470-5170 Application for Health Coverage and Help Paying Costs - dhs iowa-2026

1. Click ‘Get Form’ to open the 470-5170 Application in our editor.
2. Begin by filling out your personal information in Step 1. Include your full name, address, and contact details. Ensure accuracy as this will be used for communication regarding your application.
3. In Step 2, provide details about your family members who need coverage. List each person living with you, including their relationship to you and relevant income information.
4. Proceed to Step 3 if applicable, where you can indicate if any family members are American Indian or Alaska Native, which may affect eligibility for certain services.
5. Complete Steps 4 and 5 by detailing any current health coverage and employment-related health plans available to your family.
6. If someone is assisting you with the application, complete Step 6 to designate an authorized representative.
7. Finally, review all entries for accuracy before signing the application in Step 7. Use our platform's features to ensure everything is clear and legible.

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