Forms and Service Center

1. Print out and complete application

2. Bring (or mail) to:
Lucas County Job & Family Services
3210 Monroe Street
P.O. Box 10007
Toledo, OH 43682-4139
or
Fax to: (419) 213-8820
If you choose to bring the application to our office at the above location, the office hours are 8:00 am - 4:30 pm.

Cash Assistance, Food Assistance or Medicaid


To access the Ohio online benefit Application:
http://odjfsbenefits.ohio.gov/SelfServiceSplash.jsf

OR

Cash Assistance, Food Assistance or Medicaid application (JFS 7200)

Cash Assistance, Food Assistance or Medicaid application Spanish (JFS 7200S)

Healthy Start/Healthy Families Medicaid


To access the Ohio online benefit application:
Apply for benefits online

OR

Healthy Start/Healthy Families application (JFS 7216)
 
  

Prevention, Retention, Contingency (PRC)


PRC Application

PRC Plan

Subsidized Child Care


Child Care application (JFS 1138)

Child Care Spanish application (JFS 1138S)

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 3210 Monroe Street Toledo, Ohio 43699. They may also be faxed to 419-213-8820. For additional questions you may call 419-213-8910

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
Click here to report changes through the online benefit application system: http://odjfsbenefits.ohio.gov/SelfServiceSplash.jsf

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 419-213-8800 or 419-213-8900. For general information call the Job & Family Services operator at 419-213-8999.

Drop Off

You can also drop your documents off in person at 3210 Monroe Street, Toledo Ohio, 43606 at the Document Drop Off Center from 8:00 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.

Other Forms:


Designation of Authorized Representative (LCJFS 1473)

Direct Deposit Authorization (ODJFS 7344)

Employment Verification Form (LCJFS 12)

Interim Report

Interim Report (Spanish)

Landlord Inquiry Form (LCJFS 1224)

Request to Reapply for Cash and Food Assistance (ODJFS 7204)

Sanction Compliance Agreement (3804)