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Employer Benefit Verification Form

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The document is an Employer Benefit Verification Form for spouses of Commonwealth of Pennsylvania employees hired on or after August 1, 2003. It outlines the requirement for spouses to enroll in their own employer's health insurance as primary coverage while remaining eligible for secondary coverage through the Pennsylvania Employees Benefit Trust Fund (PEBTF). The form must be completed by both the employee and an authorized representative of the spouse's employer within 30 days of signing.

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Versions	Form popularity	Fillable & printable
2023	4.3 Satisfied (33 Votes)
2022	4.8 Satisfied (36 Votes)
2019	4.2 Satisfied (57 Votes)
2016	4.6 Satisfied (36 Votes)
2015	4 Satisfied (58 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the employer benefits tax form?

The purpose of the DHS Verification of Employment Form is to facilitate the official process of confirming an individuals employment status and details. This form serves both current and former employees who need verification for various reasons, such as job applications and financial verifications.

Do I need my 1095-B to file taxes?

A: No. You do not need to include Form 1095-B with your federal or state tax return. But, the IRS and the California State Franchise Tax Board suggest that you save it with your tax records.

How do I get an employment verification form?

Those requesting employment or salary verification may access THE WORK NUMBER online at using DOLs code: 10915. You may also contact the service directly via phone at: 1-800-367-5690.

Do I need a 1095-A to file my taxes?

Notice: You must have your Form 1095-A before you file. Dont file your taxes until you have an accurate 1095-A. If anything about your coverage or household is wrong, contact the Marketplace Call Center. Your 1095-A includes information about Marketplace plans anyone in your household had in 2024.

How do I get a 1095 form from my employer?

How do I get Form 1095-B? This form is mailed to the IRS and to the insured member by health insurance carriers, government-sponsored plans such as Medicare, Medicaid, and CHIP, and self-insured small employers.

What is the i-9 form used for?

IRS Form 1095-C provides information regarding any employer-provided health insurance coverage or offers of coverage. It may also detail the months of coverage you and any spouse and/or eligible dependents had during each month.

Do I need to file a 1095-C form with my taxes?

Some taxpayers may not receive a Form 1095-B or Form 1095-C by the time they are ready to file their tax return. While the information on these forms may assist in preparing a return, they are not required. Individual taxpayers should not wait for these forms and file their returns as they normally would.

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