How to Fill Out and Submit Connecticut DSS Form W-35

Connecticut DSS Form W-35, officially the “Certificate for Disclosure of Gross Wages, Salary or Commission Paid,” is the wage verification form you give to your employer so the Department of Social Services can confirm your earnings for HUSKY Health, SNAP, or Temporary Family Assistance. You fill in the identifying information at the top, your employer records your recent pay periods and signs the bottom, and you send the completed form back to DSS. Most delays come from mismatches between what you reported on your application and what the employer certifies, so accuracy on both halves matters.

Where To Get a Blank Form

You can download the W-35 as a Word document from the Connecticut Department of Social Services at portal.ct.gov.¹ Blank copies are also available at any DSS Resource Center, Monday through Friday, 8:00 a.m. to 4:30 p.m.² Sometimes your caseworker will mail it to you with other paperwork during an application or renewal.

What You Fill In at the Top

The top section identifies the employee whose wages are being verified. Fill it in before handing the form to your employer.¹ The fields are:

Your name as it appears on your DSS case.
Your Social Security number.
Your DSS Client ID number, which appears on any notice DSS has mailed you or in your ConneCT account.
The name and address of your employer.

The Client ID is the one people skip most often. Without it, DSS staff have to match the form to your case by hand, and that adds days to processing.

What Your Employer Fills In

The rest of the form belongs to your employer. There is no employee signature or authorization section. Connecticut law requires employers to disclose wage information to DSS when presented with a proper request, so your employer does not need your written permission to complete it.³

The form shows a date range for the pay periods DSS wants. Your employer lists each pay period in chronological order, most recent first, and for each one records:

The start and end dates of the pay period.
Gross earnings, meaning total pay before taxes or deductions, including tips.
Deductions withheld during that period for taxes, insurance, retirement, and similar items.
Pay frequency: weekly, biweekly, semimonthly, or monthly.

If DSS only needs a few pay periods and the form has more rows than that, your employer can cross out the unused rows.¹ A business phone number goes on the form too, so DSS can call with questions. Then the employer signs and dates it.

Tips, commissions, and bonuses are part of gross earnings and should be included. Leaving variable pay off the form causes DSS to miscount your income in one direction or the other, which creates problems later.

How To Submit the Completed Form

Once your employer returns the signed form, you can send it to DSS three ways:

Online: log in to your ConneCT MyAccount at www.connect.ct.gov. If your Client ID is already linked, use the “Report Change” link at the top of the page to upload a scan or clear photo. If it isn’t, follow the “Associate Case” instructions first.⁴
Fax to (860) 812-0022.⁵
Mail to DSS ConneCT Scanning Center, PO Box 1320, Manchester, CT 06045.²

DSS Resource Centers also have outdoor drop boxes if you’d rather hand-deliver the form without waiting in line. Keep a copy no matter how you send it. If DSS later says the form never arrived, you’ll want proof you sent it. To check status, call the DSS Benefits Center at 1-855-626-6632 (TTD/TTY 1-800-842-4524) or sign in to ConneCT.⁶

When You’ll Need To Submit Another W-35

The W-35 isn’t a one-time document. DSS will ask for a new one at three predictable points:

When you first apply, to establish your baseline earnings.
At renewal, when DSS redetermines whether you still qualify. SNAP renewals require submitting a renewal application along with the required verifications.⁷
When your income changes. Starting a new job, getting a raise, losing hours, or any other shift in pay should be reported promptly through ConneCT or the Benefits Center.⁴

Unreported income changes lead to overpayments, which DSS eventually catches and recovers from your future benefits or directly from you.

If Your Employer Won’t or Can’t Complete the Form

Filling out the W-35 isn’t optional for employers. Under Connecticut General Statutes § 17b-137, an employer of someone applying for or receiving state assistance must make full disclosure of wages when presented with a certificate from the Commissioner of Social Services or a deputy, and the statute is printed across the top of the form. An employer who refuses without reasonable excuse faces a $50 fine per offense.³ If yours is stalling or refusing, tell your caseworker.

If the employer legitimately can’t help because the business has closed, records are gone, or you’re self-employed, DSS accepts other documentation. Pay stubs for the relevant period are the most straightforward substitute. Bank statements showing regular deposits, a letter on company letterhead, or tax documents like a W-2 or 1099 can also work. If you have no written documentation, your caseworker may use a collateral contact, meaning a third party outside your household who can confirm your income verbally. The caseworker needs your permission first and has to offer you the chance to provide the information another way. If none of these produce enough verification, the caseworker is responsible for finding another method rather than denying your case outright.

Penalties for False Information

Everything on a DSS application and its supporting documents, including the wages reported on a W-35, is certified under penalty of false statement. Under C.G.S. § 17b-97, obtaining or attempting to obtain benefits through false statements, misrepresentation, or impersonation carries the same penalties as larceny under Connecticut law, with severity scaling by the dollar amount, from a misdemeanor for small sums to a felony for larger ones.³ The same fraud provisions reach an employer who knowingly understates wages to help someone qualify. Any overpayment caused by inaccurate reporting is recoverable by DSS, usually through reductions to future benefits.

1
Connecticut Department of Social Services. Connecticut DSS Form W-35 – Certificate for Disclosure of Gross Wages, Salary or Commission Paid
2
Connecticut Department of Social Services. Contact Us
3
Connecticut General Assembly. Connecticut General Statutes Chapter 319s – Financial Assistance
4
Connecticut Department of Social Services. About ConneCT – DSS Service Modernization – How To
5
Town of Plymouth. DSS Service Modernization
6
Connecticut Department of Social Services. DSS Client Information Line and Benefits Center
7
Connecticut Department of Social Services. Connecticut SNAP Policy Manual – Renewal