How to Fill Out Form 1062: Utah DWS Shelter/Landlord Statement

To fill out Utah DWS Form 1062, print your name, address, phone number, DWS case number, and every person living in your home in the tenant section, then hand the form to your landlord or property manager to complete the rent amount, utility breakdown, signature, and contact information. The form is a one-page shelter and landlord statement the Department of Workforce Services uses to verify your housing costs for SNAP, General Assistance, and other benefit programs. You can download it from jobs.utah.gov or pick up a paper copy at any local DWS employment center.1Utah Department of Workforce Services. DWS Form 1062 Shelter/Landlord Statement

Gather This Information First

Before you hand the form to your landlord, have these details in front of you:

  • Your DWS case number, which appears on any letter DWS has sent you.
  • Your landlord’s full name, phone number, and mailing address. DWS staff often call landlords to confirm what’s on the form.
  • Your current monthly rent. The form asks for rent only, not late fees or other legal charges.
  • The names of everyone living in the home — every adult 18 and older, every child under 18. This includes roommates and relatives, not just people on your benefits case.
  • Who pays each utility: electric, gas, phone, sewer, water, and garbage. You’ll need to know which are included in rent and which you pay separately.

Use a black pen. Fill in your sections before passing the form along, and leave the landlord’s boxes blank — the header says the form must be completed by the landlord or property manager, and DWS will follow up or reject it if the wrong person fills in the wrong section.1Utah Department of Workforce Services. DWS Form 1062 Shelter/Landlord Statement

The Tenant Section

At the top of the form, print your name, phone number, street address, and apartment or unit number. Add your DWS case number so the form gets matched to your file. Below that, list every adult and every child living in the home. Include roommates and other tenants sharing the space even if they aren’t on your benefits case. This is a count of who physically lives there.

The Landlord Section

Your landlord enters the monthly rent, excluding late fees and legal charges, and indicates whether any portion of the rent is subsidized. If you receive a Section 8 voucher or another housing subsidy, the landlord should note the subsidy and who provides it. Only the rent you actually pay out of pocket counts toward your shelter deduction.1Utah Department of Workforce Services. DWS Form 1062 Shelter/Landlord Statement

Next comes the utility checklist: electric, gas, phone, sewer, water, and garbage. For each one, the landlord checks whether it’s included in the rent or paid separately by you. Which boxes get checked matters, because DWS applies a standard utility allowance based on the utilities you’re responsible for. Miss a checkbox and you can lose real dollars off your monthly benefit.

Finally, the landlord prints and signs their name and gives a phone number where DWS can reach them. A form without the landlord’s signature or contact information is not valid shelter verification, and DWS won’t apply a shelter deduction without it.

Shared Rentals and Homeowners

If you split a rental with a roommate who isn’t on your SNAP case, put down only the portion of rent you’re personally responsible for. Under federal SNAP rules, each household’s share of shared housing costs counts as that household’s shelter expense.2eCFR. 7 CFR 273.9 Income and Deductions If your roommate gives you their half and you write one check to the landlord, the money from your roommate isn’t counted as your income.

Form 1062 is for tenants. If you own your home, don’t use this form; ask your DWS caseworker what documentation they need for your mortgage, property taxes, insurance, and any condo fees.

Where to Send the Completed Form

The form instructs you to return it immediately to your local DWS office or fax it in.1Utah Department of Workforce Services. DWS Form 1062 Shelter/Landlord Statement You have four options:

  • Upload it through myCase at jobs.utah.gov/mycase. The portal confirms a successful upload.3Utah Department of Workforce Services. myCase Is Now Mobile Friendly and Easier to Navigate
  • Fax to 801-526-9500 in the Salt Lake area, or 1-877-313-4717 toll-free.4Utah Department of Workforce Services. Eligibility Services Contact
  • Mail to Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245.4Utah Department of Workforce Services. Eligibility Services Contact
  • Drop it off at any DWS employment center. Find the nearest office at jobs.utah.gov/office-search, and ask for a date-stamped copy as your receipt.

Fax and myCase are the fastest. Mailed documents pass through centralized imaging first, which adds a few days before your caseworker sees them. Don’t wait: shelter verification is often what holds up an application.

After You Submit

A DWS eligibility worker reviews the landlord’s entries and may call the landlord to confirm the rent amount, utility arrangement, and household members. This is routine verification, not an accusation. If DWS gives you a verification checklist with a deadline and you miss it, the shelter expense simply won’t be counted in your benefit calculation, which usually means a lower monthly benefit.

If Your Landlord Won’t Fill It Out

Some landlords delay or refuse. If yours won’t complete Form 1062, call your DWS caseworker before your verification deadline and explain the situation. DWS has some flexibility to accept alternative proof — canceled rent checks, bank statements showing recurring rent payments, a signed lease, or rent receipts. The caseworker needs to know about the problem while there’s still time to fix it. Waiting and hoping the landlord comes around is how people lose the shelter deduction entirely.

Why Accuracy on the Form Matters

The information on Form 1062 feeds directly into your shelter deduction, which is one of the largest factors in how much SNAP a household receives.2eCFR. 7 CFR 273.9 Income and Deductions Failing to check “electric” when you pay your own electric bill, or having the landlord write a rent figure that doesn’t match your lease, can shrink your benefit. Read the form over before you submit it. If something looks wrong, ask the landlord to correct and initial the change.

Be Honest on the Form

Intentionally misstating your rent, leaving out household members, or providing other false information on Form 1062 can trigger a public assistance fraud investigation. Under Utah law, penalties scale with the dollar value of benefits wrongly received, from a Class B misdemeanor under $500 to a second degree felony at $5,000 or more, and paying the money back is not a defense.5Utah Legislature. Utah Code Title 76 Chapter 8 Part 12 – Public Assistance Fraud Honest mistakes are easy to correct; call your caseworker and fix them.