45 East Satin Street, Jefferson, OH 44047
Below is a list of commonly used forms and publications we have made available for your use.
Click the form name to access the document.
Employment Verification (L564)
Changes to Medicare Part D Costs
OSHIIP Medicare Savings Levels
Medicare Part B Application (40-B)
2025 Supplement Chart
Terminating Medicare A&B
Medicare Costs
Medicare EZ Pay Form
Medicare Redetermination Request
Part D Late Enrollment Penalty Redetermination
IRMAA Appeal Form
Appointment of Representative
Social Security Tax Withholding
HSA Publication
Qualified Medical Expense Publication