Forms and Applications

1. Print out and complete application

2. Mail to:
Lucas County Job & Family Services
P.O. Box 10007
Toledo, OH 43699-0007

or
Fax to: (419) 213-8820

or
Email

Cash Assistance, Child Care Assistance, Food Assistance or Medicaid

State of Ohio - Online Benefit Application

Cash Assistance, Child Care Assistance, Food Assistance or Medicaid application (JFS 7200) (PDF)

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

Cash Assistance, Child Care Assistance, Food Assistance or Medicaid application Arabic (JFS 7200ARA) (PDF)

Request for SNAP Benefits Replacement (JFS 07222) (PDF)

Medicaid Renewal Form (PDF)

Healthy Start/Healthy Families Medicaid

State of Ohio - Online Benefit Application

Prevention, Retention, Contingency (PRC)

PRC Application (PDF)

PRC Plan (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
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:

Direct Deposit Authorization (ODJFS 7344) (PDF)

Interim Report (JFS 07221) (PDF)

Interim Report Spanish (JFS 07221-SPA) (PDF)

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

Request to Reapply for Cash and Food Assistance Spanish (ODJFS 7204-SPA) (PDF)

Sanction Compliance Agreement (JFS 03804) (PDF)

Public Assistance Authorized Rep Designation (LCJFS 1473) (PDF)

Application for Health Coverage (ODM 07216) (PDF)