W 298 2026

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4.8 out of 5

113 votes

The document is an authorization form from the Connecticut Department of Social Services (DSS) that allows clients to permit the disclosure of their personal information, including health records and benefits documentation, to specified individuals or entities. It outlines the types of information that can be disclosed, the client's rights regarding consent and revocation, and includes legal disclaimers about confidentiality protections for sensitive information such as mental health and substance abuse records.

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Click ‘Get Form’ to open the w 298 in the editor.
Begin by entering the name of the DSS client and their Client ID in the designated fields at the top of the form.
In the section for recipient information, provide the name and address of the person who will receive the disclosed information.
Specify the purpose for disclosure. If you prefer not to state a purpose, simply write 'at my request.'
Check all applicable boxes under 'Type of Information DSS is Authorized to Disclose' to indicate what information you are authorizing for release.
Fill in the expiration date or event for this authorization at the bottom of the form.
Sign and date where indicated, ensuring that if someone else is signing on behalf of the client, they attach proof of legal authority.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (113 Votes)

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