Forms and Waivers

JFS 07216 Healthy Start/Healthy Families Combined Program Application

JFS-07221 Supplemental Nutrition Assistance Program (SNAP) Interim Report

JFS-07200 Application for Cash, Food, or Medical Assistance

JFS-03804 Ohio Works First / Supplemental Nutrition Assistance Program (SNAP) Sanction Compliance Agreement

PRC Application For Vehicle Repairs and Job Related Supportive Services Checklist

Online benefit application tool for food assistance

When turning in applications or supporting documents for verifications:

  1. Email information to This email address is being protected from spambots. You need JavaScript enabled to view it.
  2. Fax information to 740-441-2108
  3. Mail information to: Gallia County Department of Job and Family Services, 848 Third Avenue, Gallipolis, Ohio 45631
  4. Drop off at our Drop Box outside the DJFS Building