If you are currently self-employed and are unable to provide other verification of your income, due to reasons such as recently becoming self-employed or a major change in your self-employment income, you can use this affidavit to prove your income status.
Once you complete your application through Maryland Health Connection, you will receive a verification notice in the mail requesting verification of income. In response to this request, you may either complete this affidavit and upload it to your online account or send it with the cover letter from the notice to the following address:
Maryland Health Connection
P.O. Box 2160
Manchester, CT 06045