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This version of the form is not currently in use and is provided for reference only. Download this version of
Form 470-5465
for the current year.
Form 470-5465 Provider Request to Terminate Enrollment - Iowa
What Is Form 470-5465?
This is a legal form that was released by the Iowa Department of Human Services - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is form 470-5465?
A: Form 470-5465 is a Provider Request to Terminate Enrollment form used in Iowa.
Q: Who uses form 470-5465?
A: Providers in Iowa use form 470-5465.
Q: What is the purpose of form 470-5465?
A: The purpose of form 470-5465 is to request the termination of enrollment for a provider.
Q: Is form 470-5465 specific to Iowa?
A: Yes, form 470-5465 is specific to Iowa and is not used in other states.
Q: What information do I need to provide on form 470-5465?
A: You will need to provide your personal and provider information, the reason for terminating enrollment, and any supporting documentation.
Q: Are there any fees associated with submitting form 470-5465?
A: There may be fees associated with submitting form 470-5465. Contact the relevant authority in Iowa for more information.
Form Details:
- Released on March 1, 2017;
- The latest edition provided by the Iowa Department of Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form 470-5465 by clicking the link below or browse more documents and templates provided by the Iowa Department of Human Services.
Download Form 470-5465 Provider Request to Terminate Enrollment - Iowa
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