Cash, Child Care, and Food Assistance
State of Ohio - Online Benefit Application
Cash Assistance, Child Care Assistance, Food Assistance or Medicaid application (JFS-07200) (PDF)
Cash Assistance, Child Care Assistance, Food Assistance or Medicaid application Arabic (JFS-07200ARA) (PDF)
Cash Assistance, Child Care Assistance, Food Assistance or Medicaid application Haitian (JFS-07200-HAT) (PDF)
Cash Assistance, Child Care Assistance, Food Assistance or Medicaid application Spanish (JFS-07200S) (PDF)
Request to Reapply for Cash and Food Assistance (JFS-07204) (PDF)
Request to Reapply for Cash and Food Assistance Arabic (JFS-07204-ARA) (PDF)
Request to Reapply for Cash and Food Assistance Haitian (JFS-07204-HAT) (PDF)
Request to Reapply for Cash and Food Assistance Spanish (JFS-07204-SPA) (PDF)
Request for SNAP Benefits Replacement (JFS-07222) (PDF)
Program Enrollment and Benefit Information (JFS-07501) (PDF)
Program Enrollment and Benefit Information Spanish (JFS-07501-SPA) (PDF)
Program Enrollment and Benefit Information Arabic (JFS-07501-ARA) (PDF)
Request for Cash Assistance Hardship Extension (LCJFS-1610) (PDF) |
Ohio Medicaid
Ohio Medicaid Consumer Homepage
Medicaid Renewal Form (PDF)
HealthChek and Pregnancy Services Assessment (ODM-03528) (PDF)
HealthChek and Pregnancy Services Assessment Arabic (ODM-03528-ARA) (PDF)
HealthChek and Pregnancy Services Assessment Spanish (ODM-03528-SPA) (PDF)
Application for Health Coverage (ODM-07216) (PDF)
Ohio Medicaid Estate Recovery (ODM-07400) (PDF) |
Prevention, Retention, Contingency (PRC)
PRC Application (LCJFS-3800) (PDF)
PRC Application Arabic (LCJFS-3800-ARA) (PDF)
PRC Application Spanish (LCJFS-3800-SPA) (PDF)
PRC Brochure (PDF)
PRC Brochure Arabic (PDF)
PRC Brochure Spanish (PDF)
PRC Plan (PDF)
IRS Form W-9 Request for Taxpayer Identification Number and Certification (PDF) |
Non-Emergency Transportation Services
Do you need help getting back and forth to your medical appointments? If you are on Medicaid, do not have access to a vehicle, and your physician can verify a medical need, you may be eligible for our Non-Emergency Medicaid transportation program. This program will assist you by providing you a ride to and from your Ohio Medicaid providers located in Lucas County.
To apply for Non-Emergency Medical Transportation you will need to submit the following forms:
All three of the above forms are needed to apply for Non-Emergency Medical Transportation. Forms can be submitted by mail or in-person to 3737 Sylvania Ave Toledo, Ohio 43623. They may also be faxed to 419-213-8820. For additional questions you may call 1-844-640-6446. |
Reporting Changes
Reporting changes within 10 days to your case worker is very important. You will need to report a change if:
- Your household composition changes
- You move
- You have a child
- Your income or monthly bills change
Change Form (JFS-1616) (PDF)
Report changes online
OR
Even though the preferred method of change reporting is the online benefit application, you may also call the agency to report changes. Any change regarding Cash Assistance, Food Assistance, Medical or Work Activities, please contact the agency call center at 1-844-640-6446.
Drop Off
You can also drop your documents off in person at 3737 W. Sylvania Ave., Toledo Ohio, 43623 at the Document Drop Off Center from 8:30 am - 4:30 pm. The Document Drop Off Center will scan your document(s) and send it to the worker, electronically, giving you back your original document. It is best to bring in original documents as they scan at a higher quality. A receipt of your scanned document(s) is available upon request. An outside drop box is available 24/7, and is located right outside of the main entrance for JFS/CSEA. |
Other Forms:
Employment Verification Statement (JFS-Letter 12) (PDF)
Public Assistance Authorized Rep Designation (LCJFS-1473) (PDF)
Sanction Compliance Agreement (JFS-03804) (PDF)
Interim Report (JFS-07221) (PDF)
Interim Report Arabic (JFS-07221-ARA) (PDF)
Interim Report Spanish (JFS-07221-SPA) (PDF)
Interim Report Haitian (JFS-07221-HAT) (PDF)
Basic Medical Assessment (JFS-07302) (PDF)
Mental Functional Capacity Assessment (JFS-07308) (PDF)
Direct Deposit Authorization (JFS-7344) (PDF)
Designation of Authorized Representative (ODM-06723) (PDF) |