Forms
Below you will find a list of the forms we refer to throughout our website. These forms may be printed/downloaded directly from your computer. Most of these forms are PDF files and will require Adobe Reader.
Administrative Services Forms
Assistance Programs Forms
- JFS 02399 Request for Medicaid Home and Community Based Services
- JFS 07161 OH Breast & Cervical Cancer Medicaid Application
- JFS 07200 Application for Cash, Food, and Medical Assistance
- JFS 07501 Program Enrollment & Benefit Information
- JFS 08058 Medicare Premium Assist Program
- JFS 08102 Medicaid Consumer Guide
- JFS 08211 OH Medicaid General Information
- Expanded Medicaid General Information
- JFS 07103 Application for Help With Medicare Expenses
- JFS 07216 Application for Health Coverage & Help Paying Costs
- JFS 01643 Provider Type B Application/Certification
- How to Apply for Medicaid
- Applying for Nursing Home Information via Medicaid
- Ohio Voter Registration Form
Provider/Caregiver Forms
Child Support Forms
- JFS 01849 Request for an Administrative Review of the Child Support Order
- Child Support Application Questionnaire and Checklist
- JFS 07076 IV-D Application for Services
- Child Support Rights-Responsibilities
- State Hearing Procedures
- Online State Hearing Request Form
- Seek Work Job Search Logs
- JFS 01852 Request for the collection of Child Support Overpayment
- JFS 04001 Request for Case Information
Children & Elderly Services Forms
- JFS 01691 Application for Child Placement
- JFS 01421 Application for Reimbursement of Nonrecurring Adoption Expenses
- JFS 01421 Instructions on how to fill out the Reimbursement of Nonrecurring Adoption Expenses
- Definitions of Child Abuse and Neglect
- Foster Care Intake Dental
- Foster Care Monthly Notes
- Foster Care Placement Intake Physical Examination
- Foster Parent Reimbursement Request
PRC Applications
- Ottawa County Emergency Financial Assistance Applications – 2023
- Ottawa County – Transition Back to Work – application 2023