Form 470 3767-2026

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4.7 out of 5

183 votes

The document outlines the Access to Confidential Abuse Information and Non-Redissemination Agreement required by the Iowa Department of Human Services for agencies accessing child and dependent adult abuse information. It details legal provisions, conditions for redissemination, penalties for violations, and requirements for maintaining signed agreements and authorizations from employees. The agreement ensures compliance with Iowa Code sections related to the handling of abuse information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Name of Facility or Agency' in the designated field. Ensure that the name is accurate and matches your official records.
Next, input the 'Billing Account Number' as provided by DCI upon approval of your SING account. This number is crucial for processing your request.
In the section labeled 'Administrator', type or print the name of the administrator responsible for signing this agreement. This ensures accountability within your agency.
Finally, have the administrator sign in the designated area. This signature confirms that your agency agrees to abide by all legal provisions regarding child and dependent adult abuse information.

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Versions	Form popularity	Fillable & printable
2016	4.7 Satisfied (183 Votes)

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