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  • Ia 470-5143 2013

Get Ia 470-5143 2013-2025

Last Name First Name Middle Name Alias if applicable Date of Birth Gender Social Security Number - - Address 1 City State 470-5143 6/13 Maiden Name if applicable Zip Code. Iowa Department of Human Services Record Check Authorization I hereby authorize the Department of Human Services to conduct any or all of the following pursuant to Iowa Code 237A. 5 A check of the Iowa sex offender registry and the sex offender registries of other states. other states. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. Any information maintained by the Iowa DCI will be released as allowed by law including deferred judgments and records of arrest without a disposition greater than 18 months old. A check of Iowa public or civil offense records or those of other states. Signature Date Information Required for Registry and Record Check Please type or print legibly. Iowa Department of Human Services Record Check Authorization....

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How to fill out the IA 470-5143 online

The IA 470-5143 form is essential for users seeking to authorize the Iowa Department of Human Services to conduct various background checks. This guide provides clear, step-by-step instructions on how to effectively complete this form online.

Follow the steps to fill out the IA 470-5143 with ease

  1. Press the ‘Get Form’ button to access the document and open it in the appropriate online editor.
  2. Begin by providing your last name, first name, and middle name in the designated fields. Ensure that your information is accurate and legible.
  3. If you have any aliases, enter them in the alias fields provided. You can include multiple aliases if necessary.
  4. Input your date of birth, followed by your gender. This information is critical for the background check process.
  5. Fill in your social security number in the specified format. This detail is necessary for identity verification.
  6. Complete your address by including Address 1, Address 2 (if applicable), city, state, and zip code. Accurate address details assist in processing your request.
  7. If applicable, provide your maiden name in the designated field. This information may be relevant for background checks.
  8. Review all the entered information for accuracy and completeness before proceeding.
  9. After verifying the details, you can save your changes, download the filled form, print it, or share it as required.

Complete your IA 470-5143 form online now for a smooth authorization process.

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Related content

ARC 2649C - Iowa Administrative Rules
... 470-5143, Iowa Department of Human Services Record Check Authorization Form, for the...
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1-800-338-7752 (Toll Free) Services Offered: Medicaid eligibility verification tool using automated voice response.

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

If you submitted an online application, you can Check Your Status online. If you mailed your application or supporting documentation contact the SNAP Retailer Service Center at 1-877-823-4369 to find out the status of your application.

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.

Generally, if your provider provides all information to Iowa Medicaid the timeframe is generally 10-15 business days.

Members should call Iowa Medicaid Member Services for help at 1-800-338-8366 or locally in the Des Moines area at 515-256-4606.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232