Champaign County Department of Job and Family Services
  • OhioMeansJobs
  • Child Support
  • Financial & Health Assistance
  • Family & Children Services
  • Forms
  • Non-Discrimination Statement
  • News
  • OhioMeansJobs
  • Child Support
  • Financial & Health Assistance
  • Family & Children Services
  • Forms
  • Non-Discrimination Statement
  • News
Search

AGENCY FORMS


To view or download forms and links, click the appropriate button below.
PRC Application and Budget
Application for Health Coverage and Help Paying Costs
Program Enrollment and Benefits Information
Request to Reapply for Cash and/or Food Assistance
Medicaid Estate Recovery
Food Assistance Reporting (reporting changes)
Child Care Application
Cash, Food or Medical Assistance
SNAP (Food Assistance) Interim Report
Your Rights & Responsibilities As a Consumer of Medicaid Health Coverage (required to be signed to complete Med Renewal)

Helpful Links


Champaign County, Ohio
Seniors United Way 211
OhioKAN Website
Ohio Foster, Adoptions, and Kinship Care
OhioMeansJobs
Adoption
Urbana Champaign County Senior Center
Champaign Co. Board of Developmental Disabilities
County Agency Directory and Web Site
Ohio Department of Job and Family Services
PCSAO
Area Agency of Aging
Ohio Medicaid
Champaign County Job and Family Services logo
Monday - Friday
8:00 AM - 4:30 PM
1512 S. US Highway 68
Suite N100
Urbana, OH 43078

1-800-837-4290
Phone: (937)484-1500
Fax: (937)484-1506
TDY: (937)484-1590
Ohio Means Jobs Champaign County logo
Monday - Friday
8:30AM - 4:00 PM

Phone: (937)484-1581
Fax: (937)484-1584
1512 S. US Highway 68
​Suite J100
Urbana, Ohio 43078
Contact Us
About Us
Join Our Team
The information through this site may include inaccuracies or errors. The Champaign County DJFS website should not be relied upon for personal, legal or financial decisions. Consult the appropriate CCDJFS personnel for advice relevant to your situation.
NON-DISCRIMINATION STATEMENT
Site powered by Berry Digital Solutions, LLC
​
Urbana, Ohio

  • OhioMeansJobs
  • Child Support
  • Financial & Health Assistance
  • Family & Children Services
  • Forms
  • Non-Discrimination Statement
  • News