Form 54-130 "Iowa Rent Reimbursement Claim" - Iowa

What Is an Iowa Rent Rebate Form?

Form 54-130, Iowa Rent Reimbursement Claim, is a legal document Iowa residents complete to refund a portion of rent assumed to cover property tax paid on a rented unit.

Alternate Name:

  • Iowa Rent Rebate Form.

This form was released by the Iowa Department of Revenue (DOR). The latest version of the form was issued on April 14, 2019, with all previous editions obsolete. You can download a fillable Iowa Rent Rebate Form through the link below. To check your Iowa Rent Rebate status, visit the DOR website. You will need your social security number (SSN), claim year, and date of birth.

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How to Fill Out Iowa Rent Rebate Form?

You are eligible for rent reimbursement in Iowa if you meet the following criteria:

  • You lived and still live in Iowa;
  • You paid rent in Iowa for a property that is charged for property tax;
  • You are 65 years or older, or disabled and 18 and older;
  • Your income is less than $ 23,810.

You may also file a claim if you lived in a motel during the year or shared an apartment with you and your roommate both on the lease providing proof of the paid rent. Additionally, attach proof of all of your income and proof of disability, if applicable.

Follow these steps to complete Iowa Form 54-130:

  1. Enter your full name, date of birth, and SSN. If you are married and live with your spouse, you are considered one household eligible for one joint claim, so add your spouse's personal details as well.
  2. Indicate your mailing address.
  3. Claim eligibility by ticking the appropriate boxes.
  4. Calculate your annual household income and benefits by adding housing benefits, gross social security and disability income, wages and salaries, pensions and annuities, interest and dividend income, profit from business and capital gain, cash, and checks received from your household members, child support, welfare gambling, etc.
  5. If you lived in a care facility or nursing home, answer "yes".
  6. Record your rental address, dates of residence, and total rent you paid at this location. If you lived in more than one location, fill out Form 54-132, Statement of Rent Paid.
  7. State total Iowa rent you paid in a report year.
  8. Calculate the estimated reimbursement if you wish, or leave the section blank to let the Department do it for you.
  9. Add your bank account details to receive direct deposit of your reimbursement.
  10. Confirm the information in the claim is true, sign, and date the form. Enter your phone number. If another individual completed the form, the preparer is also required to sign.
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Download Form 54-130 "Iowa Rent Reimbursement Claim" - Iowa

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2019 Iowa Rent Reimbursement Claim
Page 1
https://tax.iowa.gov
Clear Form
NAME AND ADDRESS:
• Complete using blue or black ink only. Do not use pencil.
• Incomplete claims will delay processing. You may be contacted for additional information.
• Married couples living together are considered one household and can file only one claim, combining
both incomes. If you do not live together, you may file separate claims.
Print your last name, first name
Birthdate (MMDDYYYY):
SSN:
Print spouse last name, first name
Birthdate (MMDDYYYY):
SSN:
Current mailing address (Include unit number):
______________________________________________
City:
_______________________________________________
State:
_________
ZIP:
____________
WHO IS ELIGIBLE:
1. Were you (or your spouse) born before 1955? ....................................................... Yes
No
2. Were you (or your spouse) born between 1955 and 2001 and totally disabled? .... Yes
No
Include a copy of your letter that shows you are disabled from the Social
Security Administration, Veterans Administration, your doctor, or Form SSA-1099.
If you answered “no” to both questions 1 and 2, STOP; YOU DO NOT QUALIFY.
3. Did you live in Iowa during 2019? If “no,” STOP; YOU DO NOT QUALIFY. ........... Yes
No
4. Do you currently live in Iowa? If “no,” STOP; YOU DO NOT QUALIFY. ................. Yes
No
TOTAL ANNUAL HOUSEHOLD BENEFITS AND INCOME:
For you and your spouse even if not reported for Iowa individual income tax purposes. Send proof of income.
5. HUD, Section 8, and any portion of rent or utilities paid for you. ................
,
.00
6. Title 19 Benefits for housing only. ..............................................................
,
.00
If you lived in a nursing home or care facility, contact the administrator for amount to enter on
line 6. Or, enter 20% of benefits if living in a nursing home or 40% if living in a care facility.
7. Gross Social Security income.
............
,
.00
Include SSI and Medicare premium withheld.
8. Gross disability income.
.....
,
.00
Include SSDI, VA, and Railroad. Provide proof of disability.
9. Wages, salaries, unemployment compensation, etc. ...................................
,
.00
10. All pension, IRA, and annuity income.
.................
,
.00
Include military retirement pay
11. Interest and dividend income. ......................................................................
,
.00
12. Profit from business/farming/capital gain. ....................................................
,
.00
13. Cash or checks received from others living with you. ..................................
,
.00
14. Other benefits and income. ..........................................................................
,
.00
Include child support, alimony, FIP, children’s SSI, welfare payments, gambling, etc.
0
15. Total annual household benefits and income. Add lines 5 through 14 .........
,
.00
Is line 15 $23,810 or more?
If yes, STOP; YOU DO NOT QUALIFY.
Continue on next page
54-130a (05/14/19)
2019 Iowa Rent Reimbursement Claim
Page 1
https://tax.iowa.gov
Clear Form
NAME AND ADDRESS:
• Complete using blue or black ink only. Do not use pencil.
• Incomplete claims will delay processing. You may be contacted for additional information.
• Married couples living together are considered one household and can file only one claim, combining
both incomes. If you do not live together, you may file separate claims.
Print your last name, first name
Birthdate (MMDDYYYY):
SSN:
Print spouse last name, first name
Birthdate (MMDDYYYY):
SSN:
Current mailing address (Include unit number):
______________________________________________
City:
_______________________________________________
State:
_________
ZIP:
____________
WHO IS ELIGIBLE:
1. Were you (or your spouse) born before 1955? ....................................................... Yes
No
2. Were you (or your spouse) born between 1955 and 2001 and totally disabled? .... Yes
No
Include a copy of your letter that shows you are disabled from the Social
Security Administration, Veterans Administration, your doctor, or Form SSA-1099.
If you answered “no” to both questions 1 and 2, STOP; YOU DO NOT QUALIFY.
3. Did you live in Iowa during 2019? If “no,” STOP; YOU DO NOT QUALIFY. ........... Yes
No
4. Do you currently live in Iowa? If “no,” STOP; YOU DO NOT QUALIFY. ................. Yes
No
TOTAL ANNUAL HOUSEHOLD BENEFITS AND INCOME:
For you and your spouse even if not reported for Iowa individual income tax purposes. Send proof of income.
5. HUD, Section 8, and any portion of rent or utilities paid for you. ................
,
.00
6. Title 19 Benefits for housing only. ..............................................................
,
.00
If you lived in a nursing home or care facility, contact the administrator for amount to enter on
line 6. Or, enter 20% of benefits if living in a nursing home or 40% if living in a care facility.
7. Gross Social Security income.
............
,
.00
Include SSI and Medicare premium withheld.
8. Gross disability income.
.....
,
.00
Include SSDI, VA, and Railroad. Provide proof of disability.
9. Wages, salaries, unemployment compensation, etc. ...................................
,
.00
10. All pension, IRA, and annuity income.
.................
,
.00
Include military retirement pay
11. Interest and dividend income. ......................................................................
,
.00
12. Profit from business/farming/capital gain. ....................................................
,
.00
13. Cash or checks received from others living with you. ..................................
,
.00
14. Other benefits and income. ..........................................................................
,
.00
Include child support, alimony, FIP, children’s SSI, welfare payments, gambling, etc.
0
15. Total annual household benefits and income. Add lines 5 through 14 .........
,
.00
Is line 15 $23,810 or more?
If yes, STOP; YOU DO NOT QUALIFY.
Continue on next page
54-130a (05/14/19)
2019 Iowa Rent Reimbursement Claim,
Page 2
RENTAL INFORMATION: Complete the Statement of Rent Paid if you lived in more than one place.
16. Did you live in a Nursing Home or Care Facility?
Yes
No
If yes, report Title 19 benefits on line 6.
17. Rental Address. (The location where you lived must be subject to property tax. You are not eligible
for rent reimbursement if the location or nursing home was not subject to property tax.)
Dates you rented in 2019 (MMDDYY):
from
to
Total Iowa rent you paid at this location ...................................................
,
.00
Street (PO Box not allowed):
______________________________________________________
City:
__________________________________________
State:
ZIP:
Landlord or Nursing Home:
Name:
________________________________________
Phone Number:
(
)
Address:
______________________________________________________________________
City:
___________________________________________
State:
________
ZIP:
___________
If you lived in more than one location, complete the Statement of Rent paid for all other locations.
18. Total Iowa rent you paid in 2019. Add rent for all locations. ..........................
,
.00
THIS SECTION OPTIONAL: Complete lines 19 to 21 below, or allow the department to compute for you.
0
19. Rent eligible for reimbursement. Multiply line 18 by 0.23, enter result
......
,
.00
.
If more than 1,000, enter 1,000. Example: if line 18 = 3,900, multiply 3,900 x 0.23 = Enter 897 on line 19
20. Select rate from table below based on total benefits and income on line 15:
X
.
$0.00
-
$12,265.99 ....... enter 1.00
$18,038 - $20,923.99 ....... enter 0.35
$12,266 - $13,708.99 ....... enter 0.85
$20,924 - $23,809.99 ....... enter 0.25
$13,709 - $15,151.99 ....... enter 0.70
$23,810 or greater....STOP; you do not qualify.
$15,152 - $18,037.99 ....... enter 0.50
0
21. Estimated reimbursement. Multiply line 19 by line 20. ...................................
,
.00
Example: line 19 = 897, multiply 897 by 0.70 = 628, enter on line 21.
DIRECT DEPOSIT INFORMATION:
To receive direct deposit of your reimbursement to your account, complete lines A and B.
A.
Routing Number:
Type: Checking
Savings
B.
Account Number:
I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this claim,
and, to the best of my knowledge and belief, it is true, correct, and complete.
If deceased,
Your signature:
Date:
date of death:
If deceased,
Spouse signature:
Date:
date of death:
Your Phone Number:
(
)
Preparer Phone Number
:(
)
Preparer Name:
Preparer
signature:
Date:
► Include proof of income and rent paid. If under 65, also include proof of disability.
Mail to: Rent Reimbursement, Iowa Department of Revenue, PO Box 10459, Des Moines, IA 50306-0459.
To check the status of a refund visit https://tax.iowa.gov or call 1-800-572-3944.
Clear Form
54-130b (05/14/19)
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