Connecticut State Department of Social Services
Publications
Page 25 of 27
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Proof of Food Loss Form - Spanish
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W-300MED - For Medicaid for the Employed Disabled - Rev. 12-19
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W-300SA - Medical Report For SAGA Cash Benefits - Rev.12-19
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W-300T19 - Medical Report For Title XIX Disability Determination - Rev.12-19
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W-650 - Authorization for Reimbursement of Interim Assistance - Rev. 09/10
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W-650S - Autorización para Reembolso de Asistencia Interina - Rev. 09/10
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W-675 - Report Form For Protective Services For The Elderly - Rev. 06/23
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W-682 - DIRECT DEPOSIT AUTHORIZATION FORM - Rev. 1-23
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W-682S - FORMULARIO DE AUTORIZACIÓN DE DEPÓSITO DIRECTO - Rev. 1-23
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W-944 - Notice of Action - Rev. 05-23
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When You Receive Help from the Department of Social Services...Important Information (71KB)
In order for you to receive help, there are rules that you need to follow. This brochure tells you about the rules that you must follow in order to be eligible for and stay on our programs.