{1}
##LOC[OK]##
{1}
##LOC[OK]##
##LOC[Cancel]##
Contact
Login
MENU
Community Resources
Forms
Services
Child Support
Food & Cash Assistance
Child Protection
Child Care
Adult Protection
Medical Assistance
Kinship, Foster & Adoption
Jobs
About Us
Mission
Leadership
Strategic Initiatives
Job Openings
Newsletter Sign-up
FCJFS e-Link
Report to the Community 2020
Community Resources
Forms
Services
Child Support
How to Apply
Report a Change
Contact Us
Establishing Paternity
Establishing an Order for Support
Enforcement
Modification
Termination
Access Case Info & Payment History
Receive Payments
Employer Information
FAQs
Learn More
Food & Cash Assistance
How to Apply
Report a Change
Submit a Reapplication or Interim Report
Food Assistance (SNAP)
Cash Assistance
Emergency Assistance - PRC Program
Report Fraud
Contact Community Services
Navigate Ohio Benefits
Child Protection
Report Abuse and Neglect
Family and Youth Meetings
Strength-Based Family Assessments
Crisis Response and Intervention
Visitation Services
Voluntary Family Support Services
Kinship, Foster & Adoption
Outreach and Training
Youth Engagement
Partnerships and Donations
Child Care
How to Apply
Report a Change
Information for Caretakers (Parents)
Information for Providers
Finding a Provider
Contact Community Services
Adult Protection
Report Elder Abuse, Neglect & Exploitation
Outreach and Training
Voluntary Services
Community Partners
Partnerships & Donations
Medical Assistance
How to Apply for Medical Assistance
Report a Change
Medicaid for Individuals & Families
Nursing Home/Waiver
Disability - (Aged, Blind, or Disabled)
Non-Emergency Transportation
Managed Care
Report Fraud
Contact Community Services
Estate Recovery
Kinship, Foster & Adoption
Kinship
Fostering
Adoption
Wendy's Wonderful Kids
Resources
FAQ
Training & Pre-Service
Contact Kinship, Foster & Adoption
Jobs
Job Seekers
Services & Training
Employer Services
OhioMeansJobs Center
FAQ
OhioMeansJobs.com
Fairfield County Job Fair
Contact Us
Local Employers
About Us
Mission
Leadership
Strategic Initiatives
Job Openings
Newsletter Sign-up
FCJFS e-Link
Report to the Community 2020
Community Resources
Forms
View More
Services
About Us
Contact Us
To report abuse or neglect please call:
(740) 652-7887
Forms
Expand/Collapse All
APPLICATIONS
7200 - Food Assistance and/or OWF Cash Assistance Application
7216- Medicaid Only Application
2399- Request for Medicaid Home and Community Based Services
7204 - Reapply for Food Assistance and / or Cash Assistance Application
MEDICAL ASSISTANCE
Managed Care Providers
Medical Provider List
MISCELLANEOUS - Benefits Related
Authorized Representative Form
Declaration of self-employment income
Community Services Brochure
Employee self-declaration
Employer statement
Explanation of State Hearing Procedures (4059)
IAR (Authorization for Reimbursement of Interim Assistance Initial Payment
)
Interim
report
(7221)
LEAP Brochure
Ohio Direction Card brochure
Ohio Eppi Card
Program Enrollment & Benefit Information
Release form
(HIPAA)
Release of Information
Report fraud
Sanction Compliance Form
State Hearing Request Form (4069)
Tax filing status form
Zero income form
PRC
Prevention, Retention & Contingency Plan
PRC application
VENDOR OR CONTRACTOR
Vendor W9
Instructions
Ohio New Hire Reporting
Instructions
O
PERS Independent Contractor Acknowledgment
TRANSPORTATION
Non-Emergency Transportation plan (NET)
Customer rights and responsibilities
NET pamphlet
Transportation Request Form
Managed Care Plan (MCP) Transportation
A-
A+
Fairfield County Job and Family Services
»
Forms