Texas Form H1028 Employment Verification: How to Fill Out and Submit

Texas Form H1028 is an employment verification form completed by the employer, not the applicant, after someone in the employee’s household applies for SNAP, TANF, or Medicaid and the Texas Health and Human Services Commission (HHSC) needs proof of earned income from payroll records.¹ If you are the applicant, your job is getting the form to your employer and confirming it comes back complete. If you are the payroll contact filling it out, the wage figures you enter decide whether the household qualifies, so pull them straight from payroll rather than estimating.

Getting a Copy of the Form

HHSC usually mails Form H1028 directly to the employer, often with a pre-paid return envelope. If you need your own copy, download the PDF from the HHSC forms page at hhs.texas.gov or pick up a paper copy at a local HHSC benefits office.¹ A Spanish version is available. The form prints on a single page, front and back.

Employee and Employer Information

The top of the form identifies the employee whose income is being verified. Enter the employee’s full legal name as it appears in payroll records, their Social Security number, and their current home address.² Match the legal name exactly. Even small mismatches between this form and the benefits application slow things down.

Below that, enter the employer’s registered company name, business address, and the name and title of the person completing the form. Include a working phone number so the caseworker can follow up if anything needs clarification.

Wage and Pay Details

This is the heart of the form and the section where most errors happen. HHSC uses these figures to calculate monthly income and compare it against program limits, so round numbers or guesses will not do.

Start with the employee’s rate of pay and check the box that matches the unit: per hour, per day, per week, per month, or per job. Then indicate how often the employee is paid (weekly, biweekly, semi-monthly, or monthly) and list the average hours per pay period.²

Check whether the employee receives commissions, tips, or bonuses. If so, use the comments section to explain how often and when the extra pay comes in. Quarterly bonuses and nightly tips get treated very differently when a caseworker projects monthly income.¹

The Pay Period Chart

The lower portion of the form is a chart where you list each pay period covered by the agency’s request. Each row asks for:

Date the pay period ended (the last day of the pay period, not the check date)
Date the employee received the paycheck
Actual hours worked in that pay period
Gross pay, meaning total earnings before deductions
Other pay such as tips, commissions, or bonuses received that period, broken out separately
Total pretax contributions for items like retirement plans or health premiums

The form does not lock you into a fixed number of pay periods. Fill in as many rows as needed to cover the timeframe the caseworker requested.² Gross pay is the critical column. Caseworkers compare gross earnings, not take-home pay, against income thresholds.

When an employee’s hours vary week to week, list each pay period individually rather than averaging. For SNAP, work hours are averaged monthly, so a slow week does not automatically disqualify anyone as long as the monthly total meets program requirements. Using real payroll data protects the employer from liability and the employee from an incorrect determination.

Health Insurance and Signature

The final substantive section asks whether the employer offers health insurance and, if so, the employee’s enrollment status. Check the appropriate box (not enrolled, enrolled for self only, or enrolled with family members) and, for enrolled employees, write in the name of the insurance company.¹ This affects eligibility for Medicaid and the Children’s Health Insurance Program, because affordable employer coverage can change which medical programs the household qualifies for.

The person completing the form then signs and dates it. The signature certifies that the information came from actual payroll and benefits records. HHSC returns unsigned forms.

Submitting the Completed Form

The form lists three return options for the employer:

Give it to the employee to return to HHSC
Mail it (in the pre-paid envelope if included) to Texas Health and Human Services Commission, PO Box 149027, Austin, TX 78714-9027
Fax it to 877-447-2839

Applicants who get the completed form back from their employer have another option: upload a scanned copy or photo through a Your Texas Benefits account at yourtexasbenefits.com, or deliver it in person to a local benefits office.³ The online portal is the fastest route because it generates an immediate confirmation.

When an Employer Won’t Fill Out the Form

Some employers stall or refuse, especially small businesses without dedicated HR staff. Texas HHSC accepts several alternatives:

Pay stubs showing at least two pay amounts from the 45 days before the application file date through the interview date
A written employer letter on company letterhead stating current income and pay frequency
A verbal employer statement documented by the caseworker after a phone call
Texas Workforce Commission quarterly wage records pulled by the agency
The Work Number (TWN), a third-party database that many large employers report to

⁴

If every avenue fails and no other proof exists, HHSC policy directs caseworkers to use the best available information to determine the budget amount.⁴ In practice, that means your own written statement of earnings plus any bank deposits or scheduling records you can supply. Tell your caseworker what is happening early rather than waiting for a deadline to pass.

Deadlines After You Submit

Once HHSC receives the form, a caseworker compares the reported income against program limits for the household’s size. If the agency is waiting on H1028 or any other verification, the household gets at least 10 calendar days from the date of the request to provide it, and that deadline must fall on a business day. If verification still has not arrived, the application is denied no earlier than the 30th day after filing, or the next business day if the 30th falls on a weekend or holiday.⁵

For SNAP, federal regulations require the state to give eligible households access to benefits within 30 calendar days of the filing date, with a seven-day expedited window for households in severe financial distress.⁶ Getting employment verification in quickly keeps the application on that timeline.

If the form contains conflicting information or does not match other records, HHSC will issue a request for additional evidence, and you again have at least 10 calendar days to respond. Missing that deadline can lead to denial, but providing the missing information within 10 days after the due date lets HHSC reopen the application using your original file date.⁵ Final determinations arrive by mail or through your Your Texas Benefits account.

Appealing a Denial Based on Reported Income

If your application is denied or benefits reduced based on the employment verification, you can request a fair hearing within 90 calendar days of the date on the notice of action. Return the appeal form included with the notice (Form 2065-A), or make a written or verbal request to HHSC.⁷ Requests filed after 90 days still get processed, with a hearings officer deciding whether good cause existed for the delay.

If you believe your employer reported income incorrectly on H1028, bring your own pay stubs, bank statements, or other records showing the correct figures. The burden is on HHSC to justify its determination, but your own evidence strengthens the case.

1
Texas Health and Human Services. Form H1028, Employment Verification
2
Texas Health and Human Services Commission. Texas Form H1028 Employment Verification
3
Texas Health and Human Services. Benefits Application Next Steps
4
Texas Health and Human Services. A-1370, Verification Requirements
5
Texas Health and Human Services. B-110, Applications
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eCFR. 7 CFR 273.2
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Texas Health and Human Services. 2900, Appeals and Fair Hearings