Provider Forms
As part of your interaction with HCJFS, you may be asked to complete a state form. To search for a state form not listed below, use the Ohio Department of Job and Family Services Forms Central.
Below are some of the most commonly requested forms.
Application Packet
- Child Care Cover Letter
- Child Care Explanation of Verification Requirements
- Child Care Application
- Child Care Employment Verification Form
- Child Care Family Household Income Statement
- Child Care Self-Employment Form
Medical/Liability
JFS 01305 Child’s Medical Statement for Child Care
JFS 01933 Liability Insurance Statement
Record Keeping
Daily Record for Infants & Toddlers.
JFS 01208 Weekly Attendance for Child Care
Permission Slips
Permission to Transport Children on Routine Trips.
Permission to Transport Children on Special Outings and Field Trips.
JFS 01227 B Permission to Participate in Swimming Activities - Type B Homes.
Incident/Injury
JFS 01299 Incident/Injury Report