Identity verification documents (REQUIRED)
Provide your identity verification documents directly to Aflac by uploading them into your claim through the CT Paid Leave Aflac Portal.
- Do not send original documents to Aflac.
- Provide color copies of the original documents.
- You can use your mobile phone to take photos or use a free application such as Adobe Scan.
When uploading identity verification documents, select Identification as document type.
Please submit one stand-alone document OR two alternate documents.
Stand-Alone Documents
The easiest way to provide proof of identity is a color copy of both front and back of your Connecticut driver's license or state issued non-driver ID.
If you do not have a Connecticut driver's license or state issued non-driver ID, you will need to provide ONE of the following documents:
Valid government issued form of identification (i.e., passport, passport card, ID card, enhanced or standard driver’s license)
Valid United States Citizenship and Immigration Service ID
- Form I-766 Employment Authorization
- Form I-551 Permanent Resident Card
Valid foreign government issued form of identification (i.e., passport, consular ID card, national identification card)
Alternate Documents
If you do not have one of the stand-alone identity verification documents, provide one of the documents in Group A and one of the documents in Group B.
Group A
Certified copy of your birth certificate filed with a State Office of Vital Statistics or equivalent agency in your state of birth
Certificate of Citizenship, Form N-560, or Form N-561, issued by Department of Homeland Security (DHS)
Certificate of Naturalization (Form N-550 or Form N-570)
Group B
Social Security Card
W-2 Form
Social Security 1099 (SSA-1099) Form
Non-SSA-1099 Form
Pay stub with your full name and Social Security Number on it
Authorization letter from the Internal Revenue Service (IRS) displaying your 9-digit individual tax identification number
Employment Verification (REQUIRED)
Are you a Sole Proprietor/Self-Employed Individual?
No Yes
If you are still having trouble getting your employer to complete and return the form, call Aflac (877-499-8606) for guidance.
Important
Important
If you currently have or if you had more than one employer within 12 weeks of your first date of leave, each employer must fill out an Employment Verification Form.This includes:
- All employers, even if you are not taking leave from them all
- Former employers, even if you are no longer employed with that employer
Documents supporting the leave reason (REQUIRED)
Different documents are required depending on your leave reason.
Your Notice of Applicationwill include the required documents, many of which are pre-filled with your name and case number.
If you lost these forms, log into the CT Paid Leave Aflac Portal to download your Notice of Application with the pre-filled forms.
Third-Party Authorization to Release Form (OPTIONAL)
To give permission to a friend or family member to communicate with Aflac or submit documents on your behalf, fill out the Third-Party Authorization To Release Form.
Sample Forms
Third-Party Authorization To Release Form (English) Third-Party Authorization To Release Form (Spanish)
If uploading the Third-Party Authorization To Release Form, select
Document Type:
Authorization Form
When uploading documents, do not use the sample forms.
Payment Election Form (OPTIONAL)
You can receive your benefit payments either through direct deposit to your bank account or a pre-paid debit card.
Applying online or by calling Aflac?
You will be prompted to make your payment election.
Requesting to receive application forms by mail?
You will receive a payment election form to complete.
If you choose direct deposit on the payment election form, you will be required to submit a voided check or deposit slip with your application documents.
If you choose debit card on the payment election form, you do not need to submit any additional banking information.
If uploading the Payment Election Form, select:
Document Type: EFT Form
When uploading voided check, select:
Document Type:
EFT Form
When uploading documents, do not use the sample forms.
Tax forms (OPTIONAL)
These benefits will be subject to federal and state taxes. Taxes are not automatically withheld from benefits paid, but payees can request voluntary tax withholding.
Applying online or by calling Aflac?
If you apply online or by calling the Aflac customer care line, you will be asked if you wish to have taxes withheld and, if so, how much.
Requesting to receive application forms by mail?
If you request to receive the application forms by mail and you wish to have taxes withheld, fill out the employee sections of the federal and state tax withholding forms. Do not fill out the Employers Only sections.
Sample Forms
W-4CT-W4
When uploading the W-4, select:
Document Type:
W4
When uploading all CT-W4 or W-4S, select:
Document Type:
W-4S
When uploading documents, do not use the sample forms.
