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Human Resources

How to show loss of income during verification of employment

Table of Contents
Table of Contents

Verifying your income and employment can be of great importance. For those currently on or applying for food stamps or Medicaid, it can mean the difference between receiving or not receiving benefits. It’s also important if you’re faced with any kind of legal suit, such as suing an employer for back pay or loss of income. In the state of Florida, this process is fairly straightforward, involving the verification of employment/loss of income form that can be downloaded here.

This form is twofold, covering both new and current employment as well as any loss of income. The form contains four sections, and either the employer or employee can complete the first two. Your current or previous employer will fill out the third and fourth sections and don’t need to completed by you, the applicant. First is the section on general employment information, followed by the loss of income section.

Correctly completing these two sections is vital to a successful application. Here, you'll learn what information to include in each section.

Section 1: General Information

The first section of the verification of employment/loss of income form covers general information. This includes employment, insurance, covered dependents, and information about your benefits. The request to provide your Social Security number (SSN) may stand out here. While it’s not required under federal law, it’s noted at the bottom of the form that providing your SSN allows the form to be processed faster and more accurately.

Rate of pay and tips

Beyond the request for your SSN, the information requested in Section 1 is fairly straightforward. It does ask about hours worked and employment start and end dates. To make this process easier, print out your pay stubs from recent months to ensure that your pay is accurate.

If you received tips at your job, you’ll need this information for Section 3 of the form, even though your current or previous employer completes this section. Accurate tip information is important because it will be factored into your total pay and influence your total benefits.

If you haven’t been tracking your tips, you can determine this information by totaling up your pay for the year so far and matching it up with your bank account, assuming your tips are deposited. Tips should be displayed as a separate deposit, allowing you to add them up to give you a total for the tax year.

Payroll savings plans and profit sharing

The only other spot in Section 1 that’s likely to cause confusion is item 10, which asks about profit sharing and payroll savings plans. A payroll savings plan is an automated program that involves using portions of your paychecks to buy bonds. A profit sharing plan also is automated and allows employees to use portions of their paychecks to invest in their employing company and grow their savings as the company grows.

If you’re unsure whether or not you participated in this type of plan, reach out to your current or former company’s HR rep. They will be able to tell you or point you in the direction, of the company’s financial or payroll specialist.

Section 2: Loss of Income

Section 2 of the form covers the actual loss of income. This is where you’ll describe when your employment ended, why you were terminated, vacation reimbursement, and eligible insurance benefits. You’ll need loss-of-income information if you’re pursuing Medicaid, food stamps, or any other welfare services. State agencies will use this information to determine your eligibility for these benefits; applicants who make too much income may not qualify. You’ll also need loss-of-income information if you have to sue for any kind of work-related injury or unjust termination. 

It’s worth noting that loss of income is different from the loss of earning capacity. Loss of income can be temporary, while loss of earning capacity means someone has lost current and future earning potential. Loss of earning capacity is commonly used in legal disputes where an employee was injured and can no longer make as much income as they did before. If this is your situation, you need to pursue loss of earning capacity, not loss of income.

Explaining income changes on the form

One of the most important parts of Section 2 is the area for explaining why you lost income. While you don’t need to write a lengthy description about why you experienced a loss of income, you will need to list a reason that accurately describes your situation.

The correct reason for loss of income is especially important if you have to go to court to sue for any damages or fight for Social Security and other benefits.

There are two primary categories that cover the majority of reasons for losing income. Read each category carefully to determine how you should classify your case.

Laid Off

If you were let go from your job, this is a valid reason to include on your form. As long as your previous employer’s contact information is accurate, it’s easy to verify this information. Your former employer can confirm that you were laid off and did not leave of your own accord.

Being laid off versus quitting is an especially important distinction, as voluntary unemployment can disqualify you from receiving any unemployment pay or benefits in most cases. If you voluntarily left due to illness, injury, or poor workplace conditions, you can still qualify.

Injury or Illness

If you had to take time off work or leave your job because of an injury or illness, this is a valid reason to include on the form as well.

In the event of a work-related injury, you’ll want to be clear that it was a work injury when filling out the form. It’s also a good idea to contact any doctors or other medical offices you attended for records and proof of your injury. Accurate medical records can also help in the event you need to sue for any kind of legal compensation on account of a work-related injury.

Again, if medical professionals determined that your work-related injury hinders your future earning potential, you’ll want to pursue a loss of earning capacity, not loss of income.

Vacation and benefits information

Section 2 is more technical than Section 1, requiring information about vacation reimbursement as well as benefits like extended insurance coverage.

This information isn’t always something you’ll know offhand. Don’t hesitate to reach out to the HR rep from your former employer. They’ll be able to give you accurate information, which can influence your benefits. Vacation and benefits are often factored into pay, which determines your eligibility for benefits.

Why Loss of Income and Employment Gaps Matter

There are a few reasons you may need to show and explain a loss of income or employment gap, two if which pertain to welfare or benefits.

  • Welfare services uses income information to determine the level of benefits you may qualify for, if you qualify at all.
  • Employment gaps can also be used by welfare services, as many benefit types require you be employed or actively searching for employment. In Florida, you need to have earned at least $3,400 in 12 months. For more information, read their full guidelines.

While not a part of the verification of employment/loss of income form, employment gaps are important when job hunting as well. Many employers will question employment gaps, so having your valid reason ready to go can be helpful to include on your resume.

Depending on the reason behind your employment gap, you may have to approach the subject differently. Read up on how to explain your employment gap to ensure you cover it properly on both your resume and in the interview process.

Who to Contact if You Need Assistance

The verification of employment/loss of income form has many fields and can vary in presentation depending on the source of the form. If you need assistance filling it out, use the following resources:

Both departments offer assistance and can help you with any areas giving you trouble. If you’re using the form to specifically apply for any kind of family welfare, the Florida Department of Children and Families is ideal. The Florida Department of Health is available to help with all other issues, including any kind of work-related injuries or grievances.


The Florida verification of employment/loss of income form is an important step in receiving benefits or payment you’re owed. It can be time consuming, but it’s worth the effort if it means the difference between receiving or not receiving benefits. This type of support can be a boon to your sense of security while you look for more work or recover from an injury or illness.

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