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Form H1028 – Fill Out and Use

H1028 Rev 4 2015 1 Eng Details

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Form H1028 – Fill Out and Use

Form H1028 is a US Internal Revenue Service form that determines whether or not you get to take the earned income tax credit (EITC). It’s used by those who meet certain eligibility requirements.

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H1028 Rev 4 2015 1 Eng Details

If you're like most people, you probably think that the only time you need to worry about tax forms is when you're filing your taxes. However, there are actually a number of other times throughout the year when you may need to fill out a form or two. One such form is Form H1028, which is used to report business income and expenses. While it can seem daunting at first, understanding what this form is for and how to complete it isn't too difficult. In this blog post, we'll take a closer look at Form H1028 and provide some tips on how to properly fill it out.

This figure has got information regarding form h1028. You might like to look at it before filling out the form.

Question	Answer
Form Name	Form H1028
Form Length	2 pages
Fillable?	Yes
Fillable fields	1
Avg. time to fill out	42 sec
Other names	about form 1028, h1028 rev 4 2015 2 eng, texas employment verification form 1028, form 1028

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Name and Address

Date

Caseworker

Office Address, Area Code and Telephone No.

Area Code and Fax No.

Employee and Household Member

Social Security No.

This individual is a member of a household applying for assistance from the Texas Health and Human Services Commission or has income that affects another household's application for assistance. To determine the household's eligibility, it is necessary to verify all earnings. Since this person is (or was) your employee, your help is needed.

Here's How You Can Help: Please provide the information requested on the back of this letter. Please ensure that all information is complete and correct, since it will affect someone's eligibility and benefits. If a question does not apply, mark it N/A. After you complete the form, give it to your employee or mail it in the envelope provided -or you may Fax it to the number listed above.

This information is needed by

. Please send it before this date.

Notice To Employers: You may be eligible for a tax refund, credit or both for hiring recipients who receive TANF or food stamp benefits. For more information contact the Texas Workforce Commission, Work Opportunity Tax Credit Unit at 800-695-6879.

Thank you for helping. If you have questions, please feel free to call.

Case Name

Case No.

Form H1028 / 11-2018

Form H1028

Page / 11-2018-E

Employment Verification

Employee Name (as shown on your records)

Employee Address (Street, City, State, ZIP Code - as shown on your records)

Is (or was) this person employed by you?		If yes, what type of job?	Full	Part	Permanent	Temporary
Yes	No		Time	Time

If no: Stop here – sign and date the bottom of this form and return it.

If yes: Answer all the questions below. If a question doesn’t apply, write “N/A

Rate of Pay	Per	Per	Per	Per	Per
	Hour	Day	Week	Month	Job

How Often Paid?

Average Hrs. per Pay Period

Commissions/Tips/Bonuses Overtime Pay

Yes

Frequently

Rarely

Never

FICA or FIT withheld		Profit Sharing/Pension Plan		If yes, current value
Yes	No	Yes	No

Health insurance available?			If yes, employee is:			Name of insurance Company
Yes	No		Not		Enrolled with	Enrolled for
Yes	No		Enrolled		Family Member	Self Only
			Enrolled		Family Member	Self Only
Date Hired		Date first check received		Average hours per Week		If Employee is/was on	Start Date	End Date
						Leave Without Pay:

Do you expect any changes to the above					If yes,	explain:
Do you expect any changes to the above				Yes	No
information within the next few months?				Yes	No
information within the next few months?

On the chart below, list all wages received by this employee during the month(s) of:

Date Pay Period Ended

Date Employee

Received Paycheck

Actual Hours

Gross Pay

Other Pay*

(tips, commissions, bonuses) EITC Advance

* Please explain (in comments section below) when and how often tips, commissions, or bonuses are received.

If this person is no longer in your employ:

Date Separated	Reason for Separation	Date Final Check Received	Gross Amount of Final Check


Comments:

Company or Employer	Address (Street, City, State, ZIP code)

This information is true and correct to the best of my knowledge and belief.

Signature – Person Verifying this Information

Date

Title

Area Code and Telephone No.

How to Edit Form H1028

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give my permission to release the information requested on this form.