Get Tx Hhsc H1028 2015-2025

The TX HHSC H1028 form is essential for employers to provide proof of employment for individuals applying for state benefits. This guide offers a clear, step-by-step approach to help you complete the form efficiently and accurately.

Follow the steps to successfully complete the TX HHSC H1028 form.

1. To begin, locate and click the ‘Get Form’ button to obtain the TX HHSC H1028 form and open it for editing.
2. Fill in the case number at the top of the form with the appropriate number associated with the individual applying for benefits.
3. Under the section for the employer, provide the company or employer name, followed by the full address including street, city, state, and ZIP code.
4. Enter the employee's name exactly as it appears in your records, followed by their address in the same manner.
5. Indicate whether the individual is or was your employee by checking 'Yes' or 'No.' If you select 'No,' stop here and sign at the bottom.
6. If you answered 'Yes,' provide details including the date hired and the date of the first payment received for the employee.
7. Describe the type of job the individual holds or held and mark the appropriate boxes indicating whether it is full-time, part-time, permanent, or temporary.
8. Provide the average hours worked per pay period and the rate of pay, specifying whether it is hourly, daily, weekly, or monthly.
9. Indicate the frequency of payment (daily, weekly, bi-weekly, semi-monthly, or monthly) and whether the employee receives overtime pay.
10. Complete sections regarding benefits, such as FICA/FIT withholding, leave without pay, and retirement plans, if applicable.
11. List all income from jobs or training in the provided chart, including pay dates, amounts, and any other applicable pay.
12. Provide the final details on whether the individual still works for you, date separated if applicable, and the reason for separation.
13. Finally, the employer should sign and date the form, attesting that the information provided is accurate and truthful.
14. Once completed, save your changes. You may download, print, or share the form as needed.

Complete the TX HHSC H1028 form online efficiently to assist with the application for state benefits.