Instructions
Verification of Ohio Residency (HCJFS 3497)

1.    Print 2 copies of the form.

2.    Complete each form.

3.    Have your signature notarized. A
       Notary Public can often be found at a
       bank or at an attorney's office. 

4.    Keep one copy for your records.

5.    Return one copy to your Home Provider
      Specialist by either:
       Mail:     Job and Family Services
                  222 East Central Parkway
                  Cincinnati, Ohio 45202
                  Attn: Child Care Provider Program

       Fax:      (513) 946-1102

Be sure to write your Home Provider Specialist's name on any forms you mail or fax. 

Click here for form