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Family, Children and Adult Services Manual
Forms
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AUD 7202 Auditor of State - Welfare Audits and Investigation
AUD 8123 Affidavit
AUD 8123-I Instructions for Completion of Affidavit
AUD 8183 Application for Replacement Warrant
AUD 8184 Application for Replacement Warrant (Holder in Due Course)
AUD 8184-I Application for Replacement Warrant (Holder in Due Course) Instructions
Instructions for Completing JFS 01653 Medical Statement for Foster Care/Adoptive Applicant and all Household Members
JFS 00147 Title Adoption Assistance Connections (AAC) to Age Twenty-One Application
JFS 00148 Title IV-E Adoption Assistance Connections to Age Twenty-One Agreement
JFS 00149 Title IV-E Adoption Assistance Connections (AAC) to Age Twenty-One Semi-annual Assurance of Parental Responsibility and Eligibility for Continued Medicaid Coverage
JFS 00150 "Title IV-E Adoption Assistance Connections (AAC) to Age Twenty-One Adopted Young Adult Semi-annual Assurance of Parental Responsibility and Eligibility for Continued Medicaid Coverage
JFS 01050 Application for Post Adoption Special Services Subsidy
JFS 01050-A Approval for Post Adoption Special Services Subsidy
JFS 01050-AI Instructions for Completing JFS 01050-A, Approval for Post Adoption Special Services Subsidy
JFS 01050A-SPA Approval for Post Adoption Special Services Subsidy (Spanish Version)
JFS 01050-I Instructions for Completing JFS 01050, Application for Post Adoption Special Services Subsidy
JFS 01050-SPA Application for Post Adoption Special Services Subsidy (Spanish Version)
JFS 01051 Application for Additional Post Adoption Special Services Subsidy Funding for Extraordinary Circumstances
JFS 01051-I Instructions for Completing JFS 01051, Application for Additional Post Adoption Special Services Subsidy Funding for Extraordinary Circumstances
JFS 01051-SPA Application for Additional Post Adoption Special Services Subsidy (PASS) Funding (Spanish Version)
JFS 01052 Credentials for Providers of PASSS Funded Therapeutic Services and Memorandum of Understanding
JFS 01200 Fire Inspection Report for Homes or Residential Facilities Certified/Approved by ODJFS
JFS 01290 Application for Certification of Agency Functions
JFS 01291 FCL Criminal Records Check Document Cover Sheet
JFS 01301 Retained Applicant Fingerprint Database Post-Notification Report
JFS 01315 Notification of Denial of Initial Certification, Recertification or Revocation of a Foster Home Certificate
JFS 01317 Recommendation for Certification/Recertification of a Foster Home
JFS 01318-I Instructions for Completing the JFS 01318, SACWIS Private Agency Provider Request
JFS 01331 Notice of Expiration and Reapplication for a Foster Home Certificate or Adoption Homestudy Approval
JFS 01331-SPA Notice of Expiration and Reapplication for a Foster Home Certificate or Adoption Homestudy Update/Amendment (Spanish Version)
JFS 01334 Recommendation for Transfer of a Foster or Adoptive Home
JFS 01348 Safety Audit
JFS 01376 Waiver Request for Agency Rules, CRCs and Group Homes
JFS 01385 Assessment for Child Placement Update
JFS 01390 ODJFS Medical Statement for Child Care Staff in Residential Facilities
JFS 01400 Comprehensive Assessment and Planning Model - I.S., Family Assessment
JFS 01400-I Comprehensive Assessment and Planning Model - I.S., Family Assessment Instructions
JFS 01401 Comprehensive Assessment and Planning Model - I.S., Safety Assessment
JFS 01401-I Comprehensive Assessment and Planning Model - I.S., Safety Assessment Instructions
JFS 01402 Comprehensive Assessment and Planning Model - I.S., Ongoing Case Assessment/Investigation
JFS 01402-I Comprehensive Assessment and Planning Model - I.S., Ongoing Case Assessment/Investigation Instructions
JFS 01403 Specialized Assessment/Investigation
JFS 01403-I Specialized Assessment/Investigation Instructions
JFS 01404 Comprehensive Assessment and Planning Model - I.S., Reunification Assessment
JFS 01404-I Comprehensive Assessment and Planning Model - I.S., Reunification Assessment Instructions
JFS 01409 Comprehensive Assessment and Planning Model - I.S., Safety Plan for Children
JFS 01409-I Comprehensive Assessment and Planning Model - I.S., Safety Plan for Children Instructions
JFS 01409-SPA Comprehensive Assessment and Planning Model - I.S., Safety Plan for Children (Spanish Version)
JFS 01410 Comprehensive Assessment and Planning Model - I.S., Case Plan
JFS 01410-I Comprehensive Assessment and Planning Model - I.S., Case Plan Instructions
JFS 01410-SPA Comprehensive Assessment and Planning Model - I.S., Case Plan (Spanish Version)
JFS 01411 Comprehensive Assessment and Planning Model - I.S., Case Plan Amendment Sheet
JFS 01411-I Comprehensive Assessment and Planning Model - I.S., Case Plan Amendment Sheet Instructions
JFS 01412 Comprehensive Assessment Planning Model - I.S. Semiannual Administrative Review (SAR)
JFS 01412-I Comprehensive Assessment Planning Model - I.S. Semiannual Administrative Review (SAR) Instructions
JFS 01412-SPA Comprehensive Assessment and Planning Model - I.S., Semiannual Administrative Review (Spanish Version)
JFS 01413 Comprehensive Assessment Planning Model - I.S. Case Review
JFS 01413-I Comprehensive Assessment Planning Model - I.S. Case Review Instructions
JFS 01416 Semiannual Administrative Review Summary (For Private Child Placing Agency Use Only)
JFS 01416-I Semiannual Administrative Review Instructions (For Private Child Placing Agency Use Only)
JFS 01421 Application for Reimbursement of Title IV-E Nonrecurring Adoption Expenses
JFS 01421-I Instruction for Completing JFS 01421, Application for Reimbursement of Title IV-E Nonrecurring Adoption Expenses
JFS 01421-SPA Application for Reimbursement of Nonrecurring Adoption Expenses (Spanish Version)
JFS 01421-SPA-I Instructions for Completing the JFS 01421-S, Application for Reimbursement of Nonrecurring Adoption Expenses (Spanish Version)
JFS 01435-I Instructions for Completing the Referral of Title IV-E Foster Care Maintenance Recipient for Child Support Services
JFS 01438 Agreement for Payment or Reimbursement for Title IV-E Nonrecurring Expenses Incurred in the Adoption of a Child with Special Needs
JFS 01438-SPA Agreement for Payment or Reimbursement for Nonrecurring Expenses Incurred in the Adoption of a Child with Special Needs (Spanish Version)
JFS 01440 Child Abuse and Neglect Protective Service Alert Report
JFS 01441 Notification of Student Out-Of-Home Placement and Request for Transfer of Records
JFS 01443 Child's Education and Health Information
JFS 01443-I Child's Education and Health Information Instructions
JFS 01443-SPA Child's Education and Health Information (Spanish Version)
JFS 01443-SPA-I Child's Education and Health Information Instructions (Spanish Version)
JFS 01447 Assessment of Relative or Nonrelative Substitute Caregiver
JFS 01447-I Instructions for Completing JFS 01447, Assessment of Relative or Nonrelative Substitute Caregiver
JFS 01449 Determination for Special Needs- Medical, Mental Health or Rehabilitation Care
JFS 01451 Title IV-E Adoption Assistance Application
JFS 01451-A Title IV-E Adoption Assistance Eligibility Determination
JFS 01451-B Title IV-E Adoption Assistance Annual Assurance of Legal Responsibility, School Attendance and Eligibility for Continued Medicaid Coverage
JFS 01451-SPA Title IV-E Adoption Assistance Application (Spanish Version)
JFS 01452-AI Title IV-E Foster Care Maintenance Redetermination Instructions
JFS 01452-I Title IV-E Foster Care Maintenance Application for Initial Eligibility Instructions
JFS 01453 Title IV-E Adoption Assistance Agreement
JFS 01454 Approval and Agreement for Title IV-E Retroactive Adoption Assistance Payments
JFS 01470 Title IV-E Adoption Assistance State Mediation Conference Request
JFS 01501 Application for Kinship Permanency Incentive
JFS 01501-SPA Application for Kinship Permanency Incentive (Spanish Version)
JFS 01502 Notice of Incomplete Kinship Permanency Incentive Application
JFS 01503 Notice of Approval For Kinship Permanency Incentive Funds
JFS 01503-SPA Notice of Approval For Kinship Permanency Incentive Funds (Spanish Version)
JFS 01504 Notice of Denial For Kinship Permanency Incentive Funds
JFS 01504-SPA Notice of Denial For Kinship Permanency Incentive Funds (Spanish Version)
JFS 01510 Safety Plan for Children
JFS 01510-I Safety Plan for Children Instructions
JFS 01530 Large Family Assessment
JFS 01607 MEPA Educational Materials
JFS 01608 Licensed Professional's Statement
JFS 01609 Family Permanency Planning Data Summary
JFS 01609-I Family Permanency Planning Data Summary Instructions
JFS 01610 Child's Permanency Planning Data Summary
JFS 01610-I Child's Permanency Planning Data Summary Instructions
JFS 01611 Non-Discrimination Requirements for Foster Care and Adoptive Placements
JFS 01613 Application for State Adoption Subsidy
JFS 01613-SPA Application for State Adoption Subsidy (Spanish Version)
JFS 01613-SPA-I Application for State Adoption Subsidy Instructions (Spanish Version)
JFS 01614 Redetermination or Amendment of a State Adoption Maintenance Subsidy
JFS 01614-I Instructions for Completing the Redetermination or Amendment of a State Adoption Maintenance Subsidy
JFS 01615 Approval for State Adoption Maintenance Subsidy
JFS 01615-I Instructions for Completing JFS 01615 State Adoption Maintenance Subsidy Agreement
JFS 01615-SPA Approval for State Adoption Subsidy (Spanish Version)
JFS 01616 Social and Medical History
JFS 01616-SPA Social and Medical History (Spanish Version)
JFS 01617 Bridges Voluntary Participation Agreement
JFS 01618 Bridges Notice of Denial
JFS 01619 Bridges Notice of Ineligibility
JFS 01620 Bridges Notice of Termination
JFS 01621 Bridges Voluntary Withdrawal Request
JFS 01622 State Hearing Request
JFS 01638-I Instructions for Micro-FACSIS Private Agency (PCPA only) Sibling Group Resource Data and Events
JFS 01640 Interstate Compact on the Placement of Children (ICPC) Transmittal
JFS 01645 Agreement for Temporary Custody of Child
JFS 01645-SPA Agreement for Temporary Custody of Child (Spanish Version)
JFS 01652 Credential of Professional Providers of PASSS Funded Therapeutic Services and Memorandum of Understanding
JFS 01652-I Credential of Professional Providers of PASSS Funded Therapeutic Services and Memorandum of Understanding
JFS 01653 Medical Statement for Foster Care/Adoptive Applicant and all Household Members
JFS 01654 Adoptive Placement Agreement
JFS 01654-SPA Adoptive Placement Agreement (Spanish Version)
JFS 01661 Interstate Compact Placement Request (ICPC 100A)
JFS 01661-I Instructions for Completing JFS 01661 Interstate Compact Placement Request (ICPC 100-A)
JFS 01662 Interstate Compact Report on Child's Placement Status (ICPC 100B)
JFS 01663 Sending State's Priority Home Study Request
JFS 01666 Permanent Surrender of Child
JFS 01666-SPA Permanent Surrender of Child (Spanish Version)
JFS 01667 Adoption Information Disclosure
JFS 01667-SPA Adoption Information Disclosure (Spanish Version)
JFS 01669 Delegation of Authority for Sensitive SACWIS Data Corrections
JFS 01671 Sensitive SACWIS Data Correction Request
JFS 01673 Assessment for Child Placement (Homestudy)
JFS 01673A Child Characteristics Checklist for Foster Care and/or Adoption
JFS 01673-I Instructions for Completing JFS 01673 Assessment for Child Placement
JFS 01674 Statement of Assurance
JFS 01675 Ohio Adoption Guide: A Handbook for Prospective Adoptive Families
JFS 01676 For Birth Parents: Are You Thinking About Making An Adoption Plan?
JFS 01678 Foster Care Exit Interview
JFS 01679 Request for Notification
JFS 01680 Verification of Assessor Qualifications
JFS 01681 Applicant Financial Statement
JFS 01681-SPA Applicant Financial Statement (Spanish Version)
JFS 01682 Psychotropic Medication Toolkit for Public Children Services Agencies
JFS 01684 Contact Preference for the Birth Parent(s) of Adopted Children
JFS 01688 Individualized Child Assessment
JFS 01688-I Individualized Child Assessment Purpose and Instructions
JFS 01689 Documentation of the Placement Decision-Making Process
JFS 01690 Documentation of the Pre-Adoptive Staffing and Updates
JFS 01691 Application for Child Placement
JFS 01691-SPA Application for Child Placement (Spanish Version)
JFS 01692 Application for Adoption of a Foster Child or Sibling Group
JFS 01692-SPA Application for Adoption of a Foster Child (Spanish Version)
JFS 01693 Ohio Law and Adoption Materials
JFS 01694 Application for Search of Ohio Putative Father Registry - Registration for Fathers
JFS 01694-I Instructions for Completing JFS 01694, Application for Search of Ohio Putative Father Registry - Registration for Fathers
JFS 01694-SPA Application for Search of Ohio Putative Father Registry (Registration Form for Fathers) (Spanish Version)
JFS 01694-SPA-I Instructions for Registration Form for Fathers (Spanish Version)
JFS 01695 Application for Search of Ohio Putative Father Registry
JFS 01695-SPA Application for Search of Ohio Putative Father Registry (Spanish Version)
JFS 01698 Step-Parent Adoption Homestudy
JFS 01699 Prefinalization Adoption Assessment Report
JFS 01700 Individual Child Care Agreement
JFS 01700-I Instructions for Completing the JFS 01700 "Individual Child Care Agreement"
JFS 01701 Individual Child Care Agreement Amendment
JFS 01701-I Instructions for Completing the JFS 01701 Individual Child Care Agreement Amendment
JFS 01702 Invoice Reimbursement for Placement and Related Services
JFS 01702-I Instructions for Completing the JFS 01702 Invoice for Placement and Related Services
JFS 01703 Contract for Title IV-E Agencies and Providers for the Provision of Child Placement and Related Services
JFS 01794 Juvenile Court Random Moment sample (JCRMS) Time Studies Results
JFS 01794-I Instructions for Completing the JFS 01794, Juvenile Court Random Moment sample (JCRMS) Time Studies Results
JFS 01797 Social Services Random Moment Cost Allocation Quarterly Billing
JFS 01797-I Instructions for Completing the Social Services Random Moment Cost Allocation Quarterly Billing
JFS 01821 Title XX County Profile
JFS 01821-I Instructions for Completing the JFS 01821 2-Year Title XX County Profile
JFS 01825 Public Children Services Agency Training Record for Caseworkers
JFS 01825-I Instructions for Completing the JFS 01825
JFS 01826 Public Children Services Agency Training Record for Supervisors
JFS 01826-I Instructions for Completing the JFS 01826
JFS 01958 Referral for Medicaid Continuing Eligibility Review
JFS 01975 Annual Foster Care Maintenance and Adoption Assistance Survey
JFS 01985 Adoption Subsidies Guide
JFS 01987 Child Fatality Report Face Sheet
JFS 01987-I Instructions for Completing the JFS 01987 Child Fatality Report Face Sheet
JFS 02132 Affidavit in Support of Application for Replacement Warrant
JFS 02333 Discrimination Complaint
JFS 02333-ARA Discrimination Complaint (Arabic Version)
JFS 02333-RUS Discrimination Complaint (Russian Version)
JFS 02333-SOM Discrimination Complaint (Somali Version)
JFS 02333-SPA Discrimination Complaint (Spanish Version)
JFS 02424 ICPC Placement Financial Information
JFS 02911 Title IV-E Single Cost Report
JFS 02911-I Instructions for Completing JFS 02911, Title IV-E Single Cost Report
JFS 02913 Title IV-E Agreed Upon Procedures
JFS 04281 Children Services Quarterly Statistical Report
JFS 04281-I Instructions for completing JFS 04281 Children Services Quarterly Statistical Report
JFS 07130 Ohio Adult Protective Services Intake Screening Tool
JFS 07130-I Adult Protective Services Tool and Guidelines
JFS 07131 Adult Protective Services Protocol
JFS 08013 Thinking About Becoming a Foster Parent or Adopting a Waiting Child
JFS 08025 A Guide to Protecting the Elderly
JFS 08027 Adult Protective Services Rack Card
JFS 08101 Permanent Planned Living Arrangement (PPLA) Caregiver Notice
JFS 08102 Foster Parent Checklist for Preparation and Support of Teenagers
JFS 09010 Envelope #10 (Central Registry), PO Box 182709
TREA 7013 Request for Stop/Release of Warrants
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