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


 
(1) Print the form (click on the link below)
Note: You will need to print one form for each person you are applying for.
 
(2) Write your social security number and name on the top right hand side.
 
(3) In the white spaces under HCJFS Information, list the information indicated in the left column from Person's name at Birth through City/State 
 
(4) 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.
 
(5)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. Or fax from any other location to (513) 946-1076.

Click here for Birth Verification Form (pdf)