Home Care Accreditation Program Form

By signing below, I hereby certify that, to the best of my knowledge and belief and after a diligent review, all information provided in this application is accurate. In addition, based on my review of this application, my knowledge of the agency and inquiry of staff of the agency, this organization is in compliance with all of the standards listed above, the documentation provided in support of this application are true, correct and complete and will remain in full compliance throughout any period of accreditation. I understand that the Iowa Health Care Association relies on the truthfulness of this certification in granting accreditation, and that any falsification or inaccuracy in the information provided may be grounds for revocation of the accreditation.