Publications

Page 21 of 23

• Therapeutic Diet Request W-351

  Therapeutic Diet Request.

• U.S. Citizenship - What you Need to Know for your benefits in Medicaid and HUSKY (85KB)

  If you are a citizen (which includes a naturalized citizen or a national of the United States), federal law now requires you to prove your citizenship and your identity if you want Medicaid, HUSKY A or HUSKY B* health coverage.

• Una breve guía a los Servicios de Pensión para ninos(as) Alimenticia en Connecticut (Pub. #98-6S - Spanish)

  Una breve guía a los Servicios de Pensión para ninos(as) Alimenticia en Connecticut

• Vendor Direct Deposit Form W-260

  Vendor Direct Deposit Form

• W-0016RR

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

• W-0016RRS

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

• W-0534FHS

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

• W-1225

  Request for Replacement SNAP Benefits

• W-1225S

  Request for Replacement SNAP Benefits - Spanish

• W-1226

  Proof of Food Loss Form

• W-1226S

  Proof of Food Loss Form - Spanish

• W-300MED

  W-300MED - For Medicaid for the Employed Disabled - Rev. 12-19

• W-300SA

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

• W-300T19

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