173-6-04 Enrollment process for those eighteen to fifty-nine years of age.

(A) An individual who is a resident of Ohio who is eighteen to fifty-nine years of age with a total and permanent disability may apply for a golden buckeye card.

(1) If the individual chooses to apply through a sign-up site, the individual shall do the following:

(a) Complete the application;

(b) Sign the application;

(c) Take the completed application along with verification of age and verification of a total and permanent disability (e.g., medicare card, SSD/SSI acceptance letter, documentation from PERS, STRS, SERS, or another retirement system for public employees) to a sign-up site for processing.

(2) If an individual chooses to apply by mail or by fax, the individual shall do the following:

(a) Complete the application;

(b) Sign the application;

(c) Make a photo copy of a document that verifies the age of the individual (e.g., photo copy of a driver’s license, photo copy of a state identification card, photo copy of a birth certificate);

(d) Make a photo copy of a card or document that verifies that the individual has a total and permanent disability (e.g., photo copy of a medicare card, photo copy of a SSD/SSI acceptance letter, photo copy of documentation from PERS, STRS, SERS, or another retirement system for public employees); and,

(e) Mail or fax the application and the photo copies required by paragraphs (A)(2)(c) and (A)(2)(d) of this rule to ODA or to the administrator designated by ODA. This may be accomplished by mailing these documents to the address listed on the application or by faxing these documents to the fax number listed on the application.

(3) If an individual chooses to apply online, the individual shall do the following:

(a) Complete the electronic application provided on the web site of ODA and/or an administrator designated by ODA;

(b) Check the box that says “I agree” that is located on the electronic application one line of text below the following statement: “I declare that the information provided on this application is truthful.”; and,

(c) Provide ODA or an administrator designated by ODA with a copy of a card or document that verifies that the individual has a total and permanent disability (e.g., medicare card, SSD/SSI acceptance letter, documentation from PERS, STRS, SERS, or another retirement system for public employees). An individual may provide this information by mail, by fax, or electronically. If an individual chooses to send the information electronically, the individual shall submit it in portable document format (.pdf) or another format that is readable by ODA or an administrator designated by ODA.

(B) Once a sign-up site receives an application from an individual who is eighteen to fifty-nine years of age with a total and permanent disability, it shall do the following:

(1) Verify that the application has been completed and signed;

(2) Verify that the individual is eighteen to fifty-nine years of age by documenting the source of information (e.g., driver’s license number, state identification card number) on the application;

(3) Verify that the individual has a total and permanent disability by documenting the source of information (e.g., medicare card, SSD/SSI acceptance letter, documentation from PERS, STRS, SERS, or another retirement system for public employees) on the application;

(4) Write the name of the sign-up site on the application;

(5) Write the initials of the staff person at the sign-up site who processed the application on the application;

(6) If the sign-up site determines that the individual is eligible for a golden buckeye card, detach the temporary card atop the application form, then provide it to the individual; and,

(7) Fax or mail the completed application to ODA or to an administrator designated by ODA within one week of receiving it from the individual.

(C) Once ODA or an administrator designated by ODA receives an application from a sign-up site or from an individual through the mail or by fax, it shall do the following:

(1) Verify the following:

(a) For an application received from a sign-up site, verify that the sign-up site complied with the requirements of paragraphs (B)(1) to (B)(5) of this rule; or,

(b) For an application received from an individual, verify that the individual complied with the requirements of paragraph (A)(2) of this rule.

(2) Issue a golden buckeye card to an individual who is eligible.

(D) Once an individual is issued a golden buckeye card, the individual shall sign the card. No card is valid unless it is signed by the cardholder.

(E) Once a golden buckeye card is signed, it shall remain valid for the remaining life of the cardholder, unless the card is revoked by ODA due to a fraudulent application or due to fraudulent use of the card.

(F) An cardholder may not transfer a golden buckeye card to any other person.

(G) If a golden buckeye card is lost, stolen, or damaged, a cardholder who is eighteen to fifty-nine years of age with a total and permanent disability may apply for a new card through one of the following means:

(1) A sign-up site, in accordance with paragraph (A)(1) of this rule.

(2) By mail or by fax, in accordance with paragraph (A)(2) of this rule.

Replaces: 173-6-03, 173-6-04

Effective: 07/01/2007

R.C. 119.032 review dates: 06/30/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.06

Rule Amplifies: 173.06

Prior Effective Dates: 7/3/80; 12/30/95; 1/12/01; 9/12/02 (Emer.); 12/11/02