The MDHS wage verification form, officially EA Form 910, is the document the Mississippi Department of Human Services uses to confirm your earnings when you apply for or recertify SNAP or TANF benefits. Your caseworker signs and gives you the form, you fill in a short employee section, your employer completes the wage details, and you return the signed form to your county MDHS office. You cannot download a blank copy and send it to your employer on your own; the form has a line for your caseworker’s signature and date, and employers may refuse an unsigned copy.1Mississippi Department of Human Services. Request for Employment Verification
Getting a Usable Copy of the Form
Your caseworker provides EA Form 910 after you apply or when it’s time to recertify. MDHS describes the form as something you obtain “if your caseworker asks you to get an Employment Wage Verification form completed by your current or former employer.”2Mississippi Department of Human Services. SNAP Forms for Clients A blank PDF sits on the MDHS website, but it still needs your worker’s signature before an employer will treat it as a legitimate request. If you can’t reach your caseworker, call MDHS Client Services at 800-948-3050 or go to your county MDHS office and ask for a signed copy in person.
What You Fill In
Your section is four fields at the top of the form:
- Employee name, exactly as it appears in MDHS records
- Employee Social Security number
- Your signature
- Date of signing
Your signature is what gives the employer legal cover to release the information. The form states that signing it “authorizes the release of wage information requested on this form and the release of any information regarding his/her employment or termination of employment.”1Mississippi Department of Human Services. Request for Employment Verification Without it, most payroll offices will send you back out the door. Check that the name and Social Security number match what you put on your application. Mismatches cause delays when MDHS tries to cross-reference your file.
What Your Employer Fills In
The rest of the form belongs to whoever handles payroll — HR, a manager, or the owner. It splits into three parts.
Current Employment
If you still work there, the employer fills in your date hired, start date, job type, hourly wage, hours per week, and any scheduled overtime. They mark how often you are paid (daily, weekly, every two weeks, semi-monthly, or monthly) and what day of the week your check arrives. The form also asks whether you receive tips, commissions, bonuses, or vacation pay beyond your base wages, whether you take part in a company savings plan, and whether any changes to your pay or schedule are expected in the coming months.1Mississippi Department of Human Services. Request for Employment Verification
Former Employment
If you no longer work there, the employer records the date employment ended or leave started, the date of your final check, the gross amount of that check, and the reason the job ended or leave was taken. This section matters when you are applying for benefits because you recently lost income.
Wage Information Chart
The bottom chart is where the employer logs pay-period-by-pay-period data for the date range your caseworker specifies. Each row covers the pay period end date, the date you received the check, actual hours worked, gross pay, any other pay such as tips or Earned Income Tax Credit advances, and the type of that other pay. MDHS uses this chart to calculate your average income, so incomplete rows and rounded numbers slow things down. If a column doesn’t apply, ask the employer to write “N/A” rather than leave it blank. Empty fields sometimes trigger a request for more documentation.
Employer Certification
The employer signs and dates the form, then adds the business name, title, address, city, state, ZIP, phone, and fax. A business stamp can stand in for a handwritten business name. MDHS may call the employer to confirm what they reported, so accurate contact information is not optional.
How To Submit the Completed Form
Get the signed form back to your assigned county MDHS office as fast as you can. Your benefits can’t be finalized until the verification is processed, and the application clock keeps running in the meantime.
- Online: Upload a scan or clear photo at ea-upload.mdhs.ms.gov. Choose “SNAP & TANF Document Upload” and enter your case number. Anything submitted after state business hours is date-stamped the next business day.3Mississippi Department of Human Services. SNAP and TANF Document Upload
- In person: Drop the form at your county MDHS office. Many offices have a drop box near the entrance if you don’t need to speak with your caseworker.
- Mail: Send it to the county office listed on your case paperwork. Certified mail or a kept copy gives you proof of the date if questions come up later.
- Fax: Each county office has its own fax number. Call MDHS Client Services at 800-948-3050 or check your caseworker’s contact details, and keep the fax confirmation page.
Whichever channel you use, keep a copy. If MDHS later says the form never arrived, that copy is your evidence.
Why Speed Matters
For a new SNAP application, MDHS must approve or deny you within 30 calendar days of the date it received your application, not from the date it received the wage verification form.4Mississippi Department of Human Services. Applying for SNAP Every day your employer sits on the form is a day eaten out of that window.
If the employer won’t cooperate, tell your caseworker. Federal rules let the eligibility worker determine an income amount from the best available information when a third party fails to cooperate.5eCFR. 7 CFR 273.2 – Office Operations and Application Processing You don’t have to let a slow payroll department sink your application.
Households in immediate financial need may qualify for expedited benefits within seven calendar days of applying. You qualify if your household has less than $150 in monthly gross income and $100 or less in liquid resources, if you are a destitute migrant or seasonal farmworker with $100 or less in liquid resources, or if your combined monthly gross income and liquid resources are less than your monthly rent or mortgage plus utilities.4Mississippi Department of Human Services. Applying for SNAP
Honest Corrections Versus Fraud
If your employer writes down the wrong numbers, ask them to correct the form before you submit it. A corrected form is routine. A false one isn’t.
Deliberately misrepresenting your income on the form, or pressuring an employer to do so, falls under Mississippi’s public-assistance fraud statute. The law covers anyone who uses false statements, misrepresentation, or other fraudulent means to obtain benefits they aren’t entitled to, and anyone who fails to report a change in circumstances in order to keep receiving a larger benefit. A conviction carries either up to three years in prison and a fine between $1,000 and $10,000, or up to one year in county jail and a fine between $100 and $1,000. The court also orders full restitution of every dollar of benefits unlawfully received and may suspend you from the program for whatever period the program’s own rules allow.6Justia. Mississippi Code 97-19-71 – Fraud in Connection With State or Federally Funded Assistance Programs; Penalty
If MDHS Denies or Reduces Your Benefits
You have 90 days from an adverse decision to request a fair hearing with the MDHS Administrative Hearings Division.7Mississippi Department of Human Services. Administrative Hearings Division File within 10 days of the notice and your benefits continue at the current level until the hearing is decided or your certification period ends. After that 10-day window, you can still request a hearing, but your benefits won’t continue at the prior rate while you wait.
If the dispute is about the wage figures your employer reported, bring your own pay stubs, bank deposit records, or any corrected documentation from the employer. The reviewer can compare them directly against what was on the form.