Health Care Employment Agency Registration

The department's new health care employment agency rules implementing House File 2521, passed by the 89th General Assembly last spring go into effect on Jan. 4, 2023. 

• The rules require all existing health care employment agencies to register with the department by Jan. 4, 2023. 
   
• The department is extending a 30-day grace period in which all existing health care employment agencies shall complete their registration (through Feb. 4, 2023). 
   
• In place of completing this form, the same information may be faxed to (515) 242-5022, or mailed to:
  
       Iowa Department of Inspections and Appeals
       Health Facilities Division
       Lucas State Office Building, Third Floor
       321 E. 12th Street
       Des Moines, Iowa 50319-0083
   
• In addition to completing this form, a payment of $500 per health care employment agency office location operating in Iowa should be sent to the mailing address above (and made payable to the same). Please include the confirmation number you receive after submitting this form along with your payment.

This form will allow you to register up to five employment agency office locations at a time. If you have more than five locations, you will need to complete another form. 

Do you need to register a second location?

Do you need to register a third location?

Do you need to register a fourth location?

Do you need to register a fifth location?

Do you need to report a second owner/managing entity?

Do you need to report a third owner/managing entity?

Do you need to report a fourth owner/managing entity?

Do you need to report a fifth owner/managing entity?

Do you need to report a sixth owner/managing entity?

Do you need to report a seventh owner/managing entity?

Do you need to report an eighth owner/managing entity?

Thank you for registering.

For each health care employment agency location operating in Iowa, a payment of $500 should be sent to (and checks should be made out to):

Iowa Department of Inspections and Appeals
Health Facilities Division
Lucas State Office Building
321 E. 12th Street
Des Moines, Iowa 50309-0083

• You will need to send the department $500 for one health care employment agency location.

• You will need to send the department $1,000 for two health care employment agency locations.

• You will need to send the department $1,500 for three health care employment agency locations.

• You will need to send the department $2,000 for four health care employment agency locations.

• You will need to send the department $2,500 for five health care employment agency locations.

PLEASE NOTE

You are registering with the department only. You will not receive a "license" or certificate. Once the department has received and successfully processed your payment, you will receive an email confirmation of your registration.

PLEASE include your registration number on the check when you mail it to DIA. This will enable DIA staff to match it up with this submitted form and process your registration more quickly.