Forms

Consumer

• Ohio Civil Service Application
• Formulario de Queja del Consumidor
• Consumer Complaint Form
• State Retirement Fiduciary Complaint

Victim

• Attorney Fees Application Form Instructions

Forms for Sexual Assault Forensic Examination

• HIV Prophylaxis Reimbursement Form
• HIV Reimbursement and Supplemental Form Instructions
• Pediatric Physician, APN, or PA Expert Form
• Pediatric SANE Expert Form
• SAFE Reimbursement Request Form
• Criteria for pediatric MD, APN, or PA expert sexual abuse
• Hospital Coordinator Form
• Pediatric SANE Expert Criteria
• Drug Facilitated Sexual Assault Protocol
• SAFE FAQ 2014
• SAFE Reimbursement Instructions
• Supplemental HIV Reimbursement Form

Business

Forms for Bingo

• 2019 Good Standing List
• Approved Instant Bingo Ledger Form (PDF)
• Approved Instant Bingo Ledger Form (Excel)
• Daily Sheet
• Appendix A - Instant Bingo Fundraising Contract
• Appendix B - Fundraising Contract - Veteran, Fraternal, Sporting-Organizations
• Attachment A - Type I and Type II Bingo Location
• Distributor and Manufacturer License Application
• Request to Add a Type III Instant Bingo Retail Establishment Location (501(c)3 Organizations Only)
• Attachment B - Type III Instant Bingo Locations for Non-Retail Establishments
• Attachment C - Bingo Personnel Updates
• Bingo Supply Inventory Form
• Checklist
• Approved Software Companies
• Bingo and Charitable Gaming Complaint Form
• Remote Location Invoice

Forms for Business Counsel

• Agency A/E Contract Checklist
• Agency Construction Contract Checklist
• Four-Year A/E Contract Checklist
• Four-Year Construction Contract Checklist
• Two-Year A/E Contract Checklist
• Two-Year Construction Contract Checklist

Forms for Charity

• Charitable Organization or Solicitation Complaint Form
• Final Annual Report and Asset Disposition Form
• Notification Form

Forms for Collections

• Administrative Review of Income Tax Refund Offset Application and Instruction
• Administrative Review of Income Tax Refund Offset Eligibility and Procedure
• Affidavit Eligibility
• Certificate of Deletion
• Collections Special Counsel and Third Party Vendor Frequently Asked Questions
• Confidentiality Agreement
• Email Encryption Procedures
• Family Educational Rights and Privacy Act of 1974 (FERPA) Acknowledgment Form
• Health Insurance Portability and Accountability Act (HIPAA) Acknowledgment Form
• Mistaken Identity Affidavit
• Non AGO Network Access User Agreement
• Offer in Compromise
• Ohio Safeguards Security Report Template for Third Party Vendors
• Personal Income and Personal School District Tax Collections and Application
• Personal Income Tax Agreement for Collections Special Counsel
• Personal Income Tax Agreement for Third Party Vendors
• Request for Payoff and Information
• Request for Qualifications for Collections Special Counsel
• Request for Qualifications for Third Party Vendors
• Retention Agreement for Collections Special Counsel
• Retention Agreement for Third Party Vendors
• Special Counsel RFQ Clarifications
• Special Counsel RFQ Questions
• Third Party Vendor RFQ Questions
• Vendor Identification Form

Forms for Required Mortgage Loan Disclosure

• Acknowledgment of Receipt of Home Mortgage Loan Informational Document
• Disclosure of Right Not to Close
• Ohio Homebuyers’ Protection Act - Informational Document