Notice of Intention To Be Included - Connecticut 2025

1. Click ‘Get Form’ to open the Notice of Intention To Be Included in the editor.
2. Begin by entering the District Number and the District Office Address where you will submit the form.
3. Select your intention by checking either the box to be included for coverage or to revoke previous inclusion under Sec. 31-275.
4. Fill in your business name, employee's name, and both business and employee addresses accurately.
5. Provide the Employee's Social Security Number and Federal Employer Identification Number as required.
6. Complete the date section with the current day, month, and year, followed by your signature as the employee.
7. Review all entries for accuracy before saving or printing your completed form for submission.

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