Revised Form
|
Revised Form Title
|
Prior Effective Date of Form
|
Effective Date of Form
|
JFS 00593
|
Child Support Financial Affidavit
|
02/2019
|
03/2019
|
This form is used by a CSEA to gather information needed
to calculate the amount of child support to be paid and to allocate the costs
of providing for the health care needs of the children between the parents. Changes to the form include: minor word changes; removing
the checkboxes for "receiving or paying child support"; and amending
language from "family cost" to "out of pocket cost" for the
cost of health care, in accordance with H.B. 366. |
JFS 01849
|
Request for an Administrative Review of the Child Support
Order
|
02/2009
|
02/2019
|
This form can be completed by any party on a child support
order to request an administrative review of the child support order. Changes to the form were made to be consistent with the
requirements of OAC rules 5101:12‑60‑05 to 5101:12‑60‑05.6, which include: - a change in the circumstances of a caretaker including
income changes do not warrant a request for an administrative review;
- adding language to require IV-D application for
the CSEA to review and adjust a support order; and
- adding "documentation required and attached";
replaced "party" with "parent"; and made changes to comply
with IPP 4301 and SETS formatting requirements.
|
JFS 01849
|
Request for an Administrative Review of the Child Support
Order
|
02/2019
|
03/2019
|
This form can be completed by any party on a child support
order to request an administrative review of the child support order. Changes to this form include: removing language on number
ten "a family plan and the cost of an individual plan" and replacing
with "the health insurance coverage"; and adding language "issued
prior to March 28, 2019" to (E)(12). |
JFS 01866
|
Administrative Review Pending Notice
|
07/2005
|
02/2019
|
This form is issued by the CSEA to the requester of the
administrative review and adjustment when the recommendation to the administrative
review cannot be issued as a result of the JFS 07606, "Administrative Adjustment
Review Notification" being sent to the non-requesting party and returned
to the CSEA as undeliverable. Changes to this form include: adding new data elements to
the form header; changes to comply with IPP 4301 requirements; and adding the
"name of unlocatable party" data element. |
JFS 01867
|
Right to Request an Administrative Review of the Support
Order
|
7/2005
|
02/2019
|
This form is issued by a CSEA to notify an obligee that
is a recipient of Ohio Works First, and who has established good cause, of their
right to request an administrative review and adjustment and waive good cause
for administrative review and adjustment purposes only. Changes to this form include: adding new data elements to
the form header and changes to comply with IPP 4301 requirements. |
JFS 01868
|
Dismissal of Administrative Review Request
|
07/2005
|
02/2019
|
This form is issued by the CSEA to the non-requesting party,
to notify of the dismissal of the request as the result of the requesting party’s
failure to provide the required documents to proceed with the administrative review
and adjustment. Changes to this form include: adding new data elements to
the form header; changes to comply with IPP 4301 requirements, and replacing "party"
with "parent" to comply with OAC rule 5101:12‑60‑05.3. |
JFS 04031
|
Notice Regarding Cash Medical Support Order
|
01/2015
|
02/2019
|
This form is used by the CSEA to notify the parties when
private health insurance that is accessible and reasonable in cost becomes available
to the Health Insurance Obligor. The Health Insurance Obligor shall be required
to provide private health insurance coverage for the child(ren) named in the order
and the cash medical support obligation for the child(ren) named in the order
shall cease while private health insurance coverage is being provided. This form
also includes a Request for a Medical Support Mistake of Fact Hearing. Changes to this form include: amending the objection time
from seven business days to fourteen days and adding new data elements to the
form header. |
JFS 04031
|
Notice Regarding Cash Medical Support Order
|
02/2019
|
03/2019
|
This form is used by the CSEA to notify the parties when
private health insurance that is accessible and reasonable in cost becomes available
to the Health Insurance Obligor. The Health Insurance Obligor shall be required
to provide private health insurance coverage for the child(ren) named in the order
and the cash medical support obligation for the child(ren) named in the order
shall cease while private health insurance coverage is being provided. This form
also includes a Request for a Medical Support Mistake of Fact Hearing. The changes made to this form include revising the definition
for reasonable in cost in accordance with Sub. H.B. 366. |
JFS 04032
|
Notice to Provide Cash Medical Support
|
01/2015
|
02/2019
|
This form is used by the CSEA to notify the parties during
any period in which private health insurance that is reasonable in cost and accessible
is not being provided for the child(ren) as ordered. The Child Support Obligor
is required to pay cash medical support and both parties are required to immediately
report to the CSEA any available private health insurance coverage for the child(ren).
This form also includes a Request for a Medical Mistake of Fact Hearing. Changes to the form include: amending the objection time
from seven business days to fourteen days and adding new data elements to the
form header. |
JFS 04032
|
Notice to Provide Cash Medical Support
|
02/2019
|
03/2019
|
This form is used by the CSEA to notify the parties during
any period in which private health insurance that is reasonable in cost and accessible
is not being provided for the child(ren) as ordered. The Child Support Obligor
is required to pay cash medical support and both parties are required to immediately
report to the CSEA any available private health insurance coverage for the child(ren).
This form also includes a Request for a Medical Mistake of Fact Hearing. The changes made to this form include revising the definition
for reasonable in cost in accordance with Sub. H.B. 366. |
JFS 04033
|
Notice to Provide Private Health Insurance
|
01/2015
|
02/2019
|
This form is used by the CSEA to notify the parties when
private health insurance that is accessible and reasonable in cost becomes available
to one of the parties, that party shall be deemed the Health Insurance Obligor
and be required to provide private health insurance coverage for the child(ren)
named above and the cash medical support obligation for the child(ren) named above
shall cease while private health insurance coverage is being provided as ordered.
This form also includes a Request for a Medical Mistake of Fact Hearing. Changes to the form include: amending the objection time
from seven business days to fourteen days and adding new data elements to the
form header. |
JFS 04033
|
Notice to Provide Private Health Insurance
|
02/2019
|
03/2019
|
This form is used by the CSEA to notify the parties when
private health insurance that is accessible and reasonable in cost becomes available
to one of the parties, that party shall be deemed the Health Insurance Obligor
and be required to provide private health insurance coverage for the child(ren)
named above and the cash medical support obligation for the child(ren) named above
shall cease while private health insurance coverage is being provided as ordered.
This form also includes a Request for a Medical Mistake of Fact Hearing. The changes made to this form include revising the definition
for reasonable in cost in accordance with Sub. H.B. 366. |
JFS 04036
|
Notice of Medical Support Enforcement Activity
|
01/2015
|
02/2019
|
This notice is used by the CSEA to inform the party that
since they were determined by a court or CSEA to be the Health Insurance Obligor
a National Medical Support Notice was sent to their employer to enroll the child(ren)
listed on the order in any available health insurance plan and to withhold premiums
for health insurance coverage in accordance with section 3119.33 of the Revised
Code. Attached is also a Request for an Administrative Mistake of Fact Hearing. Changes to the form include: amending the objection time
from seven business days to fourteen days and adding new data elements to the
form header. |
JFS 04037
|
Medical Support Enforcement Administrative Mistake of Fact
Hearing Decision
|
01/2015
|
02/2019
|
This form is used by the CSEA to inform the party of the
decision made during the Medical Support Enforcement mistake of fact hearing. Changes to the form include: amending the objection time
from seven business days to fourteen days; adding "MI" to the obligor
mailing field; and adding new data elements to the form header. |
JFS 07053
|
Notice of Medical Support Mistake of Fact Hearing
|
01/2015
|
02/2019
|
This form is used by the CSEA to inform the parties that
the CSEA received a request for a medical support mistake of fact hearing and
the date of the hearing. This form has been amended to add new data elements to the
form header. |
JFS 07053
|
Notice of Medical Support Mistake of Fact Hearing
|
02/2019
|
03/2019
|
This form is used by a CSEA to inform clients that the CSEA
received a request for a Medical Support Mistake of Fact Hearing and to provide
the date of the hearing. The change made to this form include revising the definition
for reasonable in cost in accordance with H.B. 366. |
JFS 07058
|
Medical Support Mistake of Fact Hearing Determination
|
01/2015
|
02/2019
|
This form is used by the CSEA to inform the party of the
decision made during the Medical Support mistake of fact hearing. Changes to the form include: amending the objection time
from seven business days to fourteen days and adding new data elements to the
form header. |
JFS 07521
|
Results of Support Order Termination Investigation
|
06/2014
|
02/2019
|
This form is issued to the parties in response to a request
to terminate the support order administratively, and the CSEA does not terminate
the order based on its findings and informs the parties to file an action with
court if the parties wishes to pursue the matter. This form is being changed to add new data elements to the
form header. |
JFS 07522
|
Findings and Recommendations to Terminate the Administrative
Child Support Order
|
06/2014
|
02/2019
|
This form is used by the CSEA to inform the parties that
an investigation has been conducted to determine whether an administrative termination
reason exists to terminate a child support order or continue support. Changes to the form include: adding new data elements to
the form header and amending the objection time frame from thirty days to fourteen
days. |
JFS 07522
|
Findings and Recommendations to Terminate the Administrative
Child Support Order
|
02/2019
|
03/2019
|
This form is used by a CSEA to notify the clients that the
CSEA has conducted an investigation to determine whether one of the administrative
termination reasons exist to terminate support. The changes made to this form include: revising language
describing the order consistent with the changes made to the JFS 07719 and JFS 07724, and amending the checkbox to describe ongoing support orders for remaining
minor children for orders that include always-on cash medical. |
JFS 07523
|
Administrative Order to Impound Support
|
11/2008
|
02/2019
|
This form is used by the CSEA to inform the parties that
an investigation has been conducted to determine whether an administrative termination
reason exists to terminate a child support order or continue support. Changes to the form include: adding new data elements to
the form header and amending the objection time frame from thirty days to fourteen
days. |
JFS 07524 |
Denial of Administrative
Termination Hearing Request
|
11/2008
|
02/2019
|
This form is used
by the CSEA to inform the parties that their request for an administrative hearing
has been denied. Changes to the
form include: adding new data elements to the form header; made changes to comply
with IPP 4301; amending the objection time frame from thirty days to fourteen
days; and removing language "parties to the order received the" and
adding "was issued." |
JFS 07525
|
Notice of Administrative
Termination Hearing
|
02/2009
|
02/2019
|
This notice is
by the CSEA to inform the parties that an administrative termination hearing has
been scheduled based on a request from either party. Changes to the
form include: adding new data elements to the form header and made changes to
comply with IPP 4301. |
JFS 07526
|
Administrative Termination Hearing Decision
|
11/2008
|
02/2019
|
This form is sent from the CSEA, issuing the results of
the administrative termination hearing. Changes to the form include: adding new data elements to
the form header; made changes to comply with IPP 4301; and amending the objection
time frame from thirty days to fourteen days. |
JFS 07527
|
Administrative Order to Terminate the Administrative Child
Support Order
|
11/2008
|
02/2019
|
This form is issued to terminate the administrative child
support order when neither party has objected to the JFS 07522 or, if one of them
objected to the JFS 07522, then when neither party objected to the JFS 07526. Changes to the form include: adding new data elements to
the form header and made changes to comply with IPP 4301. |
JFS 07606
|
Administrative Adjustment Review Notification
|
08/2008
|
02/2019
|
This form is issued by the CSEA to the obligor and obligee
when the CSEA has scheduled the administrative review. This form has been revised to remove the financial affidavit
part and placed in a new form JFS 00593, "Child Support Financial Affidavit";
added new data elements to the form header and made changes to comply with IPP
4301 requirements. |
JFS 07719
|
Administrative Order for Child Support and Medical Support
|
08/2008
|
02/2019
|
This form is used by a CSEA to order the amount of support
to be paid and the provisions for medical support. The changes made to this form include: - Amending the header;
- Making updates to comply with IPP 4301;
- Changing the objection period of the administrative
order from 30 to 14 days;
- Adding reasons for when the CSEA shall be notified
by the obligee that support should be terminated;
- Various language changes to comply with S.B. 70.
|
JFS 07719
|
Administrative Order for Child Support and Medical Support
|
02/2019
|
03/2019
|
This form is used by a CSEA to order the amount of support
to be paid and the provisions for medical support. The changes made to this form include: - Amending the title to some section headings;
- Adding paragraph (B)(2) to clarify a health insurance
obligor;
- Amending language to paragraph (C)(1) to clarify
the monthly obligation for the child support obligor;
- Adding language to paragraph (C)(2) for eighty
dollar minimum order and for an order less than eighty dollars pursuant to ORC
3119.06;
- Adding language for reasons to determine a health
insurance obligor pursuant to ORC section 3119.30;
- Adding language to paragraph (C)(2) for eighty
dollar minimum order and for an order less than eighty dollars pursuant to ORC
section 3119.06;
- Adding language for reasons to determine a health
insurance obligor pursuant to ORC section 3119.30;
- Adding language that the obligee should obtain
health insurance no later than 30 days after it becomes available for a reasonable
cost to be consistent with HB 366; and
- Removing the obligor and obligee phone number from
the "notice to health insurance obligor" pursuant to ORC section 3119.32(B).
|
JFS 07724
|
Administrative Adjustment Recommendation
|
08/2008
|
02/2019
|
This form is used by a CSEA to provide the results of the
administrative adjustment review. The changes made to this form include: - Amending the form header;
- Making updates to comply with IPP 4301;
- Changing the objection period of the administrative
order from 30 to 14 days;
- Adding reasons for when the CSEA shall be notified
by the obligee that support should be terminated;
- Various language changes to comply with S.B. 70.
|
JFS 07724
|
Administrative Adjustment Recommendation
|
02/2019
|
03/2019
|
This form is used by a CSEA to provide the results of the
administrative adjustment review. The changes made to this form include: - Amending title to some section headings and making
them bold;
- Moving the recommendations section to the front
of the form;
- Adding language if recommending an eighty dollar
minimum order and an order less than eighty dollars pursuant to ORC section 3119.06;
- Adding language for reasons to determine a health
insurance obligor pursuant to ORC section 3119.30;
- Adding language that the obligee should obtain
health insurance no later than 30 days after it becomes available at a reasonable
cost to be consistent with HB 366;
- Revising the language regarding the CSEA applying
a court deviation to make it clear that the CSEA is not deviating, but rather
is applying a court's deviation;
- Adding an "attachments" section; and
- Adding header fields to hearing request page.
|
JFS 07728
|
Denial of Request for an Administrative Adjustment Hearing
|
11/2001
|
02/2019
|
This form is issued by the CSEA to either party when the
hearing request has been denied. The form advises the parties of the denial reason(s)
and of their rights to request a court hearing. This form is being revised by adding new data elements to
the form header and made changes to comply with IPP 4301 requirements; revised
title; added an additional reason for a denial, and updated objection period to
14 days to be consistent with OAC rule 5101:12‑60‑05.6. |
JFS 07770
|
Administrative Adjustment Hearing Decision
|
11/2001
|
02/2019
|
This form is issued by the CSEA to the parties of the case
of the decision to an administrative review and adjustment hearing. The form also
advises the parties of their rights. This form is being revised by adding new data elements to
the form header and made changes to comply with IPP 4301 requirements; updating
objection period to 14 days to be consistent with OAC rule 5101:12‑60‑05.6; and
simplified "Right to a Hearing" section because court and administrative
orders have the same objection period. |