Champaign County Department of Job and Family Services - Agency Forms - Champaign County Department of Job and Family Services

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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

Urbana Champaign County Senior Center

Champaign Co. Board of Developmental Disabilities

County Agency Directory and Web Site

Ohio Department of Job and Family Services

Area Agency of Aging

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

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

Local Food Resources

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.

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