Appendix 1 - 14 Reserved Appendix 15 JFS 07402WS - Application Worksheet Appendix 16 Instructions for Completing the Application Worksheet (JFS 07402-WS) Appendix 17 Reserved Appendix 18-A JFS 04218 -Notice of Missed Interview Appendix 18-B JFS 04218-SPA - Aviso De Entrevista Perdida Appendix 19-A JFS 04219 -Request for Contact Appendix 19-B JFS 04219-SPA - Solicitud Para Contactar Appendix 20 Determination of Food Stamp Benefits when OAC 5101:4-6-16 Applies Appendix 21-A Instructions for Completing JFS 07424 - Report of Claim Determination/Lost Benefits Appendix 21-B Summary Sheet - Claim Determination/Lost Benefits (Model) Appendix 22 JFS 07341 - Applicant/Recipient Authorization for Release of Information Appendix 23-A JFS 04196 - Food Stamp Change Report for Assistance Groups with Earned Income Appendix 23-B JFS 04196-SPA - Reporte De Cambios En Grupos Con Ayuda De Estampillas Para Comida (Food Stamps) Con Ingresos Devengados Appendix 24-A Reserved Appendix 24-B Reserved Appendix 25-A Reserved Appendix 25-B Reserved Appendix 25-C Food Stamp Allotment Proration (FSP-13) Appendix 25-D Reserved Appendix 25-E Reserved Appendix 26 Reserved Appendix 27 Receipt for Application for a Social Security Number (SSA 5028-5029) Appendix 28 Reserved Appendix 29 Reserved Appendix 32 Reserved Appendix 33 JFS 03900 - Notice of IntercountyTransfer Appendix 34 Food Stamp Notice of Change (Model) Appendix 35 Record of Changes to Hand Book Appendix 36 Reserved Appendix 37 Social Security Administration Transmittal for Food Stamp Applications (SSA-4233) Appendix 38 Reserved Appendix 39 JFS 07355 - Notice of Application for Social Security Number Appendix 40 Reserved Appendix 41 Reserved Appendix 42 Food Stamp Overpayment Report Appendix 43 - 47 Reserved Appendix 48 Notice of Food Stamp Work Registration Responsibility Appendix 49 JFS 07446 - Work Registration Appendix 50 - 54 Reserved Appendix 55-A JFS 07222 - Statement Requesting Replacement Food Assistance Benefits Appendix 55-B JFS 07222-SPA - Statement Requesting Replacement Food Stamps (Spanish Version) Appendix 55-C JFS 07222-SOM - Statement Requesting Replacement Food Stamps (Somali Version) Appendix 56 Reserved Appendix 57 Reserved Appendix 58 - 60 Reserved Appendix 61 Compromise Agreement Appendix 62 G-845S - SAVE Document Verification Request Appendix 63 G-845 - SAVE Document Verification Request Supplement Appendix 63-A SAVE Instructions for Completion of the Document Verification Request (G-845S) and Document Verification Request Supplement (G-845) Appendix 64 Reserved Appendix 65 Reserved Appendix 66 Reserved Appendix 67 Sample Certification Letter for Adult Victims of Severe Forms of Trafficking Appendix 68 Sample Letter for Children Who are Victims of Severe Forms of Trafficking Appendix 69 Sample Recertification Letter for Adult Victims of Severe Forms of Trafficking Appendix 70 Sample Re-eligibility Letter for Children Who are Victims of Severe Forms of Trafficking Appendix 71 Reserved Appendix 72 JFS 07251 - Request for Disclosure of Information Obtained from Food Stamp Assistance Groups by Law Enforcement Officials Appendix 73 - 75 Reserved Appendix 76 Ohio Department of Job and Family Services - Claim Referral Plan Appendix 77 Flow Chart - Food Stamp Claim Referral Process ( AE and IHE Referrals - Non QC) Appendix 78 Flow Chart - Food Stamp Claim Referral Process (IPV Referrals) Appendix 79 Flow Chart - Food Stamp Claim Referral Process ( AE and IHE Referrals - Identified by QC) Appendix 80 JFS 07430 - Offset Programs Referral Cancellation / Refund Form Appendix 81 Treasury Offset Program Review Decision - Overruled Appendix 82 Treasury Offset Program Review Decision - Sustained Appendix 83 - 87 Reserved Appendix 88 Reserved Appendix 89 Reserved Appendix 90 - 97 Reserved Appendix 98 IEVS Specifications Glossary Appendix 99 Reserved Appendix 100 JFS 01846 - Case Worksheet - Cash, Food Stamp, and Medical Assistance Interview Appendix 101-A JFS 07200 - Request for Cash, Food Stamp and Medical Assistance Appendix 101-B JFS 07200-SPA - Pedido para Recibir Efectivo, Estampillas de Alimentos y Asistencia M├ędica Appendix 101-C JFS 07200-SOM -Codsiga Kaashka, Gargaarka Cuntada (Food Stamp), iyo Gargaarka Caafimaadka (Medical Assistance) Appendix 102-A JFS 07501 - Your Rights and Responsibilities Appendix 102-B JFS 07501-SPA - Sus Derechos y Obligaciones Appendix 102-C JFS 07501-SOM - Xuquuqdaada iyo Waajibaadka (Your Rights and Responsibilities translated into Somali) Appendix 103 Reserved Appendix 103-A Reserved Appendix 104 Reserved Appendix 105 JFS 07449 - Work Registration/Information Sharing Form Appendix 106 Reserved Appendix 107 Reserved
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