Iowa Code r. 801-10.3 - Application

All applicants shall apply for admission to IVH in accordance with the following subrules:

(1) All applicants shall make application to IVH through the county commission of veterans affairs in the applicant's county of residence.

(2) Application shall be made on the "Veteran Application for Admission to the Iowa Veterans Home," Form 475-0409, the "Spouse's Application for Admission to the Iowa Veterans Home," Form 475-0410, or the "Gold Star Parent Application for Admission to the Iowa Veterans Home," Form 475-2044. Separate applications shall be required for an eligible veteran and the spouse of the veteran when both veteran and spouse are applying for admission. The applications may be obtained at:

a. The county commission of veterans affairs' office.

b. DVA medical centers located in or serving veterans in the state of Iowa.

c. IVH.

d. Website: ivh.iowa.gov.

(3) The applicant shall provide a copy of a physical which has been completed within three months of application. If needed, a physical examination shall be scheduled by the applicant's primary care provider. Information must be authenticated by the medical provider's original signature or electronic signature.

(4) The following items shall be attached to the application before it is forwarded to IVH:

a. A copy of the veteran's honorable discharge (DD214) from the armed forces of the United States.

b. If the applicant is a married or surviving spouse, a copy of the marriage certificate or evidence of a common-law marriage on which a prudent person would rely.

c. If the applicant is a Gold Star parent, a copy of the child's birth certificate and certification of the child's death while serving on active duty in the armed forces of the United States during a time of military conflict.

d. A copy of the applicant's birth certificate.

e. A copy of the marriage license(s), divorce decree(s) or death certificate of the spouse, as applicable.

f. A completed "Personal Functional Assessment," Form 475-0837.

g. A completed "Supplement to Application for Admission to the Iowa Veterans Home," Form 475-0843.

h. A completed "Financial Affidavit," Form 475-0839.

(5) Once the requirements of subrules 10.3(2), 10.3(3) and 10.3(4) have been met, the county commission of veterans affairs shall forward the completed application to the admissions office at IVH. No county shall require additional requirements for the application for admission beyond the requirements stated in these rules. Neither shall a county require additional forms to be filled out or provided by the applicant other than the forms required by these rules.

(6) Eligibility determinations are subject to approval by the commandant or designee.

Notes

Iowa Code r. 801-10.3

ARC 9689B, IAB 8/24/11, effective 9/28/11; ARC 1157C, IAB 10/30/13, effective 12/4/13; see Delay note at end of chapter; ARC 2675C, IAB 8/17/16, effective 9/21/16; ARC 5800C, IAB 7/28/21, effective 9/1/21

ARC 9689B, IAB 8/24/11, effective 9/28/11; ARC 1157C, IAB 10/30/2013, effective 12/4/2013 Amended by IAB August 17, 2016/Volume XXXIX, Number 04, effective 9/21/2016 Amended by IAB July 28, 2021/Volume XLIV, Number 2, effective 9/1/2021