Get Ct W-1hus 2012-2025

Filling out the CT W-1HUS form online can be a straightforward process with the right guidance. This form is essential for individuals and families in need of health insurance through Medicaid or related programs in Connecticut.

Follow the steps to complete your CT W-1HUS application online.

1. Click ‘Get Form’ button to obtain the CT W-1HUS form and open it in your preferred online editor.
2. Begin by filling out Section A, where you will specify whom you want health insurance coverage for. Check all categories that apply to your situation, including yourself and any dependents.
3. In Section B, provide your personal information, including your last name, first name, and contact details. Indicate if you are Hispanic or Latino, your race, and your gender.
4. Proceed to Section C, where you will list all individuals who need health coverage. For each individual, fill out their name, relationship to you, Social Security number, gender, and any other applicable information.
5. Complete Section D with details of other household members who may not be applying for coverage but live in the same home. Include their relation to the applicant and whether they earn an income.
6. In Section E, agree to cooperate with child support requirements if applicable. Provide details about any parents not residing in the household if you are applying for coverage.
7. Fill out Section F with employment income details for anyone working in the household, specifying their employer and income.
8. Section G requires you to report any other income sources. List the type of income, how much, and how often it is received.
9. If relevant, describe in Section H any daycare expenses you or others in your household incur.
10. In Section I, provide information about any other health insurance that you or applicants currently have.
11. Complete Section J for individuals who are not US citizens, providing their immigration information.
12. Reach Section K to indicate if any individuals belong to a federally recognized American Indian tribe.
13. Finally, read carefully and sign in Section L. Ensure all information is accurate and complete, as you will be required to verify it.

Take the first step towards securing health coverage by completing your CT W-1HUS application online today.