Contents
The Iowa 54 130A form is an essential document for residents seeking financial relief through the Rent Reimbursement program. This form is specifically designed for individuals who have paid rent in Iowa during the previous year and are looking to claim a reimbursement based on their household income. To initiate the process, claimants must provide personal information, including names, Social Security numbers, and birth dates, as well as details about their rental payments. The form includes a series of eligibility questions that help determine if the claimant qualifies for the reimbursement. It is important to note that certain conditions, such as age and disability status, may affect eligibility. Additionally, the form requires claimants to calculate their total household income and the rental period to ensure accurate reimbursement calculations. A worksheet is provided on the reverse side to assist in this process. Timely submission is crucial; claims must be filed by June 1, 2003, to avoid delays in processing, which can take up to 14 weeks. By completing this form accurately, individuals can potentially receive significant financial support, easing the burden of housing costs.
Iowa 54 130A Preview
I OWA
department of Revenue and Finance IOWA RENT REIMBURSEMENT CLAIM www.state.ia.us/tax
2002 TO BE FILED IN 2003
File early to receive your rent reimbursement sooner.
Claimant’s Last Name |
First Name |
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Claimant’s Social Security Number |
Claimant’s Birth Date |
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Spouse’s Last Name |
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Spouse’s Social Security Number |
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Mailing Address |
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Street Address |
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Apt #, Lot #, Suite#, PO Box |
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Apt #, Lot #, Suite# |
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City, State, Zip Code |
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ANSWER THESE QUESTIONS TO DETERMINE ELIGIBILITY: |
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1.Did you file a Rent Reimbursement claim last year? _____________________________________
2a. Were you 65 or older 12/31/02? __________________________________________________
2b. Were you totally disabled and 18 or older as of 12/31/02? Attach Proof of Disability _____________
3.Were you a resident of Iowa during any part of 2002? __________________________________
4.Do you presently live in Iowa? ____________________________________________________
5.Were you a resident of a nursing home or care facility during 2002? _________________________
COMPLETE THE WORKSHEET ON THE REVERSE SIDE |
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6.Total household income from line K side 2__________________________ |
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7. Rental period in Iowa from ___________ , 2002, to ____________ , 2002 |
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8. Total rent paid in Iowa for 2002 _________________________________ |
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9.Allowable percentage _________________________________________________________ X . |
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10. Multiply line 8 by line 9 (NOT TO EXCEED $1,000) ____________________________ |
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11. Reimbursement rate from table on reverse side 2 __________________________________ X |
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12.This is yourreimbursement(multiplyline10 byline 11) ____________________ |
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13.Name of apartment, nursing home or facility: ____________________________________________________
Landlord: Name _______________________________________ Telephone ( ______ ) ______________
Address: ______________________________________________________________________
City, State, Zip Code: ____________________________________________________________
14.I declare under penalty of perjury that I have reviewed this claim and to the best of my knowledge and belief, it is true, correct and complete.
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Claimant’sSignature |
Date |
Preparer’s Signature |
( _________ ) ___________________________ |
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( __________ ) ___________________ |
Claimant’sTelephoneNumber |
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Preparer’s Telephone Number |
Review your claim for accuracy. Incomplete claims and errors will delay processing of your reimbursement check.
Side 1 |
IT MAY TAKE AS LONG AS 14 WEEKS TO PROCESS YOUR CLAIM. |
Worksheet for line 6
2002 TOTAL YEARLY HOUSEHOLD INCOME
“Household income” includes the income of the claimant, the claimant’s spouse and monetary contributions received from other persons living with the claimant.
Use Whole DOLLARS Only
A. Wages, salaries, tips, etc. ________________________________________
B. Rent subsidy/utilities assistance____________________________________
C. Title 19 Benefits for housing only (see instructions) ____________________
D. Social Security income received in 2002 ____________________________
E. Disability income for 2002 _______________________________________
F.All pensions and annuities from 2002 _______________________________
G. Interest and dividend income from 2002 ____________________________
H. Profit from business and/or farming and capital gains
if less than zero, enter 0 (see instructions) ________________________
I.Actual money received from others living with you in 2002 (see instructions) _ J. Other income (read instructions before making this entry) _______________
K. ADD amounts on lines
This is your total household income
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REIMBURSEMENT RATE TABLE FOR LINE 11
If your total household income from Line K above is:
$ 0.00 |
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9,060.99 |
enter 1.00 on Line 11, Side 1 |
9,061 |
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10,126.99 |
enter 0.85 on Line 11, Side 1 |
10,127 |
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11,192.99 |
enter 0.70 on Line 11, Side 1 |
11,193 |
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13,324.99 |
enter 0.50 on Line 11, Side 1 |
13,325 |
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15,456.99 |
enter 0.35 on Line 11, Side 1 |
15,457 |
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17,588.99 |
enter 0.25 on Line 11, Side 1 |
17,589 or greater |
no reimbursement allowed |
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For assistance in completing this form, call
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Where’s my refund check? |
Call |
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You must provide claimant’s Social Security Number |
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and date of birth when calling |
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Mail this form to: |
IOWA DEPARTMENT OF REVENUE AND FINANCE |
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RENT REIMBURSEMENT PROCESSING |
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PO BOX 10459 |
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DES MOINES IA |
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Claims must be filed no later than June 1, 2003, unless the Director of Revenue and Finance |
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Side 2 |
has granted an extension of the time to file through December 31, 2004. |
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Document Attributes
| Fact Name | Details |
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| Form Purpose | The Iowa 54 130A form is used to claim rent reimbursement for eligible residents of Iowa. |
| Eligibility Criteria | Applicants must be 65 or older, or totally disabled, and have resided in Iowa during the claim year. |
| Filing Deadline | Claims must be submitted by June 1, 2003, unless an extension is granted by the Director of Revenue and Finance. |
| Income Calculation | Household income includes wages, Social Security, pensions, and contributions from others living with the claimant. |
| Reimbursement Rates | The reimbursement rate is based on total household income, with rates ranging from 1.00 to 0.25 or no reimbursement. |
| Processing Time | It may take up to 14 weeks to process the claim after submission. |
| Governing Law | This form is governed by Iowa Code Chapter 425, which outlines the rent reimbursement program. |
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