Connecticut Residential Rental Application

Inside the Connecticut application

Every part of the form, in order — the application summary, 17 sections, and the office-use panel.

• Application summary The reasonable-accommodation contact line, property applied for, requested move-in date, offered rent, and stated security deposit.
• 1. Application Money Disclosure Completed by the owner/manager before distribution: the Conn. Gen. Stat. § 47a-4d no-fee or tenant-screening-fee election, statutory cap, and receipt-or-invoice and report-delivery duties.
• 2. About You Identity, contact channels, an electronic-notice election with a paper-mail alternative, and identity-document choices (SSN, ITIN, government-issued ID, or a lawful alternative) — no date-of-birth field anywhere on the form.
• 3. Other Proposed Occupants Household composition with a separate-signed-application election for each person — ages, birth dates, and adult/minor classifications are never collected; every other adult completes and signs a separate application.
• 4. Pets and Assistance Animals Household pets only; service and assistance animals are handled as fair-housing accommodations, never as pets.
• 5. Residential History Current and prior addresses, housing payments, owner/manager contacts, and an optional neutral move reason.
• 6. Employment & Income Employment plus any lawful source of income, with the Connecticut source-of-income note.
• 7. Banking or Asset Verification An optional verification election; the form never collects account numbers.
• 8. References and Emergency Contact An optional personal reference and an emergency contact that is not used for screening.
• 9. Vehicle Information Vehicle details where parking is requested.
• 10. Additional Information An open area for lawful qualification information.
• 11. Screening Criteria Election
• 12. Reusable or Portable Tenant-Screening Reports The reusable or portable tenant-screening report note — Connecticut has no acceptance mandate; § 47a-4d separately requires delivery of the screening report or request information.
• 13. Screening Information and Legal Limits No criminal-history self-reporting; erased criminal-history record information is not requested or considered, and Judicial-Branch-removed summary-process records barred from commercial use by Conn. Gen. Stat. § 47a-26j are excluded.
• 14. Consumer Report Disclosure How consumer reports are obtained and the adverse-action notice commitment.
• 15. Privacy, Retention, and Disposal Data-minimization commitments under the FCRA and its Disposal Rule.
• 16. Applicant Declaration The signed certification of accuracy with a verification-contact authorization; electronic and copied signatures honored.
• 17. Screening Report Disclosure and Authorization The standalone signed authorization, investigative-report notice, agency identification, free-report-copy election, and the federal Summary-of-Your-Rights package insert.
• For Office Use Only