The following is a list of forms used by Clermont County Job and Family Services. In order to assist us in processing your documents, please put your name and social security or case number on all documents you submit. The easiest and most efficient way to submit document is by visiting your local library. Library staff will assist you with scanning your documents to PA, or you can fax them to us from their free-to-use fax machines.

You can also submit documents via email to clermontcasebank3@jfs.ohio.gov, our drop box, lobby, or by mail. Our fax number is 513-732-7216.

Click below for an application or apply online here. 

• Food Assistance, Cash Assistance and Medicaid
• Food Assistance, Cash Assistance and Medicaid (Spanish)
• Child and Family Medicaid Application Only
• Child and Family Medicaid Application Only in Spanish (Comienzo Saludable y Familias Sanas)
• Child Care Application
• Emergency Assistance (PRC) Application
• Medicaid Waiver Application
• Help with Medicare Expenses
• Request for Medicaid Home and Community-Based Services

Change Reporting: 

• SWO Employment Verification Form
• SWO Household/Shelter/Utility Verification Form
• SWO Statement of Support
• SWO Self-Declaration of Circumstances
• Applicant / Recipient Authorization for Authorized Representative
• Cash and Food Assistance Interim Report
• Request to Reapply for Cash and Food Assistance
• Resource Statement
• Release of Information
• Statement Replacement of Electronically Stolen SNAP benefits
• OWF/SNAP Sanction Compliance Form
• Benefits Verification List
• Request Replacement of SNAP Benefits