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Designation of Personal Representative, Form 470-3948 - Iowa ... - dhs state ia-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the 'Name of Client' at the top of the form. This identifies who is designating a personal representative.
- Fill in the 'Date of Request' to indicate when you are completing this form.
- Provide your 'Mailing Address' including street or P.O. Box, city, state, and zip code for correspondence.
- Enter your 'Social Security Number', 'Patient Number', or 'State ID' for identification purposes.
- Indicate your phone number for any follow-up communication.
- Check all applicable programs such as Medicaid or hawk-i that relate to your situation.
- In the section labeled 'I designate', write the name of the person you wish to appoint as your personal representative.
- Select the relationship of this person to you from options like son, spouse, friend, attorney, or specify another relationship.
- Sign and date the form at the bottom to validate your designation.
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