Iowa Admin. Code r. 481-6.17 - Sample petition for waiver
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Include the following information in the petition for waiver where applicable and known:
1. Provide
the petitioner's (the person that is asking for the waiver) name, address and
telephone number.
2. Describe and
cite the specific rule from which a waiver is requested.
3. Describe the specific waiver requested. Include the
exact scope and time period that the waiver will extend.
4. Explain the important facts that the petitioner
believes justify the waiver. Include in your explanation (a) why application of
the rule would pose an undue hardship to the petitioner; (b) why granting the
waiver would not prejudice the substantial legal rights of any person ; (c)
state whether the provisions of a rule subject to this petition are
specifically mandated by statute or another provision of law; and (d) state
whether public health, safety and welfare will be affected if the requested
waiver is granted.
5. Provide
history of prior contacts between the department and the petitioner relating to
the regulated activity, license, audit, investigation, inspection or
representation that would be affected by the waiver. In that history, include a
description of each affected regulated activity, license, appeal, hearing,
audit, investigation, inspection, representation or other assigned function of
the department , any notices of violation, contested case hearings, or
investigative reports relating to the regulated activity, license, appeal,
hearing, audit, investigation, inspection, representation or other assigned
function of the department within the last five years.
6. Provide information known to the petitioner
regarding the department 's treatment of similar cases.
7. Provide the name, address and telephone number of
any public agency or political subdivision which also regulates the activity in
question or which might be affected by the granting of a waiver.
8. Provide the name, address and telephone
number of any person or entity that would be adversely affected or
disadvantaged by the granting of the waiver.
9. Provide signed releases of information authorizing persons with
knowledge regarding the request to furnish the department with information
relevant to the waiver.
I hereby attest to the accuracy and truthfulness of the above information.
________________________ ___________
Petitioner's signature Date
Notes
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