I am looking to apply for Eligibility for supports or services for a person with Intellectual Disability (formerly known as Mental Retardation)

  • Print Application(PDF, 1 MB)    Application Spanish (PDF, 1 MB)
    You can download and print the application.
  • To request an Application to be sent via US Mail:
    Email address:  DDS.Eligibility@ct.gov
    Toll free in state phone number: 866-433-8192.  Out of state phone number: 860-418-6117
Requested information should be submitted to
Department of Developmental Services
Eligibility Unit
460 Capitol Avenue
Hartford, CT 06106
Fax: 860-622-2797
How to Apply for Title 19 (Medicaid)
Record Retention Policy: Pursuant to Connecticut General Statute §11-8 and §11-8a, DDS retains records used in the eligibility determination process for 10 (ten) years from the date of application.