INSTRUCTIONS: CONNECTICUT ADDENDUM TO IDENTIFY ALL PROVIDER NETWORKS CONTRACTED WITH MANAGED CARE ORGANIZATIONS

Connecticut organizations use the form discussed in this article to identify all provider networks which are contracted with managed care. This document can be obtained from the website maintained by the government of Connecticut.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 1: Enter your network name on the first blank line.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 2: Enter your network address on the next two blank lines.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 3: Enter a contact name for your network on the fourth blank line.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 4: Enter a phone number for your network on the fifth blank line.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 5: Enter the effective date of your current contract on the sixth blank line.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 6: Enter the contract renewal date on the seventh blank line.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 7: If the network is a licensed preferred provider network in Connecticut, enter its state license number on the eighth blank line.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 8: On line 1, place a check mark next to all types of services provided by this network.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 9: On line 2, indicate with a check mark whether or not the network is owned and operated by the managed care organization. If yes, indicate with a check mark whether the network provides services to Connecticut enrollees of other health plans.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 10: On line 3, indicate with a check mark whether the managed care organization makes payments to the network, which distributes them to participating providers, or whether payments are made directly to individual network providers.

Connecticut Addendum To Identify All Provider Networks Contracted With Managed Care Organizations Step 11: Answer questions 4 through 7 as instructed. 

INSTRUCTIONS: CONNECTICUT CERTIFICATE OF CLOSED PROCEEDINGS (Form JD-CV-11)

When pleadings have closed in a Connecticut case, a form JC-CV-11 should be completed. This document can be obtained from the website maintained by the Connecticut Judicial Branch.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 1: Enter the case docket number in the first blank box.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 2: Enter the name of the case in the second blank box.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 3: In the third blank box, indicate with a check mark whether the case is being heard in a judicial district, housing sessions or geographical area number court. If the latter, give its number.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 4: In the fourth blank box, give the address of the court.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 5: In the fifth blank box, enter the name of the person completing this form.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 6: In the sixth blank box, enter your signature.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 7: In the seventh blank box, indicate with a check mark whether the person completing the form is the plaintiff, their attorney, the defendant or their attorney.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 8: The next section requires you to indicate how the case will proceed. Place an "X" next to all applicable statements.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 9: Section A should only be completed if the case is privileged. If so, place an "X" next to all statements which are the basis of this privilege.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 10: Section B concerns the relief being requested. Place an "X" in the first box if seeking $15,000 or more.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 11: Place an "X" in the second box if seeking less than $15,000.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 12: Place an "X" in the third box if claiming other relief in addition to or instead of monetary damages.

Connecticut Certificate Of Closed Proceedings JD-CV-11 Step 13: The bottom portion of the form should be completed to certify that copies of this document have been mailed or delivered electronically or non-electronically to all attorneys and self-represented parties involved in this case. 

INSTRUCTIONS: CONNECTICUT NOTICE OF JUDGMENT AND ORDER FOR WEEKLY PAYMENTS (Form JD-CV-50)

In a Connecticut case involving creditors and debtors, a form JD-CV-50 is used to render judgment and order the defendant to make weekly payments. This document can be found on the website of the Connecticut Judicial Branch.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 1: Section I is for completion by the plaintiff or their attorney. If the case occurred in a judicial district court, check the first box.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 2: If the case occurred in a housing session court, check the second box.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 3: If the case occurred in a Geographic Area Number court, check the box and enter the number.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 4: Enter the address of the court, including the street number and name, town name and zip code.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 5: Enter the name of the case.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 6: Enter the names of all defendants who must pay judgment.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 7: Section II is for completion by the court clerk. On line 1, the amount due on claims will be entered.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 8: On line 2, the amount of interest due will be entered.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 9: On line 3, the amount of reasonable attorney's fees due will be entered. On line 4, the amount due for other reasonable charges will be entered.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 10: Add lines 1 through 4. Enter the resulting sum on line 5. On line 6, the plaintiff's costs will be entered. This will be added to line 5 and the resulting amount due entered on line 7.

Connecticut Notice Of Judgment And Order For Weekly Payments JD-CV-50 Step 11: The weekly payments due will be entered below. Section III will be completed once copies of this form have been delivered to all involved self-represented parties and attorneys.

INSTRUCTIONS: CONNECTICUT ANSWER TO COMPLAINT CIVIL CASES ONLY (Form JD-CV-106)

When a civil lawsuit is filed against you in Connecticut, you should file two documents in response. Form JC-DL-12 should be filed to be informed of all upcoming court dates. Form JD-CV-106 is used to respond to the numbered allegations in the complaint against you. This form can be found on the website maintained by the Connecticut Judicial Branch.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 1: Enter the name of the case in the first blank box.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 2: In, the second blank box, indicate with a check mark whether the case concerns a judicial district, a housing session, or property at a specific geographic location. If the latter, give its area number.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 3: In the third blank box, enter the address of the court.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 4: On lines 1 through 8, you may respond to the corresponding numbered allegations in the complaint filed against you. Check "Agree," "Disagree" or "Do Not Know" as applicable.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 5: In the blank section provided below, write any special defenses you have.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 6: Enter your signature in the next blank box.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 7: Enter the date in the next blank box.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 8: The paragraph below states that a copy of this document has been mailed or delivered electronically or non-electronically to all attorneys and self-represented parties of record. Enter the date on which you took this step.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 9: Enter the name and address of each party and attorney to whom a copy of this document was delivered. If necessary for full documentation, attach additional sheets.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 10: In the next three blank boxes, sign and print your name, as well as entering the date.

Connecticut Answer To Complaint Civil Cases Only JD-CV-106 Step 11: In the last two blank boxes, enter your mailing address and telephone number.

INSTRUCTIONS: CONNECTICUT APPLICATION FOR SPECIAL PERMIT TO OPERATE A MOTOR VEHICLE TO AND FROM WORK (Form A-62)

Connecticut drivers whose licenses have been suspended use a form A-62 to request a special permit to operate a vehicle to and from work. This document can be obtained from the website of the government of Connecticut.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 1: Enter your name in the first blank box.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 2: Enter your date of birth in the second blank box.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 3: Enter your operator license number and the state of issue in the third blank box.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 4: Indicate your sex by checking "M" for male or "F" for female.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 5: Enter your mailing address in the fourth blank box.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 6: If different, enter your residential address in the fifth blank box.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 7: Enter the name of your employer in the sixth blank box. If self-employed, enter your business name and attach legal proof of self-employment.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 8: Enter your employer's address in the seventh blank box.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 9: Enter your occupation and home phone number in the eighth and ninth blank boxes.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 10: Document your days and hours of employment and answer all questions concerning your request.

Connecticut Application For Special Permit To Operate A Motor Vehicle to And From Work A-62 Step 11: Your supervisor should print and sign their name, as well as providing their title and work telephone number. You should then print and sign your name and give the date where indicated.