Publications

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• W-1225

  Request for Replacement SNAP Benefits

• W-675

  W-675 - Report Form For Protective Services For The Elderly - Rev. 06/23

• W-300T19

  W-300T19 - Medical Report For Title XIX Disability Determination - Rev.12-19

• Vendor Direct Deposit Form W-260

  Vendor Direct Deposit Form

• HIPAA Authorization for Disclosure of Information W-298S

  HIPAA Authorization for Disclosure of Information W-298S

• HIPAA Authorization for Disclosure of Information W-298

  HIPAA Authorization for Disclosure of Information W-298

• Medicare Savings Program Application W-1QMB

  Medicare Savings Program Application.

• SNAP ABAWD Work Requirement Medical Report W-1210

  SNAP ABAWD Work Requirement Medical Report.

• W-944

  W-944 - Notice of Action - Rev. 05-23

• Medicare Clearance Form W-9

  Medicare Clearance Form.

• Acquired Brain Injury (ABI) Waiver Request Form W-1130

  Application for Acquired Brain Injury (ABI) Waiver Request.

• CT Fatherhood Initiative Event to Focus on State Local Partnerships Supporting Families

  The special role fathers play in raising children and supporting healthy families will be in the spotlight Thursday, May 3, when a coalition of state and private agencies invites the public to a special event at the Legislative Office Building.

• W-0534FHS

  W-0534FHS - Audiencia Imparcial - Rev. 05-23

• W-0534FH

  W-0534FH Fair Hearing Notice - Rev. 05-23

• Health Information Technology/Health Information Exchange: Status Report & Plan (March 2015)

  The Health Information Technology Exchange of Connecticut (HITE-CT), a quasi-public agency, was created by the 2010 Connecticut General Assembly, was sunset effective June 30, 2014, and the responsibilities1 for Health Information Technology (HIT) and Health Information Exchange (HIE) were transferred to the Department of Social Services (DSS) via Public Act 14-217...