Notice to Dependants - Connecticut 2026

1. Click ‘Get Form’ to open the Notice to Dependants - Connecticut in the editor.
2. Begin by entering the name of the employee in the designated field at the top of the form. This identifies who the notice pertains to.
3. Next, fill in the employee's address accurately. This information is crucial for proper communication regarding benefits.
4. Indicate the date of injury in the specified section. Ensure this date aligns with your records for consistency.
5. Review any additional instructions regarding filing a written notice of claim. Make sure you understand the time limits set forth in § 31-294c of the Connecticut General Statutes.
6. Finally, complete the section indicating who is sending this notice, including their name and address, and ensure you enter the date when this notice is being sent.

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