Ct request waiver 2026

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The document is a notice from the Office of Victim Services in Connecticut, informing victims of their right to request a waiver for the $100 deductible that is typically deducted from compensation claims. It outlines the process for submitting the request and emphasizes that the form must be completed and submitted before a decision on the claim is made.

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Click ‘Get Form’ to open the ct request waiver in the editor.
Begin by entering the 'Name of Victim' and 'Claim Number' in the designated fields. Ensure that this information is accurate as it is crucial for processing your request.
Next, fill in the 'Name and Address of Claimant'. This section identifies who is requesting the waiver, so double-check for correctness.
Locate the section where you can indicate your relationship to the claimant. Check one box that applies (e.g., Self, mother, father, guardian).
In the next part, select whether you are requesting a waiver of the $100 deductible due to financial hardship. Make sure to read both options carefully before making your selection.
Finally, print your name, sign, and date the form at the bottom. This step confirms your request and must be completed before submission.

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