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STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH Office of Emergency Medical ServicesApplication for Mobile Integrated Health Care Services (MID) Considerations 1. A request of waiver in the form

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How to fill out waiver application form connecticut

01

To fill out the waiver application form in Connecticut, follow these steps:

02

Obtain a copy of the waiver application form from the Connecticut Department of Social Services website or from your local DSS office.

03

Carefully read the instructions provided with the form to understand the eligibility criteria and required documents.

04

Gather all the necessary supporting documents such as proof of income, identity, address, and any other required documentation.

05

Fill out the form legibly and accurately. Provide all the requested information, including personal details, financial information, and any relevant details related to the waiver you are applying for.

06

Double-check your completed application form for any errors or omissions before submitting it.

07

Make copies of the completed form and all supporting documents for your records.

08

Submit the completed application form along with all the necessary documents to the designated address provided on the form or as instructed by the DSS.

09

Wait for the processing of your application. You may be contacted for additional information or clarification if needed.

10

Once your application is reviewed and approved, you will be notified of the outcome. If approved, you will receive further instructions regarding the waiver program you applied for.

11

Note: It is recommended to keep copies of all correspondence and documents related to your waiver application for future reference.

Who needs waiver application form connecticut?

01

Individuals who meet certain eligibility criteria and require assistance or services provided by waiver programs in Connecticut need to fill out the waiver application form. The specific types of waivers available vary, but they generally serve individuals who have disabilities, mental health needs, or require long-term care services and supports. It is advisable to review the eligibility requirements and consult with the Connecticut Department of Social Services or a qualified professional to determine if you or someone you know needs to fill out the waiver application form.

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