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Franklin cdjfs verifications jfs ohio gov 2026

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The document is a referral form for enrollment in the Residential State Supplement (RSS) Program administered by the Ohio Department of Job and Family Services. It outlines the process for individuals to apply for RSS and Medicaid eligibility, requiring signatures from both the RSS administrator and a CDJFS caseworker. The form includes sections for personal information, Medicaid status, and authorization for information exchange regarding eligibility.

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Click ‘Get Form’ to open the franklin cdjfs verifications form in our platform.
Begin by completing Section A. Enter your name, Social Security Number, facility details, and contact information. Ensure all entries are legible.
In Section B, leave this block for the CDJFS to complete. It will confirm your Medicaid status and any applicable spenddown amounts.
Proceed to Section C. Here, sign and date the form to authorize the exchange of information regarding your eligibility for Medicaid and RSS.
Review all sections for accuracy before submitting. Once completed, you can easily save or share the document directly from our editor.

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id verification jfs ohio gov

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