CSPMTL 33 (Cash Medical Support Forms - JFS 01849, JFS 07606, JFS 07768, JFS 07769, JFS 7058)
Child Support Program Manual Transmittal Letter No. 33
August 21, 2008
TO: All Child Support Program Manual Holders
FROM: Helen E. Jones-Kelley, Director
SUBJECT: Cash Medical Support Forms - JFS 01849, JFS 07606, JFS 07768, JFS 07769, JFS 7058

OCS has proposed to revise the following forms:

Revised FormRevised Form TitlePrior Effective Date of FormEffective Date of Revision
JFS 01849Request for an Administrative Review of the Support Order07/200508/2008
This form can be completed by either the obligor or obligee to request an administrative review of the child support order, which includes medical support provisions. Changes from the existing form include: referenced all the administrative review and adjustment rules in the introductory paragraph; clarified the language in the third paragraph; changed the language in box 8 to make it clearer to the user; added "private" to the words "health insurance" in paragraphs 9 and 10 to comply with changes to Ohio Revised Code (ORC) section 3119.30; added additional reasons for requesting an administrative review in less than 36 months in boxes 11 (private health insurance is not reasonable in cost or accessible) and 12 (the obligor requests the cash medical support order be terminated because his/her annual gross income is now less than 150% of the poverty level for an individual); and modified the first paragraph after the numbered paragraphs because the ORC does not restrict the administrative review and adjustment process to IV-D cases.
JFS 07606Administrative Adjustment Review Notification12/200108/2008
The Child Support Enforcement Agency (CSEA) issues this form to the obligor and obligee when the CSEA has scheduled the administrative review. Changes include: moved the address line to the left; moved the data fields so that they are more logically placed; included references to cash medical support and private health insurance, where appropriate; clarified other language for ease of understanding; and requested more information to assist the CSEA in conducting the review.
The 12/2001 version of this form is automatically issued as a notice in the support enforcement tracking system (SETS). Until the 8/2008 version of this form is updated in SETS, the CSEAs should continue to use the 12/2001 version issued in SETS, and may also issue the 08/2008 version manually via ODJFS Forms Central.
JFS 07768Child Support Computation Worksheet - Sole Residential Parent or Shared Parenting Order12/200108/2008
This form is used when the CSEA calculates the child support and cash medical support obligations for a sole residential parent or shared parenting order, in accordance with the Ohio Child Support Guidelines. The form was changed to comply with ORC section 3119.022 as amended by Amended Substitute House Bill 119 of the 127th General Assembly (House Bill 119).
Please note: the phrase "plus any processing charge" has been added to line 31 (the cash medical support obligation) because ORC section 3119.27, independent of the worksheet, requires the CSEA to impose the processing charge, and in order to avoid any confusion, as line 29 (the monthly child support obligation) includes the phrase "plus any processing charge."
When the CSEA is calculating the child support obligation for a child support order that is subject to ORC section 3119.022 as it existed prior to implementation of House Bill 119, the CSEA shall use the 12/2001 version of the JFS 07768.
JFS 07769Child Support Computation Worksheet - Split Parental Rights and Responsibilities12/200108/2008
This form is used when the CSEA calculates the child support and cash medical support obligations for a split parental rights order, in accordance with the Ohio Child Support Guidelines. The form was changed to comply with ORC section 3119.023 as amended by House Bill 119.
Please note: the phrase "plus any processing charge" has been added to line 29 (the cash medical support obligation) because ORC section 3119.27, independent of the worksheet, requires the CSEA to impose the processing charge, and in order to avoid any confusion, as line 27 (the monthly child support obligation) includes the phrase "plus any processing charge."
In addition, in line 26 the language refers to "line 24g" but in ORC section 3119.023 as amended by HB 119, in line 26 the language refers to "line 24h." The amount in line 24g is the cash medical support obligation and the amount in line 24h is the sum of the cash medical support obligation plus the child support obligation. When the amount from line 24h is used to calculate line 26, the obligor is charged twice for cash medical support. OCS requested a legislative fix on this and it was included in House Bill 562, which was signed by Governor Strickland on June 24, 2008 with an effective date of September 23, 2008. The legislation changed "24h" to "24g" in line 26 of ORC section 3119.023.
When the CSEA is calculating the child support obligation for a child support order that is subject to ORC section 3119.023 as it existed prior to implementation of House Bill 119, the CSEA shall use the 12/2001 version of the JFS 07769.

OCS has proposed to adopt the following forms:

Adopted FormAdopted Form TitleEffective Date of Adoption
JFS 07058Medical Support Mistake of Fact Hearing Decision08/2008
The CSEA shall issue this form to the obligor and obligee after conducting the medical support mistake of fact hearing, in accordance with proposed Ohio Administrative Code rule 5101:12‑57‑08 (note: This rule was proposed in Clearance package 6166 and has a tentative effective date of 12/1/2008). The form contains the findings and recommendations from the mistake of fact hearing.

INSTRUCTIONS:

When the CSPMTL is published, the CSPM will be updated as follows:

  • A revised form will be replaced with the amended form.
  • An adopted form will be inserted.

The forms in the CSPM can be accessed at:

http://emanuals.jfs.ohio.gov.

Forms can also be accessed on the ODJFS Forms Central InnerWeb page at:

http://www.odjfs.state.oh.us/forms/inner.asp