The Utah DWS-630 form is a one-page employment verification your employer fills out so the Department of Workforce Services can confirm your wages when you apply for SNAP, Medicaid, or other DWS programs. You download it from jobs.utah.gov, complete the header yourself, hand it to your employer to fill in the wage and job details, and then submit the signed form through the myCase portal, by fax, or by mail.
Who Fills Out Which Part
Most of the form is designed for your employer’s payroll or HR contact. You fill in the header, then pass it along. If you work more than one job, you need a separate DWS-630 for each employer.
Before you hand it over, gather any recent pay stubs. Your employer does the heavy lifting on the numbers, but having your own records lets you catch mistakes before the form goes back to DWS.
What You Complete Before Handing It Over
The header asks for your case name, case number, the name of the employed person, and a Social Security number. Your case number appears on any notice DWS has sent you and inside your myCase account.
DWS instructs everyone filling out the form to use a black pen.
What Your Employer Fills In
The form has two blocks: employer information at the top, then a numbered series of questions about your job and pay.
Employer Information
Your employer enters the company name, corporate name if different, and the payroll company name if a third party handles paychecks. The block also asks for the company address, a supervisor or HR contact, and a phone number. The form does not ask for a Federal Employer Identification Number.
The Numbered Questions
The 14 questions walk through everything DWS needs to calculate your income:
- Question 1 — the date employment began, changed, or when you returned from a leave.
- Question 2 — whether the job is temporary, and if so the expected end date.
- Question 3 — whether the position qualifies as educational work study.
- Question 4 — your hourly wage or salary, specified as monthly or yearly.
- Question 5 — weekly hours. If hours vary, the employer enters the minimum and maximum; if fixed, the set number.
- Question 6 — whether certain months involve more or fewer hours than normal, which is common for school employees who don’t work summers.
- Question 7 — whether overtime is regularly offered, and if so the typical weekly overtime hours and the overtime pay rate.
- Question 8 — pay frequency (weekly, every two weeks, twice per month, monthly, or other) and the specific payday.
- Question 9 — the date of the first paycheck, its estimated gross amount before taxes, and the hours it covers.
- Question 10 — when each pay period closes.
- Question 11 — whether employment includes tips, commissions, a health savings account contribution, or a shift differential, plus the amount and how often it is paid.
- Question 12 — whether you receive bonuses such as holiday, profit-sharing, or performance bonuses, plus amount and frequency.
- Question 13 — whether the employer offers health insurance and whether you are eligible to enroll. If you aren’t eligible, the employer explains why.
- Question 14 — if employment ended, the termination date and the date of the final paycheck.
Every dollar figure on the form should be gross pay, meaning the amount before taxes and deductions rather than the take-home number on your check. Gross pay is what DWS uses for eligibility calculations, and entering net pay instead is one of the most common mistakes that triggers a correction request.
Signatures
The form has two signature lines. Your employer signs to certify the wage and job information is accurate. You sign on the customer line to confirm you’re aware of what’s being reported.
The form warns that “additional verification will be required if employer does not sign form.” If your employer refuses to sign or is slow to respond, submit the unsigned form along with backup documents such as recent pay stubs, a direct-deposit record, or a screenshot of your payroll portal showing gross wages and hours. DWS will use those records instead, though the review takes longer than a signed form.
The DWS-630-T Variant
If you’ve been terminated or left a job and DWS needs income verification for a prior period, you may be given a DWS-630-T instead. It asks for the gross amount of your last paycheck and total gross pay in the month you received it. It also requires pay stubs or a wage printout covering income received in the last 90 days. Same rules apply: black pen, employer signature.
How to Submit the Form
Once both signatures are on the form, you have three ways to get it to DWS.
Upload Through myCase
The fastest option is uploading a scan or clear photo through your myCase account at jobs.utah.gov. Log in, go to the documents tab, and upload the file. Verifications that are due show up in your account, and you can attach the 630 right there. Uploading gives you immediate confirmation the document reached DWS.
Fax
Fax the form to 801-526-9500 in the Salt Lake City area or toll-free at 1-877-313-4717. Keep the transmission confirmation page. It’s your proof of the submission date if timeliness is ever questioned.
Mail the form to DWS Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245. Mailed documents take longer to process than electronic submissions, so if your verification deadline is close, fax or upload instead.
What Happens After DWS Receives It
DWS reviews submitted documents within 14 days to determine eligibility. The overall eligibility decision must come within 30 days of your application date for SNAP and most other programs, or within 90 days for Medicaid applications involving a disability claim.1Utah Department of Workforce Services. The Application Process
DWS cross-references the information on your 630 against state wage databases and the National Directory of New Hires, a federal database tracking employment and wage records across all 50 states.2Administration for Children and Families. Overview of National Directory of New Hires If the numbers on your form don’t match what an employer reported in quarterly tax filings, DWS will contact you or your employer for clarification before deciding. Minor discrepancies from rounding or pay-period timing are usually resolved with a phone call. Larger gaps can delay your case.
If You’re Self-Employed
The DWS-630 is built entirely around a traditional employer-employee relationship. It asks for a company name, a supervisor contact, and an employer signature, none of which apply if you drive for a rideshare app, freelance, or run your own business.
Self-employed applicants use different forms: the DWS-ESD 452 (Self-Employment Information) and the DWS-ESD 455 (Self-Employment Ledger). The ledger asks you to report total income before business expenses for each month DWS requests. For non-medical programs like SNAP, you can either deduct your actual business expenses or take a flat 40% deduction from total self-employment income. The same two options apply for medical programs. You must keep receipts or other documentation of reported income and expenses on file for at least one year.3Utah Department of Workforce Services. Self-Employment Information