How to Fill Out and Submit the State Verification of Earnings Form

A State Verification of Earnings form is an official request from a government agency asking an employer to confirm an employee’s pay. If one just landed on your desk, your job is straightforward: pull the specific payroll figures the form asks for, report them exactly as your records show them, and return the form through the channel and by the deadline printed on it. Child support offices, unemployment insurance auditors, Medicaid and SNAP caseworkers, the Social Security Administration, and courts all use some version of this form, and federal law makes the response mandatory in several of those contexts.

Who Sent It and Why That Matters

The agency’s purpose shapes what time period you’ll report and how much detail they want.

State child support enforcement offices operating under Title IV-D of the Social Security Act send verification requests to establish or modify support orders. All states and territories have agreed to accept a standard Verification of Employment/Income form, and employers must provide employment status, wages, withholdings, and available health insurance coverage on request.¹
The U.S. Department of Labor’s Benefit Accuracy Measurement program audits paid and denied unemployment claims. BAM investigators contact employers to verify base-period wages, separation details, and any earnings received during the benefit year.²
Agencies administering Medicaid, SNAP, and TANF verify income before approving or renewing benefits. They often pull data electronically first and contact the employer only when the electronic record and the applicant’s statement don’t match.
The Social Security Administration verifies wages for SSI recipients, sometimes through the Payroll Information Exchange with participating employers and sometimes by contacting the employer directly.³
Courts handling alimony, garnishment, or other financial litigation can order employers to provide earnings data so the judge can set a payment amount tied to actual income.⁴

Read the top of the form to confirm which agency sent it. The deadline, the acceptable return channels, and the window of pay history requested all come from the agency, not from a universal template.

What the Form Asks For

Fields vary, but most verification requests ask for the same core payroll data. The child support program’s standard form is a good reference point:

Employee identification: full name, Social Security number, date of birth, and last known home address.
Employment status: whether the person is currently employed, the hire date, and if separated, the date and reason.
Rate of pay: current hourly wage or salary, with pay frequency (weekly, biweekly, semi-monthly, or monthly).
Gross earnings: total compensation before deductions, usually for the most recent pay period and year-to-date.
Deductions: federal and state tax withholdings, health insurance premiums, retirement contributions, union dues, and any active garnishments.
Net pay: take-home amount after all deductions.
Health insurance availability: whether dependent coverage exists through the employer, whether the employee is enrolled, and the cost of adding dependents.¹

Unemployment insurance audits add a few questions on top: the reason for separation, recall status, any special payments like severance or vacation payouts, and whether you reported the person as a new hire if you rehired them during the benefit year.⁵

How to Pull and Enter the Numbers

Pull every figure directly from your payroll system or accounting software. Don’t estimate. The numbers you report will be compared against W-2 filings, quarterly wage reports, and the employee’s own statements, so even small discrepancies create follow-up work or trigger an audit.

Start with gross pay. Report the total before any deductions, covering the exact period the form specifies. Some forms want a single recent pay stub; others want the past twelve months or a specific calendar quarter. Reporting the wrong time period is one of the most common reasons agencies send a form back.

Break deductions out by category. A lump-sum total isn’t useful to an agency trying to calculate disposable income. List federal income tax withholding, state income tax, Social Security and Medicare, health insurance premiums, retirement contributions, and any active garnishments separately. If the employee is already subject to a child support income withholding order, note the case number and the withholding amount.

Include a payroll contact’s name, direct phone number, and email address. Agencies verify by phone more often than you’d expect, and a direct line to someone who can pull the records saves everyone time.

Tips, Bonuses, and Overtime

Irregular income is where these forms get tricky. An agency setting a support obligation or a benefit level needs the full picture, not just base salary. When the form has dedicated lines, report overtime, shift differentials, commissions, and bonuses as separate items. When it doesn’t, use whatever “additional compensation” space is available.

For tipped employees, report tips the employee has disclosed through payroll. Employees are required to report cash tips of $20 or more per month to their employer by the 10th of the following month.⁶ Mandatory service charges added by the business are not tips. They’re regular wages and belong in gross pay, not on the tips line.

When pay fluctuates heavily from period to period, agencies often average earnings over a longer window to arrive at a stable monthly figure. If the form only asks for one recent period, and that period happened to include an unusually large bonus or an unusually slow week, note that the period is atypical. A single sentence of context can prevent an entire support order from being built on an outlier paycheck.

If the Worker Is an Independent Contractor

If the person named on the form was never your employee and received payments as a 1099 contractor, say so plainly on the form. You aren’t obligated to produce the same payroll breakdown, but confirm whether the person performed services for you and report the total amount paid. Businesses that paid a contractor $600 or more during the year must file Form 1099-NEC with the IRS, which creates a paper trail the agency can cross-reference.⁷

Reporting Disposable Earnings and Garnishment Caps

Several forms ask for disposable earnings so the agency can apply the correct federal withholding limit. Disposable earnings means the amount left after legally required deductions like taxes and Social Security. Voluntary deductions such as 401(k) contributions and extra insurance typically don’t reduce disposable earnings for garnishment purposes.

The Consumer Credit Protection Act sets the ceilings:

Ordinary debts such as credit cards, medical bills, and personal loans: garnishment cannot exceed 25 percent of disposable earnings for the week, or the amount by which weekly disposable earnings exceed 30 times the federal minimum wage, whichever is less.⁸
Child support, supporting another family, no arrears: up to 50 percent.
Child support, supporting another family, over 12 weeks in arrears: up to 55 percent.
Child support, not supporting another family, no arrears: up to 60 percent.
Child support, not supporting another family, over 12 weeks in arrears: up to 65 percent.⁹

Report disposable earnings accurately on the form so the agency can apply the right cap.

If a National Medical Support Notice Is Attached

Child support agencies sometimes bundle a National Medical Support Notice with the earnings request. The NMSN is a separate legal document that requires the employer to enroll an employee’s child in available health coverage. Part A directs the employer to withhold the employee’s share of health insurance premiums; Part B goes to the plan administrator to actually enroll the child.¹⁰

Complete and return Part A within 20 business days of receiving the notice. If you offer dependent health coverage, forward Part B to the plan administrator within the same window. If the employee is no longer employed, or group health coverage isn’t available, still complete and return Part A with the appropriate explanation checked.¹¹

How to Submit the Completed Form

Return the form through whatever method the agency specifies. Most child support offices accept responses through a secure employer portal, by fax to a dedicated number printed on the form, or by certified mail. BAM investigators conducting unemployment audits may request an in-person records review or accept mailed documents, depending on the state’s procedures.²

Keep a copy of everything you send, along with any transmission confirmation. If you upload through a portal, save the confirmation screen or receipt. If you fax, keep the transmission report. These records protect you if the agency later claims it never received a response.

After submission, a caseworker may follow up when the figures don’t align with what the employee reported or with quarterly wage records. Respond promptly. Delays at this stage can stall benefit determinations or court proceedings.

Penalties for Ignoring or Mishandling the Request

This isn’t optional paperwork. Federal law creates real consequences in the child support context.

Under 42 U.S.C. § 666, once an employer receives a valid income withholding notice, the employer must withhold the specified amount from the employee’s pay and remit it to the state disbursement unit within seven business days of each payday. An employer who fails to withhold after proper notice is liable to the state for the full amount that should have been withheld. States are also required to impose fines on employers who fail to withhold or who retaliate against an employee because of a withholding order.¹²

Separately, federal new-hire reporting law under 42 U.S.C. § 653a requires employers to report each newly hired employee to their state’s Directory of New Hires within 20 days of the hire date. States can set civil penalties of up to $25 per unreported hire, jumping to $500 if the failure results from a conspiracy between employer and employee to avoid reporting.¹³

In court-ordered verification, a judge can hold an employer in contempt for refusing to comply. Specific penalties vary by jurisdiction but can include additional fines and sanctions against the business. Providing intentionally false wage information carries its own risks. Beyond potential contempt, inaccurate data that produces an incorrect support order can create civil liability.

Send It Only to the Agency That Asked

Federal agencies that collect earnings verification data are subject to the Privacy Act of 1974, which restricts how they use and share it. The Act generally bars an agency from disclosing records about an individual without written consent, subject to twelve statutory exceptions such as law enforcement needs or routine uses published in the Federal Register, and gives individuals the right to access and request corrections to their records.¹⁴

State agencies have their own confidentiality rules, which vary. Your obligation as the employer is to send the completed form only to the requesting agency through the channel they specified, never to the employee’s spouse, attorney, or any third party who contacts you claiming to need it. If you’re unsure whether a request is legitimate, call the agency directly using a number from their official website rather than a number printed on a form you haven’t verified.

1
Administration for Children and Families. Verification of Employment
2
U.S. Department of Labor. UIPL17-09a1
3
Social Security Administration. SSI Spotlight on the Payroll Information Exchange (PIE)
4
U.S. Department of Labor. Garnishment
5
U.S. Department of Labor. ET Handbook No. 396, 4th Edition
6
Internal Revenue Service. Tip Recordkeeping and Reporting
7
Internal Revenue Service. Reporting Payments to Independent Contractors
8
Office of the Law Revision Counsel. 15 USC 1673 – Restriction on Garnishment
9
Administration for Children and Families. Processing an Income Withholding Order or Notice
10
Administration for Children and Families. National Medical Support Notice Forms and Instructions
11
Administration for Children and Families. Part A Notice to Withhold for Health Care Coverage Instructions
12
Office of the Law Revision Counsel. 42 USC 666 – Requirement of Statutorily Prescribed Procedures to Improve Effectiveness of Child Support Enforcement
13
Office of the Law Revision Counsel. 42 USC 653a – State Directory of New Hires
14
U.S. Department of Justice. Privacy Act of 1974