Follow the steps to successfully complete the OH JFS 07120 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out Section A. Enter the individual's name, including first and last names, and their Social Security Number. Next, provide the facility name and street address, along with their phone number and complete address including the city, state, and zip code.
3. Indicate the county where the individual resides. If there is a representative payee or legal guardian, include their name and address along with their phone number in the designated fields.
4. Section B must be filled out by the County Department of Job and Family Services. Ensure that the question regarding current Medicaid status is answered with 'Yes' or 'No'. If applicable, include the spenddown amount and MITS claim number, as well as the county.
5. In Section C, the individual in need of the RSS program (or their representative payee/guardian) should sign and date the form to authorize information exchange regarding Medicaid and RSS eligibility.
6. Once all sections are completed, review the form for accuracy. Users can then save changes, download, print, or share the completed form as needed.

Complete your OH JFS 07120 form online today.