Publications

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• TANF Caseload Reduction Report Request for Comments

  Pursuant to federal regulations at 45 CFR § 261.40 et seq., the Connecticut Department of Social Services is seeking public review and comment on the methodology and the case number estimates used in its Temporary Assistance for Needy Families (TANF) Caseload Reduction Report to calculate the state’s TANF Work Participation Rate for Federal Fiscal Year 2020.

• W-1226

  Proof of Food Loss Form

• Therapeutic Diet Request W-351

  Therapeutic Diet Request.

• W-300SA

  W-300SA - Medical Report For SAGA Cash Benefits - Rev.12-19

• W-1225S

  Request for Replacement SNAP Benefits - Spanish

• W-650

  W-650 - Authorization for Reimbursement of Interim Assistance - Rev. 09/10

• W-0016RRS

  Client Rights and Responsibilities - W-0016RRS Rev 1-23 - Spanish

• W-0016RR

  Client Rights and Responsibilities - W-0016RR Rev 1-23 - English

• Patient Liability Change Report W-1696

  Patient Liability Change Report

• Determination of Spousal Assets W-1-SA

  This form is for use by individuals requesting an assessment of spousal assets when one spouse starts a continuous period of institutionalization of 30 or more days in a medical institution, long term care facility, or begins receiving home and community based services.

• W-682

  W-682 - DIRECT DEPOSIT AUTHORIZATION FORM - Rev. 1-23

• Determination of Spousal Assets W-1-SAS - Versión en Español

  Aplicación para la Determinación de Bienes Personales del Esposo (de la Esposa)

• Acquired Brain Injury (ABI) Waiver Request Form W-1130S - Versión en Español

  Application for Acquired Brain Injury (ABI) Waiver Request - Versión en Español.

• W-650S

  W-650S - Autorización para Reembolso de Asistencia Interina - Rev. 09/10