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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Rule 5101:12-57-99 | Chapter 5101:12-57 forms - enforcement of medical support provisions.


The forms identified in this rule are referenced within various rules contained within division 5101:12 of the Administrative Code. The effective or revised effective dates of the forms are as follows:

(A) JFS 03377, "Employer/Health Plan Administrator Health Insurance Verification Request" (rev. 1/2015);

(B) JFS 03399, "Notice of Administrative Mistake of Fact Hearing" (rev. 10/2019);

(C) JFS 04031, "Notice Regarding Cash Medical Support Order"(rev. 10/2019);

(D) JFS 04032, "Notice to Provide Cash Medical Support"(rev. 10/2019);

(E) JFS 04033, "Notice to Provide Private Health Insurance"(rev. 10/2019);

(F) JFS 04034, "Notice of Selection of Health Plan Option" (rev. 1/2015);

(G) JFS 04035, "Notice of Available Health Plan Options" (rev. 4/2022);

(H) JFS 04036, "Notice of Medical Support Enforcement Activity" (rev. 10/2019);

(I) JFS 04037, "Medical Support Enforcement Administrative Mistake of Fact Hearing Decision" (rev. 10/2019);

(J) JFS 04098, "Notice Regarding National Medical Support Notice Withholding Requirements" (rev. 1/2015);

(K) JFS 07053, "Notice of Medical Support Mistake of Fact Hearing" (rev. 3/2019);

(L) JFS 07058, "Medical Support Mistake of Fact Hearing Determination" (rev. 2/2019); and

(M) OMB 0970-0222, "National Medical Support Notice" (NMSN) (

Last updated June 1, 2022 at 8:25 AM

Supplemental Information

Authorized By: 3125.25.
Amplifies: 3125.03.
Five Year Review Date: 2/16/2027
Prior Effective Dates: 1/1/2015, 1/15/2017, 2/14/2019, 1/15/2020