PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form W-675
for the current year.
Form W-675 Report Form for Protective Services for the Elderly - Connecticut
What Is Form W-675?
This is a legal form that was released by the Connecticut State Department of Social Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form W-675?A: Form W-675 is a report form for protective services for the elderly in Connecticut.
Q: Who is required to file Form W-675?A: Individuals responsible for providing protective services to the elderly in Connecticut are required to file Form W-675.
Q: What information is required on Form W-675?A: Form W-675 requires information about the recipient of services, the services provided, and any changes in the recipient's circumstances.
Q: When is Form W-675 due?A: Form W-675 is due within 10 days of the end of the month in which services were provided.
Q: What happens if I don't file Form W-675?A: Failure to file Form W-675 may result in penalties or loss of funding for the protective services program.
Form Details:
- Released on June 1, 2015;
- The latest edition provided by the Connecticut State Department of Social Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form W-675 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Social Services.
