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Get Contractor Reporting Form - Iowa Department Of Human Services - Secureapp Dhs State Ia

Iowa Department of Human Services Centralized Employee Registry Contractor Reporting PAYOR OF INCOME Telephone Number - Federal ID Number Area Code plus Telephone Number FEIN plus 3-digit Iowa location suffix Name Street Address State City Date of Contracted Service Month ZIP Day Year CONTRACTOR Date of Birth Last Name Social Security Number Middle Initial First Name Reporting Requirements Mail this form within 15 days of contract to PO Box 10322.

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