Economic Security - Financial Assistance--Documents

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Due to far below normal precipitation and ongoing fire danger levels, a Stage 2 Drought Advisory has been declared for Connecticut. Residents are encouraged to be mindful of water consumption and use extra caution to prevent fires. An emergency burn ban is in effect at all state parks, forests, and wildlife management areas, prohibiting the use of all outdoor grills, firepits, campfires, etc.

Economic Security - Financial Assistance

Documents/Forms

2023 FPL and SMI Percentages

Authorization for Disclosure of Information (English)

Authorization for Disclosure of Information (Spanish)

Authorization for Reimbursement of Interim Assistance (English)

Authorization for Reimbursement of Interim Assistance (Spanish)

Rights and Responsibilities (English)

Rights and Responsibilities (Spanish)

SAGA Medical Statement

SAGA Cash Medical Report

SAGA Client Supplement for Medical Information (English)

SAGA Client Supplement for Medical Information (Spanish)

SAGA Permission to Share Medical Information

TFA Medical Report for Person Who Needs Care

TFA Medical Report for Incapacity

TFA Noncustodial Parents Information Sheet

For information on applying, please follow this link.