211 Connecticut

FOR STATE-FUNDED COMPONENT OF THIS PROGRAM, self-declaration suffices for most areas of the application EXCEPT proof of citizenship or legal resident statusFOR MEDICAID and MEDICAID WAIVER-FUNDED COMPONENT OF THIS PROGRAM THE FOLLOWING APPLIES: Proof of address (current rent receipt or mortgage bill, utility bill); Proof of income (if employed: copies of pay stubs; if self-employed: tax returns or bookkeeping records; copies of checks from source of income; an award letter or signed statement from the person or source of any income); Proof of all assets (bank books, bank statements, trust fund agreements, copies of stocks/bonds/U.S. Savings bonds, life insurance policies, a letter from a financial institution, a copy of a car registration, deeds or legal agreements); Proof of citizenship (self-statement or letter of citizenship if naturalized) or proof of legal resident status (green card, Visa papers); Proof of age (birth certificate, baptismal certificate, immigration papers, passport, voter registration card, drivers license, hospital records, adoption papers, naturalization certificate, census records, school records, insurance company records, social security records, physician's statement, statements from disinterested third party); Proof of family size (birth certificates or rental lease); Social Security numbers for all family members (Social Security cards); Proof of disability (Social Security determination letter or physician's statement); Proof of housing expenses (lease or mortgage bill, utility bills); Proof of medical expenses (medical bills); If employed, proof of employment (pay stubs or letter from employer); If applicable: documentation of trusts, transfer of assets, burial funds, reverse mortgage