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 renewing benefits. "You" refers to the person who is renewing benefits for their family. Their information will be factored into the renewal. If you're helping someone use this website, please fill out this page as if you were that person.
Contact Information
Select your preferred language.
Choose if you need an interpreter.
Provide the best phone number you could be reached at.
To continue, click the NEXT button.
To go back to the prior page, click the PREVIOUS button.
To save the renewal or exit the page, click the SAVE & EXIT button. This takes you to the SAVE and EXIT screen where you have a choice of saving or continuing to work on the renewal.
To close this window and return to ConneCT, click the CANCEL & EXIT button.