The department's new health care employment agency rules implementing House File 2521, passed by the 89th General Assembly last spring went into effect on Jan. 4, 2023.
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.
Location 1
Do you need to register a second location?
Location 2
Do you need to register a third location?
Location 3
Do you need to register a fourth location?
Location 4
Do you need to register a fifth location?
Location 5
Owner/Managing Entity 1 Address
Do you need to report a second owner/managing entity?
Owner/Managing Entity 2 Address
Do you need to report a third owner/managing entity?
Owner/Managing Entity 3 Address
Do you need to report a fourth owner/managing entity?
Owner/Managing Entity 4 Address
Do you need to report a fifth owner/managing entity?
Owner/Managing Entity 5 Address
Do you need to report a sixth owner/managing entity?
Owner/Managing Entity 6 Address
Do you need to report a seventh owner/managing entity?
Owner/Managing Entity 7 Address
Do you need to report an eighth owner/managing entity?
Owner/Managing Entity 8 Address
Submission #
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
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.