Complete this form if you are self employed and have received
an Additional information letter from the EITC group
Download and complete the Questionnaire
below and return with all documentation.


Name Type Description Revised


Form 2018 Earned Income Tax Credit Self-Employed Questionnaire 12/2018
Mail completed Form CT-EITC SEQ and all documents to:

Department of Revenue Services
State of Connecticut
PO Box 2980
Hartford, CT 06103-2980