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About You

Information About You

You are required to answer questions and fill in fields with a red asterisk (*) next to them. Enter your legal first and last name. Entering the middle initial is optional. Do not enter nicknames. If you have two last names, enter both of them into the Last Name field. If your name does not fit into the field, type as much as will fit.

"You" means the person who is applying for benefits or the primary applicant.  "You" refers to the person who is applying for benefits for their family.  Their information will be factored into the application. If you're helping someone use this website, please fill out this page as if you were that person.

Contact Information

Select either the male or female button. Enter your birth date in the following format MM/DD/YYYY. Use slashes (/) when you type the date.

Select your language from the drop-down menu. Select the city you currently live in.

Where You Live

Enter the address where you currently live. This is the address that DSS will use to send letters and other information to you. If you are homeless, you can choose a city office to have your mail sent to on the next page.

If you think your living arrangement is going to be for less than 90 days, select YES from the drop-down list.

Mailing Address

If you cannot receive mail at your home address, enter a different mailing address here. DSS sends all mail to your residential address unless you have good cause to use a mailing address.  If you are homeless but you have a mailing address, please type a mailing address.

Previous Addresses

To enter an address you previously lived at, click the ADD button.

To close this window and return to ConneCT without saving, click the CANCEL & EXIT button.