Lorain County Job & Family Services

Report Changes to your Cash, Food and Medical Assistance

Please provide as much information as possible so we may process your reported change quickly & accurately. If you are reporting a change in Earned or Unearned Income, please list Employer or Source of income.

Name:
Email:
Date of Birth:
Case Number:
Please provide detailed explanation of change:
Please provide us with your telephone number so we may contact you for further information:
In addition to my Cash/Food/Medical Worker, please forward this information to my: