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
321 E. 12th St.
Des Moines, IA 50319