IA DHS 470-2844 2011 free printable template

Case #: Date Sent: Iowa Department of Human Services Employer s Statement of Earnings Employee's Name: SSN: Business Name: Employee Permission I give my employer

How to fill out iowa dhs employer statement

How to fill out Iowa DHS Employer Statement?

1. Obtain the Iowa DHS Employer Statement form from the official website or your employer.
2. Read the form instructions carefully to understand the information required.
3. Fill in your employer's name, address, phone number, and federal employer identification number (FEIN).
4. Provide your personal details, including your name, address, Social Security number, and date of birth.
5. Enter the start and end dates of your employment with the employer mentioned.
6. Specify the number of hours you worked per week during the employment period.
7. Indicate your job title, duties, and responsibilities during your employment with the employer.
8. If applicable, provide information on any income received during the employment period.
9. Sign and date the form, certifying that the information provided is true and accurate to the best of your knowledge.

Who needs Iowa DHS Employer Statement?

1. Individuals who have received public assistance or benefits from the Iowa Department of Human Services (DHS) and have had employment during the period.
2. Individuals who need to report their employment status and income to the Iowa DHS.
3. Individuals who are applying for or renewing their public assistance or benefits and need to provide evidence of their employment.

People Also Ask about iowa dhs employer statement of earnings

What is the 800 number for DHS in Iowa?

For problems or concerns regarding your local DHS office contact the Central Office at 1-800-972-2017 or by email at contactdhs@dhs.state.ia.us.

What is the number for food stamps in Iowa?

You can report any changes to your SNAP case by calling 877-347-5678.

How do I report an income change to Iowa DHS?

Changes included could be income, address, rent/utility payments, household members, etc. Call 1-877-347-5678 or Fax 515-564-4041.

How do I check the status of my food stamp application in Iowa?

If you submitted an online application, you can Check Your Status online. If you mailed your application or supporting documentation contact the SNAP Retailer Service Center at 1-877-823-4369 to find out the status of your application.

How do I contact Iowa DHS SNAP?

Customer Service Call Centers: Report changes to your Supplemental Nutrition Assistance Program (SNAP), Cash Assistance or Medicaid Case at 1-877-347-5678.

How do I report income change to Medicaid in Iowa?

To report your change by phone, call 1-877-347-5678 between the hours of 7 am and 6 pm Monday through Friday.

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Who is required to file iowa dhs employer statement?

The Iowa DHS Employer Statement must be completed and submitted by employers who are required to register with the Iowa Department of Human Services (DHS).

What is the purpose of iowa dhs employer statement?

The Iowa DHS Employer Statement is an agreement between employers and the Iowa Department of Human Services that outlines the responsibilities of both parties in providing services and support to citizens of Iowa. It outlines the rights and responsibilities of employers and employees, and outlines the process for making and receiving payments. It is an important part of the partnership between the Iowa DHS and employers to ensure that citizens of Iowa receive the services and supports they need.

What information must be reported on iowa dhs employer statement?

The Iowa DHS Employer Statement must include the following information: 1. The employer’s name, address, and federal tax identification number 2. The total number of employees 3. The total number of employees who are Iowa residents 4. The total wages paid to all employees 5. The total wages paid to Iowa residents 6. The total amount of unemployment insurance taxes paid 7. The period during which wages were paid 8. The total amount of Social Security taxes paid 9. The total amount of Medicare taxes paid 10. The total amount of Iowa withholding taxes paid

What is the penalty for the late filing of iowa dhs employer statement?

The Iowa Department of Human Services does not have a specific penalty for late filing of the employer statement. However, employers may be subject to other penalties and fines for not filing the required reports or forms on time.

What is iowa dhs employer statement?

I am sorry, but I cannot provide the specific employer statement for Iowa DHS as it may vary depending on the individual employer and their specific policies. It is recommended to contact the Iowa Department of Human Services directly for accurate and up-to-date information regarding their employer statement.

How to fill out iowa dhs employer statement?

To fill out the Iowa DHS Employer Statement, follow these steps: 1. Obtain the form: You can download the Iowa DHS Employer Statement form from the Iowa Department of Human Services website or request a copy from your employer. 2. Provide your personal information: Fill in your full name, date of birth, Social Security number, address, and contact information. 3. Fill in employer details: Include your employer's name, address, phone number, and other relevant contact information. 4. State employment details: Provide details about your employment such as job title, start and end dates of your employment, and your work schedule. 5. Indicate your employment status and wages: Check the box that best describes your employment status (full-time, part-time, temporary, etc.). Then, provide your hourly, weekly, or monthly wage. If you receive any additional compensation or benefits, include those details as well. 6. Provide employer verification and signature: It is essential that your employer verifies the information you provided and signs the form. This confirms the accuracy of your employment details. 7. Complete employee's section: Sign and date the form, certifying that the information provided on the Iowa DHS Employer Statement is true and accurate to the best of your knowledge. 8. Submit the form: Once you have completed and signed the form, provide it to the appropriate parties. This might include submitting it to the Iowa Department of Human Services, your caseworker, or any other entity that requires the information. It is crucial to thoroughly review the completed form for accuracy and legibility before submitting it, as any errors could cause confusion or delays in processing your information.

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