The Benefit Survey

Complete the following survey to quickly learn whether you might be able to get help to pay for things like food, health insurance, and child care.

Completing the survey is quick, and easy. All you have to do is either enter a number in a box, or pick an option from a pre-set list.
If you get stuck on a question, look for text with a dotted underlineFor tips and extra information, hover over any underlined text. , and try rolling your mouse over it.

Click here to start.

How old are you?

What is your citizenship or immigration status?

Do you live in Connecticut?

Do you have a spouse or partner living with you?

How many children (18 and under) live in your house?

Besides your spouse or partner, how many adults living with you do you claim as dependents on your tax return?

Are any of your children US citizens, or green-card holders?

Are any of the children living with you under 13 years old?

Are any of the children living with you under 5 years old?

Do you, or any adult living with you, have any kind of disability For most of the programs, this means that the government has determined that you, or anyone living there, have a physical or mental impairment that prevents substantial work, and that will last at least 12 months.?

Is anyone in your household currently pregnant or been pregnant in the last 12 months?

Are you currently employed?

Is your spouse/partner currently employed?

Does your household have income from other sources other than employment Please include any income you may be getting from state and federal assistance programs, interest on investments and/or bank accounts, pensions, self employment, rental properties, etc. ?

How will you be filing your taxes this year?

You are not employed. Are you in an approved training activity? An "approved training activity" is what you do while you are out of a job. It can be job-searching, going to school, or anything in between. It has to have been approved by the Connecticut's Department of Labor.

How much money do you make before taxes and other deductions are taken out Please enter your gross pay, not your take home pay. Gross pay is the total before any deductions for taxes or other items. If your gross pay changes a lot over the year, enter an estimate of what you make anually , and how often do you get paid?

Your spouse/partner is not employed. Is he/she in an approved training activity? An "approved training activity" is what you do while you are out of a job. It can be job-searching, going to school, or anything in between. It has to have been approved by the Connecticut's Department of Labor.

How much money does your spouse/partner make before taxes and other deductions are taken out Please enter your gross pay, not your take home pay. Gross pay is the total before any deductions for taxes or other items. If your gross pay changes a lot over the year, enter an estimate of what you make anually , and how often does your spouse/partner get paid?

About that other income: how much is it? How often?

How much money would you say you earned in 2007?

How much money would you say your spouse earned in 2007?