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Programs & Services

When a background check revealed a criminal conviction (including a deferred judgement), founded child or dependent adult abuse, or a combination thereof, complete the Record Check Evaluation form in black ink or typed.

Record Check Evaluation Spanish

Evaluation materials may be submitted via email, fax or mailed to:

Iowa Department of Health and Human Services

321 E. 12th St., FWBP/CPS/Operations/RCE

Des Moines, IA 50319

Currently processing forms received on January 15, 2025.