801—10.3 (35D) Application. All applicants shall apply for admission to IVH in accordance with the following subrules:
	 10.3(1) All applicants shall make application to IVH through the county commission of veterans affairs in the applicant’s county of residence.
	 10.3(2) Application shall be made on the “Veteran Application for Admission to the Iowa Veterans Home,” Form 475-0409, or on the “Spouse’s Application for Admission to the Iowa Veterans Home,” Form 475-0410. Separate application shall be required for an eligible veteran and the spouse of the veteran when both veteran and spouse are applying for admission. The applications may be obtained at:
	  a.   	 The county commission of veterans affairs’ office.
	  b.   	 DVA medical centers located in or serving veterans in the state of Iowa.
	  c.   	 IVH.
	 10.3(3) The applicant shall be scheduled for a physical examination by a medical provider, and the results of the examination shall be entered on the application by the examining medical provider. If the applicant has had a complete physical examination within three months of application, a copy of this physical shall suffice. Information must be authenticated by the medical provider’s original signature or electronic signature.
	 10.3(4) The following items shall be attached to the application before it is forwarded to IVH:
	  a.   	 An affidavit signed by two members of the county commission of veterans affairs and notarized by the appropriate county official attesting to the best of their knowledge and belief that the applicant is a resident of that county and is an eligible applicant.
	  b.   	 An original or a certified copy of the veteran’s honorable discharge from the armed forces of the United States.
	  c.   	 If the applicant is a married or surviving spouse, a copy of the marriage certificate or evidence of a common-law marriage on which a prudent person would rely.
	  d.   	 An original or a certified copy of applicant’s birth certificate if not in receipt of Social Security.
	  e.   	 A copy of divorce decrees or death certificate for the spouse, if applicable.
	  f.   	 A completed “Personal Functional Assessment,” Form 475-0837.
	  g.   	 A completed “Supplement to Application for Admission to the Iowa Veterans Home,” Form 475-0843.
	  h.   	 A completed “Financial Affidavit,” Form 475-0839.
	 10.3(5) Once the requirements of subrules 10.3(2), 10.3(3) and 10.3(4) have been met, the county commission of veterans affairs shall forward the completed application to the admissions office at IVH. No county shall require additional requirements for the application for admission beyond the requirements stated in these rules. Neither shall a county require additional forms to be filled out or provided by the applicant other than the forms required by these rules.
	 10.3(6) Eligibility determinations are subject to approval by the commandant.