Form H1857 at a glance
What it is: Form H1857, Landlord Verification: this form must be completed by the client's landlord or a representative.
Who signs: The landlord or representative enters the Name (printed), Signature, Date, Business Address or Residential Address and Telephone No. with Area Code. The head of household or responsible household member signs and dates the form in the spaces provided giving his permission for release of the requested information.[2]
A filled-in Form H1857 example: a client's letter and permission
How to fill out Form H1857, box by box
Date, Caseworker, Office Address, Client Name and Address and the return date
Enter the Date, the Caseworker, and the Office Address and Phone No. with Area Code.
Enter the Client Name and Address.
Enter the Name of Client and the Case No., then the Address (Street, City, State and ZIP Code).
Complete the information requested on the back of the letter and return it in the postage paid envelope provided. Return it as soon as possible, but no later than the Date entered.
Permission to release the information, Signature and Date
To give permission, enter the Signature and the Date under "I hereby give my permission to release the information requested on this form."
More rules for Form H1857
Enter the Tenant Move Date.
Enter how many people live in the house or apartment.
List the names of all people who live in the house or apartment, and their employer, if known, under Name of Person, Working? (Yes or No) and Employer.
For the questions about the rent payment, enter the Amount of Rent, the Tenant's Portion of Rent and the Person making payment.
For How often paid?, mark Weekly, Every Two Weeks, Twice a Month or Monthly.
For Method of payment?, mark Cash, Check, Money Order or Other (explain).
Mark Yes or No for Is the tenant current in paying the rent? If "No," enter when the last month rent was paid and the total amount of past due rent.
For the questions about the utilities, mark Yes or No for Are all utilities included in rent?
Under Utilities the tenant is responsible for paying (check all that apply), mark Telephone, Electric and Gas, all that apply; for Utility bills are paid directly to, mark Utility Company or Landlord.
Provide the tenant's complete residential address: Street Address, Apt. No., City and ZIP Code.
Common questions about Form H1857
What is form H1857 used for?
Form H1857 (May 2016-E), Landlord Verification, must be completed by the client's landlord or a representative: the person named at Name of Client reports renting this residence from you, and to correctly evaluate the household's situation, the department needs your assistance.
Sources
[1] Form H1857 (May 2016-E), Landlord Verification, Texas Health and Human Services (the Official source link on this page).
[2] fhb.hhs.texas.gov, signature_rule (fhb.hhs.texas.gov). Accessed October 20, 2026.
