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    • Request for Proposals
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    • Application Process
    • Agency Info
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    • EPPICard- Reporting Lost or Stolen Cards
    • Ohio Direction Card- Reporting a Lost, Stolen or Transaction Issues
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  • PROGRAMS

     

    • OWF - Cash Assistance
    • Food Assistance
    • Prevention, Retention, and Contingency (PRC)
  • MEDICAID

     

    • Program Overview
    • Disability Determination Redesign
    • How to Apply
    • What Happens Next
    • Managed Care Providers
  • SUPPORTIVE SERVICES

     

    • Adult Protective Services
    • Child Care
    • Transportation
    • LEAP

Applications & Forms

Upon completion of any forms or applications you will need to print the document and submit your information to the Warren County Department of Human Services either via mail, fax, or in person.

FOOD ASSISTANCE, CASH ASSISTANCE, AND MEDICAID APPLICATIONS

  • Request for Cash, Food, and Medical Assistance - JFS 07200
  • Voter Registration - JFS 07200VR
  • Combined Programs Application - ODM 07216
  • Interim Report - JFS 07221
  • Re-Determination for Cash and Food Assistance - JFS 07204


  • Application for Help With Medicare Expenses - ODM 07216
  • Medicaid Buy-In for Workers with Disabilities- JFS 07211
  • Request for Medicaid Home and Community-Based Services - ODM 02399
  • Healthchek and Pregnancy Related Services JFS 03528

CHILD CARE APPLICATIONS

  • Application for Child Care Benefits - JFS 01138
  • Re-Determination Application for Child Care Benefits - JFS 01124

ADULT PROTECTIVE SERVICES REFERRAL FORM

  • Adult Protective Services Referral Form

PREVENTION, RETENTION, AND CONTINGENCY (PRC PROGRAM) APPLICATIONS

  • Warren County PRC Application

VERIFICATIONS/FORMS

  • Ohio Benefits Electronic Asset Verification Acknowledgement Form
  • Employment Verification - JFS 2775
  • Self Employment Verification
  • Household Verification - JFS 3390
  • Self Declaration of Circumstances
  • Job Lead Forms/Verification
  • Designation of Authorized Representative Form
  • Authorization to Release
  • Reporting Changes
  • Withdrawal Form

CONTACT US

  • Hours of Operation:
  • Monday - Friday, 7:00 AM to 4:30 PM (except holidays)
  • Agency Call Center Hours- 7:30 AM to 11:30 AM and 12:30 PM to 4:00 PM
  • Telephone:
  • 513-695-1420- Main Phone Line
  • 513-695-1600- Adult Protective Services After-Hours Hotline
  • 844-640-6446- Statewide IVR/Call Center
  • Fax: 513-695-2940
  • Email: WARRE_CDHS_INFO@jfs.ohio.gov
  • Mailing Address:
    Warren County Department of Job & Family Services
    Division of Human Services
    416 S. East Street
    Lebanon, Ohio 45036
  • Warren County Campus Map
  • Directions

QUICK LINKS

  • Employment, Training & Assessment Classes
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