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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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Related content

470-5143(S) Record Check Authorization (Spanish)...
Effective August 3, 2018, form 470-5143(S), Record Check Authorization. (Spanish), is...
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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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