441—58.3 (29C) Application for assistance. To request assistance 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: (1) receipts for the claimed expenses or (2) a request to participate in a voucher system.
	 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 shall include:
	  a.   	 A declaration of the household’s annual income, accompanied by:
	 (1) 	 A current pay stub, W-2 form, or income tax return, or
	 (2) 	 Documentation of current enrollment in an assistance program administered by the department of human services, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or other subsidy program.
	  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.
	  f.   	 A short, handwritten narrative of the disaster event and how the disaster caused the loss being claimed.
	  g.   	 A copy of a picture identification document for each adult applicant.
	  h.   	 When vehicle damage is claimed, current copies of the vehicle registration and liability insurance card.
[ARC 9128B, IAB 10/6/10, effective 10/1/10; ARC 9312B, IAB 12/29/10, effective 3/1/11]