IA 470-2917 2019 free printable template
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O. Box 36450 Des Moines IA 50315 For questions contact Tel. 800 338-7909 option 2 or 515 256-4609 option 2 local Individual applicants applying to provide Consumer-Directed Attendant Care CDAC must complete and submit the following forms Form 470-2917 - Medicaid HCBS Waiver Provider Application Sections I and II Form 470-2965 - Provider Agreement Form 470-4202 - EFT IRS Form W9 Form 470-4612 - Individual CDAC Disclosure Form 470-4457 - Atypical Provider Declaration Form 470-4227 - Record...
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Obtain a copy of the IA 470-2917 form from the appropriate source.
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Who needs IA 470-2917?
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People Also Ask about
How do I report changes to Medicaid in Iowa?
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.
What is the authorized representative form for Medicaid in Iowa?
Clients may use Form 470-3948 when there is a need to designate a personal representative. A "personal representative" is someone designated by another as standing in the other's place or representing the other's interest for one or more purposes. Record of Disclosure of Health Information, Form 470-4015.
What are the Medicaid guidelines for 2023 in Iowa?
In 2023, the Medically Needy Income Limit (MNIL) for individuals is the same as for married couples and is $483 / month. The amount one must “spend down” can be thought of as a deductible. It is the difference between one's monthly income and the MNIL. In IA, the spend down is calculated for a 2-month period.
What is the form for Medicaid reconsideration in Iowa?
Form 470-5526 shall be completed by the Medicaid member or their parent, if the member is a minor. The member and the authorized representative must both sign the form. Once completed, the form should be submitted to the Medicaid member's MCO, if for a managed care appeal, or to HHS, if for a state fair hearing.
How do I become a Medicaid provider in Iowa?
Providers wanting to enroll as an Iowa Medicaid provider must submit an enrollment application to the Iowa Medicaid Enterprise (IME) Provider Enrollment Unit. No payment will be made to a provider for services prior to the effective date of the department's approval of an application.
How do I appeal Medicaid denial in Iowa?
You also may call the Appeals Section at (515) 281-3094 or send us an email at appeals@dhs.state.ia.us if you have questions. We accept collect phone calls.
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What is IA 470-2917?
IA 470-2917 is a form used by the Iowa Department of Revenue for certain tax reporting purposes, specifically relating to nonresident income.
Who is required to file IA 470-2917?
Nonresidents who earn income in Iowa and meet certain income thresholds are required to file IA 470-2917.
How to fill out IA 470-2917?
To fill out IA 470-2917, individuals must provide their personal information, report their Iowa-source income, and calculate their Iowa tax based on the provided instructions.
What is the purpose of IA 470-2917?
The purpose of IA 470-2917 is to report and pay Iowa state income tax on income earned by nonresidents in Iowa.
What information must be reported on IA 470-2917?
IA 470-2917 requires reporting of personal identification information, total income earned in Iowa, deductions, and the calculation of Iowa tax owed.
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