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  • 470 2310 Rev 212 Form

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City: State: Zip Code: C. Evaluation Determination. 470-2310 (Rev. 2/12). Return completed form to Record Check Evaluation Fax: 515-564-4034. Print Form .

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How to fill out the 470 2310 Rev 212 Form online

Filling out the 470 2310 Rev 212 Form can be a straightforward process when guided appropriately. This guide will walk you through each section of the form, ensuring you provide the necessary information clearly and accurately.

Follow the steps to complete the form effectively

  1. Click ‘Get Form’ button to access the form and open it in the editing interface.
  2. Begin by filling out section A, which includes your name, phone number, and the agency requesting the evaluation. Make sure to provide accurate contact information.
  3. Continue to section B, where you will enter details about the person being evaluated. Include their full name, previous names, and the position they are applying for.
  4. In section C, you will indicate your evaluation determination. Ensure that all pertinent details are included.
  5. Move to section D to detail any crimes or abuse. Include dates, locations, involved parties, and descriptions of the events. If necessary, use additional sheets to provide thorough explanations.
  6. Also within section D, outline any changes you have made to ensure safety in future roles, including any relevant accomplishments or educational history.
  7. After completing all sections, review the form for accuracy and completeness. Remember to include supporting documents as needed.
  8. Finally, save your completed form, and choose the appropriate option to download, print, or share it as required.

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For problems or concerns regarding your local DHS office contact the Central Office at 1-800-972-2017 or by email at contactdhs@dhs.state.ia.us.

For problems or concerns regarding your local DHS office contact the Central Office at 1-800-972-2017 or by email at contactdhs@dhs.state.ia.us.

For more information, contact DHS staff directly: Russ Saunders, rsaunde@dhs.state.ia.us or 515.362. 7440.

How do I report a change in income to Medicaid Iowa? Agency: Iowa Department of Health and Human Services Changes included could be income, address, rent/utility payments, household members, etc. Call 1-877-347-5678 or Fax 515-564-4041.

The Single Contact Repository (SING) provides authorized organizations online access to Iowa Criminal History and Sex Offender Registry information held by the Department of Public Safety/Division of Criminal Investigation (DCI), Department of Human Services' (DHS) Central Abuse Registry for Child Abuse (CA) and ...

It's everyone's responsibility to report it now! The Child Abuse Hotline at 1-800-362-2178 (available 24 hours a day, 7 days a week). Please be ready to provide identifying information and the whereabouts of the child. You may remain anonymous unless you are making a report as a mandatory reporter.

1-800-338-7752 (toll-free)

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