DFA Form 756 – NH Employment Verification PDF

DFA Form 756 PDF Details

The BFA Form 756, issued by the New Hampshire Department of Health and Human Services (NH DHHS) Bureau of Family Assistance, is an Employment Verification PDF that employers must complete to support an applicant's eligibility review for state assistance programs including SNAP, Medicaid, and TANF. Accuracy is a legal requirement. Incomplete or inaccurate responses can delay or interrupt a client's benefits.

Information Required on the Employment Verification Form

Employers completing this form must provide all of the following:

• Employee identification – full name, Social Security Number (SSN), and current job title
• Wages and pay frequency – gross pay per period and the pay schedule (weekly, biweekly, monthly)
• Hours per week – average hours worked, including any regular overtime
• Pre-tax deductions – retirement fund contributions, health insurance premiums, and child support garnishments
• Employment status changes – reason for termination, date of the final paycheck, gross amount of the final check, and any severance pay
• Supplemental income – tips, bonuses, commissions, or other earnings not included in gross wages
• COBRA details – medical insurance end date and whether COBRA coverage is available
• EITC information – whether the employee has received Earned Income Tax Credit advance payments

Who Completes BFA Form 756

Only the employer completes this employment verification form. The NH Bureau of Family Assistance mails the form directly to the employer on file after a client applies for or recertifies assistance. Employees must not alter or fill in any section. Employers should return the form within the timeframe specified in the BFA cover letter. Late returns can put the applicant's eligibility determination on hold.

Common Mistakes to Avoid

The most frequent errors on NH employment verification forms include reporting net wages instead of gross wages, leaving the average hours field blank, and missing the "Additional Information Requested" field when BFA staff have written a question there. Always respond to that field if it contains a question. A blank response to a BFA inquiry is treated as a failure to comply and may trigger a second request or an adverse action notice for the client.

Related New Hampshire DFA Forms

Other NH DHHS Bureau of Family Assistance forms commonly used alongside this employment verification include the DFA Form 768, the DFA Form 778, and the DFA 1239 Form. For a general employment verification format not tied to a specific state agency, see the Employment Verification Form template on FormsPal.