"Social Security Number (Ssn) Waiver Request Iowa Liheap Program" - Iowa

Social Security Number (Ssn) Waiver Request Iowa Liheap Program is a legal document that was released by the Iowa Department of Human Rights - a government authority operating within Iowa.

Form Details:

  • Released on September 17, 2018;
  • The latest edition currently provided by the Iowa Department of Human Rights;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Iowa Department of Human Rights.

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Social Security Number (SSN) Waiver Request
Iowa LIHEAP Program
DCAA prior approval is required when requesting a waiver from the Social Security Number (SSN) verification
documentation. See the
Social Security Number (SSN) Documentation Requirements
Section of the
Iowa LIHEAP
Policy and Procedures Manual
for more information.
Agency
Date
Contact Person
Phone
Client Name
Phone
Address
City, Zip
The Social Security Number (SSN) of each household member, regardless of age, must be provided in order for
Iowa LIHEAP
the household to be deemed eligible (unless presenting a current Iowa Driver's License - See the
Policy and Procedures Manual
for more information). Waivers may be granted in certain hardship cases for a child
18 or younger, on a case-by-case basis. Relevant information must be documented for the file, and the household
made aware that this is a one-time only waiver.
Reason for Request
Has a waiver been previously requested for this individual?
Yes
No
If yes, when?
DCAA Review
Approval
Yes
No
Reviewed By
Date
Comments
Page 1 of 1
09/17/18
Social Security Number (SSN) Waiver Request
Iowa LIHEAP Program
DCAA prior approval is required when requesting a waiver from the Social Security Number (SSN) verification
documentation. See the
Social Security Number (SSN) Documentation Requirements
Section of the
Iowa LIHEAP
Policy and Procedures Manual
for more information.
Agency
Date
Contact Person
Phone
Client Name
Phone
Address
City, Zip
The Social Security Number (SSN) of each household member, regardless of age, must be provided in order for
Iowa LIHEAP
the household to be deemed eligible (unless presenting a current Iowa Driver's License - See the
Policy and Procedures Manual
for more information). Waivers may be granted in certain hardship cases for a child
18 or younger, on a case-by-case basis. Relevant information must be documented for the file, and the household
made aware that this is a one-time only waiver.
Reason for Request
Has a waiver been previously requested for this individual?
Yes
No
If yes, when?
DCAA Review
Approval
Yes
No
Reviewed By
Date
Comments
Page 1 of 1
09/17/18