The DHS 1266 form is an essential document initiated by the State of Hawaii's Benefit, Employment, and Support Services Division, Department of Human Services. This form serves a pivotal role in gathering employment and payroll information for certain individuals, necessitating responses from employers regarding the employment status, earnings, and benefits of the specified person. Employers are asked to provide thorough details, including the starting and ending dates of employment, nature of the work carried out, reasons for termination, any potential for re-employment, and entitlements to pensions, among other specifics. Additionally, the form inquires about any non-traditional compensations like sick pay, vacation pay, severance pay, cash payments, commissions, and even non-financial rewards. It extends further to probe into whether the individual had applied for or received any Workmen’s Compensation or Temporary Disability Insurance claim payments. Health insurance coverage details, including the type and effective dates, are also requested, rounding out a comprehensive view of the employee's compensation and benefits scenario. This form, therefore, stands as a critical tool for the Department of Human Services, enabling it to accurately assess eligibility for services or benefits, reinforcing its commitment to maintain meticulous records for those it serves.
| Question | Answer |
|---|---|
| Form Name | DHS 1266 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 1266 form, hawaii employment record certification form, hi dhs 1266 fill, dhs 1266 2 03 |