This SHMTL contains six internal forms that have been revised for accuracy and compatibility with existing computer systems. The effective date of the forms is June 2019. Additionally, one form has been obsoleted.

JFS Form 04025, “IMPORTANT NOTICE ABOUT YOUR WELFARE BENEFITS,” effective 05/2001 is obsolete and replaced by JFS 04025, “IMPORTANT NOTICE ABOUT YOUR WELFARE BENEFITS,” Effective 06/2019. This revised form removes outdated references to the now-obsolete spend-down program and updates the phrase “nursing home payment liability” to “monthly share of cost.” The updated form also places boxes to capture the case name, case number and form mail date at the top of page 2. Finally, the form provides all of the current methods for requesting a state hearing at the bottom of page 2 including the self-service web portal.

JFS Form 04065, “PRIOR NOTICE OF RIGHT TO A STATE HEARING,” effective 05/2001 is obsolete and replaced by JFS 04065, “PRIOR NOTICE OF RIGHT TO A STATE HEARING,” Effective 06/2019. This revised form removes outdated references to the now-obsolete spend-down program. The updated form also places boxes to capture the case name, case number and form mail date at the top of page 2. This form corrects the phone number for the Legal Aid office in Ohio. Finally, the form provides all of the current methods for requesting a state hearing at the bottom of page 2 including the self-service web portal.

JFS Form 04074, “NOTICE OF APPROVAL OF YOUR APPLICATION FOR ASSISTANCE,” effective 09/2011 is obsolete and replaced by JFS 04074, “NOTICE OF APPROVAL OF YOUR APPLICATION FOR ASSISTANCE,” Effective 06/2019. This revised form places fields to capture a request for a hearing by telephone or the need for a specific interpreter and removes reference to the former DFA program on page 2. Moreover, the form provides all of the current methods for requesting a state hearing at the bottom of page 2 including the self-service web portal.

JFS Form 04074-SPA, “NOTICE OF APPROVAL OF YOUR APPLICATION FOR ASSISTANCE,” effective 09/2011 is obsolete and replaced by JFS 04074-SPA, “NOTICE OF APPROVAL OF YOUR APPLICATION FOR ASSISTANCE,” Effective 06/2019. This revised form places fields to capture a request for a hearing by telephone or the need for a specific interpreter and removes reference to the former DFA program on page 2. Additionally, the form provides all of the current methods for requesting a state hearing at the bottom of page 2 including the self-service web portal. Finally, the form corrects the Ohio Legal Aid Phone number and corrects Spanish language grammatical errors.

JFS Form 07334, “NOTICE OF DENIAL OF YOUR APPLICATION FOR ASSISTANCE,” effective 09/2011 is obsolete and replaced by JFS 07334, “NOTICE OF DENIAL OF YOUR APPLICATION FOR ASSISTANCE,” Effective 06/2019. This revised form places fields to capture a request for a hearing by telephone or the need for a specific interpreter and removes reference to the former DFA program on page 2. Moreover, the form provides all of the current methods for requesting a state hearing at the bottom of page 2 including the self-service web portal.

JFS Form 07334-SPA, “NOTICE OF DENIAL OF YOUR APPLICATION FOR ASSISTANCE,” effective 12/2010 is obsolete and replaced by JFS 07334-SPA, “NOTICE OF DENIAL OF YOUR APPLICATION FOR ASSISTANCE,” Effective 06/2019. This revised form places fields to capture a request for a hearing by telephone or the need for a specific interpreter and removes reference to the former DFA program on page 2. Additionally, the form provides all of the current methods for requesting a state hearing at the bottom of page 2 including the self-service web portal. Finally, the form corrects the Ohio Legal Aid Phone number and corrects Spanish language grammatical errors.

JFS Form 04022, “NOTICE OF MEDICAL DETERMINATION AND RIGHT OF STATE HEARING,” effective 3/2002 is obsolete and is not being replaced.

Instructions:

This information is also available in the Internet and may be accessed at:

ODJFS ELECTRONIC MANUALS: http://emanuals.jfs.ohio.gov/

Innerweb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/

Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/