
The online upload is the fastest option because it feeds directly into HHSC’s imaging system. If you mail the form, build in several days for delivery. Keep a copy of the completed form for your records whichever method you use.
What Happens After You Submit
A caseworker reviews the reported income and expenses as part of your eligibility determination. For SNAP, federal rules require the state to act on your application within 30 calendar days from the date it was filed.8eCFR. 7 CFR 273.2 – Office Operations and Application Processing If the 30th day falls on a weekend or holiday, HHSC acts the next business day.9Texas Health and Human Services. B-160, SNAP Timeliness Charts for Applications and All Redeterminations Medicaid and TANF have their own timelines, but the 30-day window is a useful benchmark.
Your caseworker may ask for additional documentation if the numbers raise questions, for example if your reported expenses are unusually high relative to income, or if the work you described doesn’t match the payment amounts. Answering quickly keeps the application moving. Monitor status through YourTexasBenefits.com or the mobile app, and watch for letters from HHSC.
The net self-employment figure HHSC calculates from your form, gross income minus allowable expenses, is added to any other household earnings to determine your total countable income.4eCFR. 7 CFR 273.11 – Action on Households With Special Circumstances That total decides whether you qualify and how much you receive. Reporting legitimate expenses lowers your net income and may raise your benefit; underreporting them does the opposite.
If You Get It Wrong
The signature block warns that providing false information can lead to criminal charges and repayment of benefits.3Texas Health and Human Services. Texas HHS Form H1049 Client’s Statement of Self-Employment Income The more common problem isn’t fraud. It’s sloppy reporting: forgetting a payment you received, or inflating an expense because you’re guessing instead of checking a receipt. Those discrepancies trigger reviews that delay benefits. If you catch a mistake after submitting, contact your caseworker or call 2-1-1 to correct it before the error becomes something larger.