Verification Forms (Household, Employment)
for Medicaid, Ohio Direction Card (food stamps), Ohio Works First
 


(1) Print the form (click on link below)
 
(2) Sign your name in the appropriate section
 
(3) If you don't know your caseworker's name, district number or fax number, please call (513) 946-1000 and an Information and Referral Specialist will assist you.
 
(4) Take the form to your landlord or employer to be completed.
 
(5) Before returning the form, make sure you write your Social Security Number or Case Number on the top of the form.   
 
(6)You may return the form by mailing it or dropping it off at one of our Document Drop Off Centers located at 222 East Central Parkway or 237 William H. Taft Road. You can also fax it to us free of charge at any branch of the Public Library of Cincinnati and Hamilton County.  

Household verification form (pdf)

Employment verification form (pdf)