Form 470-5170 - Iowa Department of Human Services - Iowa.gov - dhs state ia-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information in Step 1. Include your first name, last name, address, and contact details. Ensure accuracy as this will be used for communication regarding your application.
3. In Step 2, provide details about all family members living with you. List their names, relationships, and relevant information such as Social Security Numbers if applicable.
4. Continue through the form by answering questions related to income and employment for each family member. Be thorough to ensure eligibility for health coverage options.
5. Once all sections are completed, review your entries for accuracy before signing the application on the designated page.
6. Finally, submit your completed application by mailing it to the address provided at the end of the form.

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