441—58.3 (29C) Application for assistance. To request reimbursement for disaster-related expenses, the household shall complete Form 470-4448, Individual Disaster Assistance Application, and submit it within 45 days of the disaster declaration to the county emergency management coordinator along with receipts for the claimed expenses.
	 58.3(1) Application forms are available from county emergency management coordinators and local offices of the department of human services, as well as the Internet Web site of the department at www.dhs.iowa.gov.
	 58.3(2) The application includes:
	  a.   	 A declaration of the household’s annual income.
	  b.   	 A release of confidential information to personnel involved in administering the program.
	  c.   	 A certification of the accuracy of the information provided.
	  d.   	 An assurance that the household had no insurance coverage for claimed items.
	  e.   	 A commitment to refund any part of a grant awarded that is duplicated by insurance or by any other assistance program, such as but not limited to local community development groups and charities, the Small Business Administration, or the Federal Emergency Management Administration.