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
Record Check Evaluations
P.O. Box 4826
Des Moines, IA 50305-4826.