Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form 470-5170 for the current year.

Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa

What Is Form 470-5170?

This is a legal form that was released by the Iowa Department of Human Services - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 470-5170?A: Form 470-5170 is an application for health coverage and help paying costs in the state of Iowa.

Q: Who can use Form 470-5170?A: Residents of Iowa who need health coverage and financial assistance can use this form.

Q: What is the purpose of Form 470-5170?A: The purpose of this form is to apply for health coverage programs and financial help to pay for medical costs in Iowa.

Q: What information is required in Form 470-5170?A: The form requires personal information, income details, household information, and other relevant details to determine eligibility for health coverage programs.

Q: Is assistance available for filling out Form 470-5170?A: Yes, you can receive assistance in completing the form by contacting Iowa Department of Human Services or a designated community organization.

Q: What health coverage programs are available in Iowa?A: Iowa offers various health coverage programs such as Medicaid, Children's Health Insurance Program (CHIP), and the Marketplace.

Q: Can I apply for multiple health coverage programs using Form 470-5170?A: Yes, you can apply for multiple health coverage programs using this form.

ADVERTISEMENT

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Iowa Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 470-5170 by clicking the link below or browse more documents and templates provided by the Iowa Department of Human Services.

Download Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa

4.8 of 5 (5 votes)
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa

    1

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 2

    2

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 3

    3

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 4

    4

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 5

    5

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 6

    6

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 7

    7

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 8

    8

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 9

    9

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 10

    10

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 11

    11

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 12

    12

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 13

    13

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 14

    14

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 15

    15

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 16

    16

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 17

    17

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 18

    18

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 19

    19

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 20

    20

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 21

    21

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 22

    22

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 23

    23

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 24

    24

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 25

    25

  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 1
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 2
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 3
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 4
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 5
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 6
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 7
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 8
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 9
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 10
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 11
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 12
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 13
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 14
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 15
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 16
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 17
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 18
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 19
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 20
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 21
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 22
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 23
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 24
  • Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa, Page 25
Prev 1 2 3 4 5 ... 25 Next
ADVERTISEMENT