Get Ct W-982 2016-2025

The CT W-982 is an essential form for individuals seeking assistance through the Personal Care Attendant program in Connecticut. This guide will provide step-by-step instructions on how to accurately complete the form online, ensuring a smooth application process.

Follow the steps to successfully complete the CT W-982 form online.

1. Press the 'Get Form' button to obtain the CT W-982 form and open it for editing.
2. In Section A, enter the applicant’s personal information: Last name, First name, Date of birth, and Social Security number. Specify the marital status and gender, and complete the address and phone number fields. If applicable, provide the Medicaid number.
3. Indicate the living situation by checking one of the options: Alone, With family, Group home, or Assisted living.
4. Proceed to Section B, the financial assessment. Input the monthly income and total assets. If applicable, indicate if you would like a Spousal Assessment by selecting Yes or No.
5. In Section C, the functional assessment, indicate the level of assistance needed for each daily living task. Use the scale provided (0-3) to show the amount of help required.
6. Include any relevant behavioral issues by circling all that apply and write down any medical diagnoses or conditions in the designated space.
7. Identify the point of contact in Section D by selecting the appropriate role (e.g., Power-of-Attorney, Conservator, Guardian). Provide the name and phone number of this individual.
8. Ensure the applicant signs and dates the form. If signed with an ‘X’, a witness signature and relationship must be included.
9. If applicable, facility staff should complete the final section with facility details.
10. After completing the form, review all information for accuracy. Users can then save changes, download, or share the form as needed.

Complete your CT W-982 application online to ensure timely assistance.