Texas Form H1028 Employment Verification: Filing Steps and 10-Day Deadline

Texas Form H1028 is the employment verification document the Texas Health and Human Services Commission (HHSC) uses to confirm your wages when you apply for SNAP, Medicaid, or TANF. You complete the identifying information on page 1, hand the form to your employer to fill in the payroll details on page 2, and return the signed form to HHSC through YourTexasBenefits.com, by fax, by mail, or at a local benefits office. The whole process has to happen fast: HHSC generally gives you 10 days to get it back.

Where to Get the Form

Download the English PDF from the Texas Health and Human Services forms library at hhs.texas.gov under “Form H1028, Employment Verification.” A Spanish version (h1028-s.pdf) sits on the same page.¹ You can also pick up a printed copy at any local HHSC benefits office or ask your caseworker to send one. For help, call 2-1-1 or the HHSC helpline at 877-541-7905.²

What You Fill Out on Page 1

Page 1 is yours, and it is short. At the top, write your full name and Social Security number so HHSC can match the form to your case file. Below that is a block of printed instructions addressed to your employer, explaining what the form is and that someone in your household is applying for state benefits.³ That language is preprinted, so you don’t need to draft a cover letter. Check that your name and identifying details are correct, then hand the form off.

What Your Employer Fills Out on Page 2

Page 2 is labeled “Proof of Employment” and is completed entirely by your employer, a payroll clerk, or an HR representative with access to payroll records. This is the section HHSC uses to calculate your income, so accuracy matters.³

The employer section asks for:

Company name and address, and your name and address as they appear in payroll records.
Employment status: whether you are currently employed, full-time or part-time, permanent or temporary.
Rate of pay (hourly, daily, weekly, monthly, or per job), how often you’re paid, and average hours per pay period and per week.
Whether you receive commissions, tips, or bonuses, and how often overtime is available (frequently, rarely, or never).
Whether FICA or federal income tax is withheld, whether a profit-sharing or pension plan is available (and its current value), and whether employer-sponsored health insurance is offered. If health insurance is available, the employer indicates whether you’re not enrolled, enrolled for yourself only, or enrolled with a family member, and writes in the insurance company name.
Date hired and date you received your first paycheck. If you’re on leave without pay, the start and end dates go here.
Whether the employer expects any changes to your pay, hours, or employment status in the coming months, with space to explain.

The Wage Chart

The core of page 2 is a chart listing each paycheck you received during the month or months your caseworker specifies. Your HHSC notice or caseworker tells you which pay periods to cover. Each row asks for the date the pay period ended, the date you received the paycheck, actual hours worked, gross pay, other pay (tips, commissions, bonuses listed separately), EITC Advance, and total pretax contributions (retirement, health premiums, and the like).

Gross pay is the figure HHSC cares about most. It’s the amount earned before taxes, insurance premiums, and retirement contributions come out. Small errors in this column can shift your projected annual income enough to change your benefit amount.¹ Before you submit the form, compare the wage chart entries against your own pay stubs. If something doesn’t match, ask your employer to fix it first.

If You’ve Left the Job

The bottom of page 2 has a separation section used only if the employment has ended. It asks for the date you separated, the reason, the date your final check was issued, and the gross amount. The employer signs and dates the form and provides their title and phone number.

Note that Form H1028 is for traditional employer-employee relationships. If you’re self-employed, HHSC uses different documentation, such as an IRS Schedule C or Form H1049.⁴

If Your Employer Won’t Fill It Out

Employers aren’t legally required to complete Form H1028. Most will as a professional courtesy, but refusal doesn’t have to stall your application. HHSC accepts several alternatives for verifying earned income.⁴

Pay stubs showing at least two pay amounts from the period starting 45 days before your application file date through your interview date. Stubs alone aren’t accepted if you started the job in the application or interview month, recently reported new employment, or ended employment in the application month or the two months before applying.
A written letter on company letterhead stating your current income and how often you’re paid.
A verbal statement from your employer, which a caseworker can collect by phone and document.
Data from The Work Number (TWN). If the figures are within $125 of what you reported, HHSC considers them consistent.
Texas Workforce Commission (TWC) wage records.

If every attempt fails because your employer refuses to cooperate and no other proof is available, HHSC policy directs caseworkers to use the “best available information” to set your budget amount.⁴ An uncooperative employer alone shouldn’t prevent you from receiving benefits.

How to Submit the Completed Form

Once the employer section is signed, you have four ways to deliver the form:⁵

Upload online. Log into YourTexasBenefits.com, scan or photograph the completed form, and upload the file. The system links the document to your active case and gives you a digital confirmation.
Deliver in person at your nearest HHSC benefits office. Find locations through the YourTexasBenefits.com office locator.
Fax to 877-447-2839. The line accepts documents around the clock. Keep the fax confirmation page as proof.
Mail to HHSC, P.O. Box 149027, Austin, TX 78714-9027. Mail is the slowest option; fax or upload gets your form into the system days sooner.

Whichever route you take, keep a copy of the signed form and your proof of submission. If HHSC later says it didn’t receive the document, that proof protects your application date.

The 10-Day Deadline

For SNAP and TANF, you generally have 10 days from the date HHSC requests verification to provide it. Miss that window and the system can automatically deny your case on the 11th day.⁶

The 10-day clock sits inside a longer processing deadline. For SNAP, HHSC aims to approve or deny by the 30th day after your file date. If verification arrives late but still within the 30-day window, your case is processed the day the documents come in.⁷ For TANF and medical programs, the processing deadline is the 45th day after the file date.⁸

Get the form to your employer the day of your HHSC interview. Employers sometimes take a week to fill it out, and that eats most of your window. If yours is slow, submit any alternative proof you have (pay stubs, for example) before the deadline, and tell your caseworker the H1028 is still in progress.

What Happens After You Submit

A caseworker reviews the reported income against program eligibility thresholds and checks that the employer completed all items and that the figures are consistent with what you reported on your application. Discrepancies have to be resolved before a decision is made.⁴

If something is missing or unclear, HHSC sends Form H1020 (Request for Information or Action) explaining what’s needed and giving you a deadline to respond.⁹ That notice arrives by mail or in the electronic correspondence section of your YourTexasBenefits.com account. If HHSC doesn’t hear back by the date on the H1020, the agency may deny your case.¹⁰

You can check case status at any time through the YourTexasBenefits.com portal. When the review is complete, HHSC sends a final notice of decision with your monthly benefit amount or the reasons for denial.

1
Texas Health and Human Services. Form H1028, Employment Verification
2
2-1-1 Texas. 2-1-1 Texas – Texas Health and Human Services Commission
3
Texas Health and Human Services Commission. Form H1028 – Employment Verification
4
Texas Health and Human Services. A-1370, Verification Requirements
5
Texas Health and Human Services. Benefits Application Next Steps
6
Texas Health and Human Services. B-120, Redeterminations
7
Texas Health and Human Services. B-160, SNAP Timeliness Charts for Applications and All Redeterminations
8
Texas Health and Human Services. Texas Works Handbook – B-110, Applications
9
Texas Health and Human Services. Form H1020, Request for Information or Action
10
Texas Health and Human Services Commission. Form H1020 – Request for Information or Action